First-episode non-affective psychosis in a total urban population: a 5-year follow-up

Background: The aim of this study is to investigate incidence rates, treatment, and outcome of a total in- and outpatient population of 71 patients (of 18-45 years of age) treated for a first-episode psychosis (DSM-IV) in three catchment areas in Stockholm. Methods: The study is based on the investigation of records and databases and on information by staff members and patients. Results: The incidence rate was 34.8 per 100,000 inhabitants (aged 18-45 years) and 16.5 per 100,000 inhabitants (total population). Sixty percent were diagnosed with schizophrenia syndromes. At 5-year follow-up, 73% of the patients in the schizophrenia syndromes group versus 47% of the non-schizophrenia group had a sick pension or were on long-term sick leave. Nine percent of the schizophrenia patients and 39% of the non-schizophrenia psychosis patients were rated as not being in need of treatment. Non-compliance of medication was present in one-third of those patients prescribed neuroleptic medication. Seven percent had never received neuroleptic medication, all of whom were rated as ill at the 5-year follow-up. Conclusions: Incidence of treated first-episode psychosis is higher than has earlier been found, when exclusively outpatient treated individuals are also included. The social outcome is negative, even in the non-schizophrenia group. Non-compliance with medication and insufficient clinical follow-up may have worsened the results.