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-episo de psychoses treated ina modern, community oriented service; to compare out comes 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-epi sode psychoses and comparison with two-year follow-up (1980-1982) of the De terminants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort . Results On most outcome measures, non-affective psychoses had a worse outco me than affective psychoses. Affective psychoses had better outcome than pr eviously reported. Substance related psychoses had very poor occupational o utcome. Similar proportions of the current and DOSMED cohort were in remiss ion but the former were rated as having greater disability. Conclusions Ina modern community service, 30-60% of patients with first-epi sode psychoses experience a goad three-year outcome. The ICD-10 criteria ha ve good predictive validity.