CHRONOLOGY OF COMORBID AND PRINCIPAL SYNDROMES IN FIRST-EPISODE PSYCHOSIS

Psychiatric comorbidity is common in psychotic disorders, but the chro nology of comorbid and principal diagnoses has not been closely examin ed. Understanding chronology may be important for identifying risk fac tors, or alternatively, prodromal syndromes, for some patients with ps ychosis. To address this issue, we examined the rates of antecedent co morbid syndromes in patients with first-episode psychoses. Patients ag ed greater than or equal to 12 years presenting with psychosis were re cruited from inpatient and outpatient treatment sites. Patients were e xcluded if they had been previously hospitalized or if symptoms result ed entirely from substance abuse or medical illness. All diagnoses wer e made using the Structured Clinical Interview for DSM-III-R-Patient V ersion (SCID-P). Comorbidity was defined as antecedent if the age of o nset of the comorbidity predated the age of the onset of the psychotic disorder by more than 1 year. Seventy-one patients were recruited dur ing a 1-year period and included 39 with bipolar disorder, 18 with sch izophrenia spectrum disorders, and 14 with psychotic depression. Comor bidity was present in 69% of patients. This comorbidity was antecedent in over 80% of the patients with concurrent syndromes. Patients with psychotic depression had the highest rates of comorbidity, in particul ar alcohol abuse and antecedent posttraumatic stress disorder (PTSD). Comorbidity is common in first-episode psychosis and is often antecede nt to the psychotic disorder. These antecedent comorbidities may repre sent risk factors or prodromal syndromes for the psychotic disorder. ( C) 1995 by W.B. Saunders Company