TY - JOUR
T1 - Persistent Psychosis During 4 Years after First Hospitalization for a Psychotic Disorder in the Suffolk County Mental Health Project
T2 - Prevalence, Risk Factors, and Relationship to 25-Year Outcomes
AU - Rubio, Jose M.
AU - Lian, Wenxuan
AU - Bromet, Evelyn J.
AU - Guinart, Daniel
AU - Kotov, Roman
AU - Correll, Christoph U.
AU - Jonas, Katherine
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2026/5
Y1 - 2026/5
N2 - Background and Hypothesis: The early phase of psychosis is critical for interventions to modify long-term outcomes. It is unclear what proportion of individuals’ exhibit early persistent psychosis and the long-term implications. Study Design: An epidemiologic sample of individuals with acute psychosis was recruited at first admission and followed for 25 years. Early persistent psychosis was defined as presence of active psychosis for ≥90% of the days of the 4 years after first hospitalization for psychosis. Multivariable regression analyses were conducted, testing the association between baseline predictors and persistent psychosis, and between persistent psychosis and 25-year outcomes. Study Results: Out of 526 individuals (age = 27.4 ± 9.4 years, males = 56.8%, baseline schizophrenia/schizoaffective disorder = 30.0%), 101 (19.2%) had early persistent psychosis. At baseline, low premorbid cognitive performance (odds ratio (OR) = 2.08, 95% CI, 1.05-4.12), lower Global Assessment of Functioning (OR = 1.59, 95% CI, 1.16-2.13), low role function (OR = 1.49, 95% CI, 1.03-2.16) and worse social function (OR = 1.52, 95% CI, 1.03-2.22) were predictive of persistent psychosis. At 25-year follow-up (n = 307, 58.9%), early persistent psychosis was associated with worse avolition ((Formula presented) =0.25, 95% CI, 0.14-0.35), more severe reality distortion ((Formula presented) =0.19, 95% CI, 0.07-0.31), disorganization ((Formula presented) =0.21, 95% CI, 0.09-0.32), worse social ((Formula presented) =-0.18, 95% CI, -0.06 to -0.30), role ((Formula presented) =-0.22, 95% CI, -0.09 to -0.34), and global function ((Formula presented) =-0.28, 95% CI, -0.17 to -0.38), greater odds of being on public assistance (OR = 2.13, 95% CI, 1.15-3.95), lower odds of living independently (OR = 0.43, 95% CI, 0.23-0.80) or recovery (OR = 0.09, 95% CI, 0.02-0.38). Conclusions: One in 5 individuals with first-episode psychosis had early persistent psychosis without clearly modifiable premorbid factors, and with strong associations with adverse long-term outcomes. Individuals experiencing early persistent psychosis require focused long-term interventions.
AB - Background and Hypothesis: The early phase of psychosis is critical for interventions to modify long-term outcomes. It is unclear what proportion of individuals’ exhibit early persistent psychosis and the long-term implications. Study Design: An epidemiologic sample of individuals with acute psychosis was recruited at first admission and followed for 25 years. Early persistent psychosis was defined as presence of active psychosis for ≥90% of the days of the 4 years after first hospitalization for psychosis. Multivariable regression analyses were conducted, testing the association between baseline predictors and persistent psychosis, and between persistent psychosis and 25-year outcomes. Study Results: Out of 526 individuals (age = 27.4 ± 9.4 years, males = 56.8%, baseline schizophrenia/schizoaffective disorder = 30.0%), 101 (19.2%) had early persistent psychosis. At baseline, low premorbid cognitive performance (odds ratio (OR) = 2.08, 95% CI, 1.05-4.12), lower Global Assessment of Functioning (OR = 1.59, 95% CI, 1.16-2.13), low role function (OR = 1.49, 95% CI, 1.03-2.16) and worse social function (OR = 1.52, 95% CI, 1.03-2.22) were predictive of persistent psychosis. At 25-year follow-up (n = 307, 58.9%), early persistent psychosis was associated with worse avolition ((Formula presented) =0.25, 95% CI, 0.14-0.35), more severe reality distortion ((Formula presented) =0.19, 95% CI, 0.07-0.31), disorganization ((Formula presented) =0.21, 95% CI, 0.09-0.32), worse social ((Formula presented) =-0.18, 95% CI, -0.06 to -0.30), role ((Formula presented) =-0.22, 95% CI, -0.09 to -0.34), and global function ((Formula presented) =-0.28, 95% CI, -0.17 to -0.38), greater odds of being on public assistance (OR = 2.13, 95% CI, 1.15-3.95), lower odds of living independently (OR = 0.43, 95% CI, 0.23-0.80) or recovery (OR = 0.09, 95% CI, 0.02-0.38). Conclusions: One in 5 individuals with first-episode psychosis had early persistent psychosis without clearly modifiable premorbid factors, and with strong associations with adverse long-term outcomes. Individuals experiencing early persistent psychosis require focused long-term interventions.
KW - early intervention services
KW - longitudinal course of illness
KW - treatment resistance
UR - https://www.scopus.com/pages/publications/105038473530
U2 - 10.1093/schbul/sbag049
DO - 10.1093/schbul/sbag049
M3 - Article
C2 - 42104800
AN - SCOPUS:105038473530
SN - 0586-7614
VL - 52
JO - Schizophrenia Bulletin
JF - Schizophrenia Bulletin
IS - 3
M1 - sbag049
ER -