First-episode psychosis: psychopathology, quality of life, and functional outcome

The burgeoning interest in investigating the first episode of schizophrenia and related disorders provides an opportunity to examine how this approach has assisted our understanding of the heterogeneity of psychopathology of this disorder and the trajectories of its outcome. We present a review of relevant literature on categorical versus dimensional perspectives on psychopathology, with special reference to early signs, its relationship with other patient- and system-related characteristics, and the status and determinants of functional outcome and quality of life. The findings from longitudinal studies of the dimensional psychopathology of first-episode psychosis suggest continuity of some psychopathological dimensions from premorbid through prodromal to post-onset phases of psychosis and some aspects of longer-term course. Short-term functional outcome improves after treatment of the first episode, but longer-term outcome remains relatively poor for a substantial proportion of patients and is associated with preadolescent onset, poor premorbid adjustment, poor cognitive functioning, cerebral asymmetry, and negative symptoms during prodromal and post-onset phases. Poor quality of life is related to residual psychopathology, long delays in treatment, and poor premorbid adjustment. The potential effects of improved treatment and/or early intervention on functional outcome and quality of life have not been adequately examined, nor have the interrelationships between predictors and the underlying processes involved in determining variations in outcome. Studies of functional outcome still lack the rigor of operational definitions, choice of specific instruments for measurement, and use of large enough samples to generate meaningful results.