This proposed study will investigate the trajectories of recovery over the two decades after first admission in a large representative sample of affective and non-affective psychoses, the only such cohort followed long-term in the US. The proposed study will provide epidemiologic data on prevalence, distribution, and development of long-term recovery. Such information is essential for sound planning of the public health policy and accurate prognostication in clinical settings, but it is currently lacking. We will examine recovery across its many facets, including clinical, occupational, financial, social, cognitive, neurobiological, subjective, and consumer-defined domains. We also will investigate a range of potential predictors of recovery and will develop algorithms to help clinicians identify patients at risk for poor outcomes. Similarly, we will investigate other problems of high public health significance (e.g., homelessness, incarceration, and medical conditions). Furthermore, we will document the extent of unmet need for care in this population. The application is aligned with the NIMH Strategic Plan in seeking to (1) chart trajectories of psychotic disorders from an early phase of the illness and (2) elucidate links between neurobiological functioning and real-world performance in these conditions. The cohort was originally recruited in the early 1990s from all of the inpatient facilities in a large county and was interviewed multiple times over a 10-year period. At each point, study psychiatrists formulated consensus longitudinal diagnoses. At the 10-year mark, we interviewed 470 cohort members (80.2% response rate), and we found that many had not achieved recovery. However, it has long been hypothesized that functioning improves during the second decade of the illness. Moreover, growing availability of recovery-oriented treatments over the last 10 years is expected to bolster rates of recovery. These predictions will be tested by assessing the cohort two decades after the first hospitalization. A major challenge in studying recovery is the lack of empirical benchmarks for defining it. To address this problem, we will recruit a demographically-matched control group and use its performance to anchor outcomes. We plan to assess 425 cohort members and 425 controls using a state-of-the-art battery of measures. We will interview participants and relatives, review medical records, and administer neuropsychological and electrophysiological assessments. This design offers statistical power to detect even small changes in functioning and will produce normative data that will enable this and other studies to define recovery with rigor and precision. This will be the first study to investigate long-term recovery from psychosis in an epidemiologic first-admission sample and provide an unbiased picture of the scope of the problem.

Public Health Relevance

The aim of this project is to investigate recovery from serious mental illnesses, such as schizophrenia and bipolar disorder, over 20 years and to identify factors that lead to better or worse outcomes. This research will produce a detailed and unbiased picture of outcomes of public concern, such as illness remission, employment, and homelessness. This information can guide improvement in care for serious mental illness.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Adult Psychopathology and Disorders of Aging Study Section (APDA)
Program Officer
Rubio, Mercedes
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State University New York Stony Brook
Schools of Medicine
Stony Brook
United States
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Strassnig, M; Kotov, R; Fochtmann, L et al. (2018) Associations of independent living and labor force participation with impairment indicators in schizophrenia and bipolar disorder at 20-year follow-up. Schizophr Res :
Kotov, Roman; Fochtmann, Laura; Li, Kaiqiao et al. (2017) Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project. Am J Psychiatry 174:1064-1074
Strassnig, Martin; Kotov, Roman; Cornaccio, Danielle et al. (2017) Twenty-year progression of body mass index in a county-wide cohort of people with schizophrenia and bipolar disorder identified at their first episode of psychosis. Bipolar Disord 19:336-343
Sabharwal, Amri; Kotov, Roman; Szekely, Akos et al. (2017) Neural markers of emotional face perception across psychotic disorders and general population. J Abnorm Psychol 126:663-678
Velthorst, Eva; Fett, Anne-Kathrin J; Reichenberg, Avraham et al. (2017) The 20-Year Longitudinal Trajectories of Social Functioning in Individuals With Psychotic Disorders. Am J Psychiatry 174:1075-1085
Mukherjee, Prerona; Sabharwal, Amri; Kotov, Roman et al. (2016) Disconnection Between Amygdala and Medial Prefrontal Cortex in Psychotic Disorders. Schizophr Bull 42:1056-67
Foti, Dan; Perlman, Greg; Hajcak, Greg et al. (2016) Impaired error processing in late-phase psychosis: Four-year stability and relationships with negative symptoms. Schizophr Res 176:520-526
Sabharwal, Amri; Szekely, Akos; Kotov, Roman et al. (2016) Transdiagnostic neural markers of emotion-cognition interaction in psychotic disorders. J Abnorm Psychol 125:907-922
Kotov, Roman; Foti, Dan; Li, Kaiqiao et al. (2016) Validating dimensions of psychosis symptomatology: Neural correlates and 20-year outcomes. J Abnorm Psychol 125:1103-1119
Klein, Daniel N; Kotov, Roman (2016) Course of depression in a 10-year prospective study: Evidence for qualitatively distinct subgroups. J Abnorm Psychol 125:337-48

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