Titre du document / Document title

Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features

Auteur(s) / Author(s)

TOHEN M. ; HENNEN J. ; ZARATE C. M. ; BALDESSARINI R. J. ; STRAKOWSKI S. M. ; STOLL A. L. ; FAEDDA G. L. ; SUPPES T. ; GEBRE-MEDHIN P. ; COHEN B. M. ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

International Consortium for Bipolar Disorder Research and the Harvard-McLean First Psychosis Project, ETATS-UNIS
Consolidated Department of Psychiatry and Neuroscience Program, Harvard Medical School, ETATS-UNIS
Department of Epidemiology, Harvard School of Public Health, Boston, ETATS-UNIS
Bipolar and Psychotic Disorders Program, McLean Hospital, Belmont, Mass., ETATS-UNIS

Résumé / Abstract

Objective: Psychotic affective disorders are the most prevalent idiopathic psychoses, but their outcome from onset has rarely been studied. In this study, the authors determined the rate and latency of syndromal recovery and rates of functional recovery after first lifetime hospitalization in patients with first-episode psychotic affective disorders. Method: From first lifetime hospitalization in 1989-1996, 219 patients with a DSM-IV psychotic affective illness were assessed at intervals over 24 months. Time to syndromal recovery (no longer meeting DSM-IV episode criteria) was assessed by survival analysis, and functional recovery (regaining baseline vocational and residential status) was rated. Factors associated with recovery were identified by bivariate and multivariate methods. Results: By 3, 6, 12, and 24 months after first hospitalization, syndromal recovery was attained by 65.1%, 83.7%, 91.1%, and 97.5%, respectively, of subjects. Time to syndromal recovery (6. 1 weeks to 50% of subjects recovered) was shorter for patients who had bipolar disorder, were married, were age 30 or older at onset, lacked comorbidity, required relatively brief hospitalization, and received fewer medicines. Functional recovery by 6 (30.4%) and 24 months (37.6% of patients) was 2.6-2.7 times less likely than syndromal recovery; 63.1% of those recovering syndromally did not recover functionally by 2 years. Functional recovery was associated with older age at onset and shorter hospitalization. Annual recovery rates remained stable as mean hospital length of stay decreased 3.6-fold over the 8-year study period. Conclusions: Syndromal recovery was attained by most psychotic affective disorder patients soon after hospitalization, but only one-third recovered functionally by 24 months. The findings suggest that these very common psychotic illnesses can carry a grave functional prognosis from the initial episode and first hospitalization.

Revue / Journal Title

The American journal of psychiatry   ISSN 0002-953X   CODEN AJPSAO 

Source / Source

2000, vol. 157, n^o2, pp. 220-228 (42 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Psychiatric Association, Washington, DC, ETATS-UNIS  (1921) (Revue)

Mots-clés anglais / English Keywords

Bipolar disorder ; Symptomatology ; Psychosis ; Inaugural sign ; Treatment ; Hospital environment ; Prognosis ; Recovery ; Syndrome ; Comparative study ; Functional recovery ; Prediction ; Follow up study ; Human ; Mood disorder ;

Mots-clés français / French Keywords

Trouble bipolaire ; Symptomatologie ; Psychose ; Signe inaugural ; Traitement ; Milieu hospitalier ; Pronostic ; Récupération ; Syndrome ; Etude comparative ; Récupération fonctionnelle ; Prédiction ; Etude longitudinale ; Homme ; Trouble humeur ;

Mots-clés espagnols / Spanish Keywords

Trastorno bipolar ; Sintomatología ; Psicosis ; Signo inaugural ; Tratamiento ; Medio hospitalario ; Pronóstico ; Recuperación ; Síndrome ; Estudio comparativo ; Recuperación functional ; Predicción ; Estudio longitudinal ; Hombre ; Trastorno humor ;

Localisation / Location

INIST-CNRS, Cote INIST : 3283, 35400008189178.0090