Three-year outcome comparison between patients presenting with first-episode psychotic mania and schizophrenia to easy program in Hong Kong

Abstract

BACKGROUND: Early intervention for first-episode psychosis has been the focus of mental health care development worldwide in the past two decades. A majority of previous research focused mainly either on outcomes of a cohort of broad-spectrum psychotic disorders (first-episode psychosis) or patients with a more specific diagnostic entity, mostly schizophrenia. Despite the fact that bipolar affective disorder frequently occurs in late adolescence or early adulthood, and is associated with poor long-term functional impairment, relatively few studies have been conducted to examine the early course of the illness. In this study, we aimed to compare the 3-year clinical and functional outcomes between first-episode psychotic mania (FEPM) and first-episode schizophrenia (FES) in the context of early intervention program in Hong Kong. METHODS: Four hundred-twenty patients aged 15 to 25 years presenting with first-episode ICD-10 psychotic mania or schizophrenia to a territory wide early intervention service in Hong Kong, namely Early Assessment Service for Young people with psychosis (EASY) between July 2001 and August 2003 and completed 3-year follow-up were included in the study. Socio-demographics, baseline and follow-up variables were obtained via systematic retrospective medical record review following standardized protocol. Symptom (CGI-S) and functional outcome (SOFAS) measures were determined for each month in the 3 years following entry to EASY program. RESULTS: Of the 420 patients, 374 and 46 were diagnosed with FES and FEPM, respectively. At baseline, patients with FES had longer duration of untreated psychosis (DUP) (t=8.4, p<0.001), fewer hospitalization at entry (χ2=29.0, p<0.001), fewer positive symptoms (t=−2.6, p=0.01) and better functioning (t=3.5, p=0.001) than patients with FEPM. By the end of 3-year follow-up, FEPM patients had significantly fewer positive symptoms (t=2.8, p<0.05), fewer readmissions (t=−3.9, p<0.001), better functioning (t=−2.9, p<0.05), higher likelihood of achieving sustained employment (χ2=4.6, p<0.05) than FES patients. Multivariate regression analyses taking into consideration baseline between-diagnostic group differences revealed that diagnostic status (i.e., FEPM vs. FES) independently predicted total number of hospitalizations over 3 years (p<0.05), sustained employment (p<0.01), and global functional outcome at 3 years of follow-up (p<0.01). DISCUSSION: In a large representative cohort of Chinese young patients presenting with first-episode psychosis to early intervention service, our findings indicated that patients with FEPM had better 3-year clinical and functional outcomes than those with FES. More prospective research is required to investigate the longitudinal course and outcome predictors of bipolar affective disorder in its early illness stage.