Women with first-episode psychosis: diagnostic stability and clinical trajectories

The aim of this study was to assess the influence of sex on diagnostic stability in first-episode psychosis during the first year of follow-up.

This was a prospective, observational study of 256 patients with FEP, of whom 188 (73.4%) completed the 1-year follow-up. Patients were consecutively recruited at a specialized early intervention program. Comprehensive psychiatric evaluations and the Structured Clinical Interview for DSM-IV-TR Axis I disorders were performed at baseline and follow-up. Diagnoses were grouped into affective and non-affective psychoses. Univariate and multivariate logistic regression analyses were conducted to identify predictors of diagnostic shift, with a particular focus on sex.

At one-year follow-up, 48.9% of patients experienced some form of diagnostic change. Specifically, 14.4% shifted from non-affective to affective psychosis. Female sex was the only independent predictor of diagnostic shift (OR = 0.30; 95% CI = 0.10-0.87; p = 0.027). No other clinical or demographic variables were significantly associated with diagnostic change.

Female FEP patients were significantly more likely to experience a diagnostic shift toward affective psychosis during the first year of follow-up. These findings highlight the importance of considering sex differences in clinical presentation at illness onset to improve diagnostic accuracy, optimize treatment strategies, and enhance long-term outcomes.