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

- First-episode mania with psychosis (FEMP) patients had better outcomes than first-episode schizophrenia (FES) patients.
- Diagnostic group membership of FEMP (vs. FES) predicted better 3-year outcomes even when baseline confounders were adjusted.
- 45.7% and 36.9% of FEMP patients attained sustained employment and functional remission at 3 years, respectively.
- Our findings underscore the need to develop specialized early intervention for FEMP to promote early functional recovery.

BackgroundThe 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).MethodsFour-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.ResultsAt 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.ConclusionOur 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.