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Subtyping first-episode non-affective psychosis using four early-course features: potentially useful prognostic information at initial presentation

Authors

  • Michael T. Compton,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
    • Corresponding author: Dr Michael T. Compton, Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, 2120 L Street, Suite 600, N.W., Washington, DC 20037, USA. Email: mcompton@mfa.gwu.edu

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  • Mary E. Kelley,

    1. Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA
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  • Dawn F. Ionescu

    1. Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland, USA
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Abstract

Aim

Heterogeneity of symptoms, course and outcomes in primary psychotic disorders complicates prognosis, treatment and diverse aspects of research. This study aimed to identify interpretable subtypes of first-episode non-affective psychosis based on four early-course features (premorbid academic functioning, premorbid social functioning, duration of the prodrome and age at onset of psychosis).

Methods

Data from 200 well-characterized patients hospitalized in public-sector inpatient units for first-episode non-affective psychosis were used in latent profile analyses. Derived subtypes were then compared along a number of clinical dimensions using analyses of variance.

Results

Using four early-course features, three classes were derived. A good premorbid/short prodrome subtype was characterized by a lower severity of positive symptoms, better social/occupational/global functioning, and a shorter duration of untreated psychosis; a poor premorbid/early onset subtype demonstrated greater negative and preoccupation symptoms, as well as greater psychosocial problems; and a long prodrome/late onset subtype was characterized by greater dysphoric symptoms.

Conclusions

Findings indicate a need for further research with first-episode samples on the utility of subtyping based on early-course (premorbid, prodromal and onset-related) characteristics. Such efforts could enhance the parsing of heterogeneity, thereby advancing clinical practice and research.

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