Three-year outcome of first-episode psychoses in an established community psychiatric service

Background Changes inservice provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis. Aims To assess the three-year outcome of an inception cohort of first-episode psychoses treated ina modern, community oriented service; to compare outcomes with an earlier cohort treated in hospital-based care; and to examine-the predictive validity of ICD-10 diagnostic criteria. Method Three-year follow-up (1995-1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980-1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort. Results On most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability. Conclusions Ina modern community service, 30-60% of patients with first-episode psychoses experience a goad three-year outcome. The ICD-10 criteria have good predictive validity.