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Three-year clinical and functional outcome comparison between first-episode mania with psychotic features and

Wing Chung Chang1, Emily Sin Kei Lau2, Shirley Sanyin Chiu3

  • 1Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.

Journal of Affective Disorders
|April 24, 2016
PubMed
Abstract

Insights

First-episode mania with psychotic features (FEMP) patients show better outcomes than schizophrenia patients. However, functional remission rates remain low, highlighting the need for specialized early interventions for FEMP.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Neuroscience

Background:

  • First-episode mania with psychotic features (FEMP) is under-studied, with limited research comparing it to first-episode schizophrenia (FES).
  • FEMP is associated with significant functional impairment, necessitating further investigation into its early course and outcomes.
  • Existing studies have not sufficiently addressed the direct comparison of clinical and functional trajectories between FEMP and FES.

Purpose of the Study:

  • To compare the clinical and functional outcomes of patients with first-episode mania with psychotic features (FEMP) versus first-episode schizophrenia (FES).
  • To identify predictors of clinical and functional recovery in early psychosis populations.
  • To evaluate the long-term functional remission rates in FEMP and FES over a 3-year period.

Main Methods:

  • A cohort of 420 patients (aged 15-25) diagnosed with FEMP or FES were studied over 3 years.
  • Data collected via systematic medical file review included baseline characteristics and follow-up variables.
  • Functional remission was defined as sustained employment and a Social and Occupational Functioning Assessment Scale (SOFAS) score >60.

Main Results:

  • At baseline, FEMP patients were younger, more likely to be hospitalized, and had shorter duration of untreated psychosis and more severe positive symptoms than FES patients.
  • By 3-year follow-up, FEMP patients exhibited significantly milder positive symptoms, higher SOFAS scores, and higher rates of sustained employment (45.7%) and functional remission (36.9%).
  • Diagnostic group (FEMP vs. FES) independently predicted better clinical and functional outcomes.

Conclusions:

  • FEMP patients demonstrate superior clinical and functional outcomes compared to FES patients within the first 3 years of treatment.
  • Despite better outcomes, only about 37% of FEMP patients achieved functional remission at 3 years.
  • There is a critical need for specialized early intervention programs tailored to FEMP populations to enhance functional recovery in the early stages of illness.
Keywords:
EmploymentFirst-episode maniaFirst-episode schizophreniaFunctional outcomeFunctional remissionLongitudinal follow-up

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