Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features

Objective: Psychotic affective disorders are the most prevalent idiopathic psychoses, but their outcome from onset has rarely been studied. In this st udy, the authors determined the rate and latency of syndromal recovery and rates of functional recovery after first lifetime hospitalization in patien ts with first-episode psychotic affective disorders. Method: From first lif etime hospitalization in 1989-1996, 219 patients with a DSM-IV psychotic af fective illness were assessed at intervals over 24 months. Time to syndroma l recovery (no longer meeting DSM-IV episode criteria) was assessed by surv ival analysis, and functional recovery (regaining baseline vocational and r esidential status) was rated. Factors associated with recovery were identif ied by bivariate and multivariate methods. Results: By 3, 6, 12, and 24 mon ths after first hospitalization, syndromal recovery was attained by 65.1%, 83.7%, 91.1%, and 97.5%, respectively, of subjects. Time to syndromal recov ery (6.1 weeks to 50% of subjects recovered) was shorter for patients who h ad bipolar disorder, were married, were age 30 or older at onset, lacked co morbidity, required relatively brief hospitalization, and received fewer me dicines. Functional recovery by 6 (30.4%) and 24 months (37.6% of patients) was 2.6-2.7 times less likely than syndromal recovery; 63.1% of those reco vering syndromally did not recover functionally by 2 years. Functional reco very was associated with order age at onset and shorter hospitalization. An nual recovery rates remained stable as mean hospital length of stay decreas ed 3.6-fold over the 8-year study period. Conclusions: Syndromal recovery w as attained by most psychotic affective disorder patients soon after hospit alization, but only one-third recovered functionally by 24 months. The find ings suggest that these very common psychotic illnesses can carry a grave f unctional prognosis from the initial episode and first hospitalization.