The overall goal of the proposed study is to identify phenomenological and psychosocial predictors of recovery and one-year outcome in patients who are hospitalized with a first psychotic episode. Information is collected on standardized clinical assessments, including obstetrical, premorbid history, features of illlmess onset, precipitating events, and type and severity of psychiatric symptoms at first episode. All first lifetime admisions to the Psychotic Disorders Program inpatient units at McLean Hospital are screened to obtain a cohort of about 80 subjects over a one year period. A major feature of this project is frequent reassessment to improve understanding of the course and processes of recovery and relapse in first-episode psychosis, including schizophrenia and mania. The Structured Clinical Interview for DSM-III-R (SCID) is administered on admission and at one year, in order to assess stebility of diagnoses. Patients are reated twice weekly during the index hospitalization with symptom rating scales and a function scale assessment. After discharge they will be rated at 6 and 12 months in order to assess recovery or relapse and overall psychological adjustment. Treatment will not be under the control of the investigators, but pharmacological and other aspects of clinical management will be documented. The significance of this study rests on the selection of recent onset psychosis, as opposed to a mixed group of first and multiple-episode cases. Precise documentation of the length of the episode and readministration of the diagnostic interview one year after recovery will provide useful chronological data with which to determine the minimum duration of acute illmess necessary to establish valid diagnostic categories. In addition, the prospective follow-up will permit characterization of the short term outcome of psychosis and assessment of associations of life events and relapse. The innovative aspect of this project relies on the prospective follow-up of recent-onset psychotic patients in order to identify predictors of the rate, time, and degree of recovery and one-year outcome, utilizing operationalized criteria for recovery and relapse.
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