Three-year clinical and functional outcome comparison between first-episode mania with psychotic features and first-episode schizophrenia

Background: The early course of first-episode mania with psychotic features (FEMP) is under-studied. Accumulating evidence suggests that FEMP is associated with substantial functional impairment. Very few studies were conducted to directly compare clinical and functional outcomes between FEMP and first-episode schizophrenia (FES). Methods: Four-hundred-twenty patients aged 15-25 years who presented with FEMP or FES to a territory-wide early intervention service in Hong Kong from July 2001 to August 2003 and completed 3-year follow-up were studied. Baseline and follow-up variables were collected via systematic medial file review. Functional remission was operationalized as attaining sustained employment, and Social and Occupational Functioning Assessment Scale (SOFAS) score > 60 in the last 12 months of follow-up. Results: At baseline, FEMP patients were younger, more likely to be hospitalized, had shorter duration of untreated psychosis, more severe positive symptoms and lower SOFAS score than FES patients. By the end of 3-year follow-up, FEMP patients had significantly milder positive symptom severity, higher SOFAS score, and higher rates of sustained employment (45.7%) and functional remission (36.9%) than FES patients. Regression analyses showed that diagnostic group membership of FEMP (vs. FES) independently predicted better clinical and functional outcomes. Conclusion: Our results indicate that FEMP patients had better clinical and functional outcomes than FES patients in the initial 3 years of treatment. Yet, only approximately 37% of FEMP patients attained functional remission at 3 years. This underscores the need to develop specialized early intervention for FEMP populations to promote functional recovery in the early stage of illness. (C) 2016 Elsevier B.V. All rights reserved.