Predictors of transition to schizophrenia and other long-lasting non-affective psychoses in first-episode patients with acute and transient psychotic disorders: a validation study

• Alvaro Lopez-Díaz ^[2] ; Jose Luis Fernandez-Gonzalez ^[3] ; Ignacio Lara ^[4] ; Benedicto Crespo-Facorro ^[1] ; Miguel Ruiz-Veguilla ^[1]
  1. [1] Universidad de Sevilla

     Universidad de Sevilla

     Sevilla, España

     
  2. [2] Mental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain; Seville Biomedical Research Centre (IBiS), Seville, Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain
  3. [3] Mental Health Clinical Management Unit, San Juan de la Cruz Hospital, Ubeda, Spain
  4. [4] Mental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain

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• Localización: European journal of psychiatry, ISSN 0213-6163, Vol. 38, Nº 2, 2024
• Idioma: inglés
• DOI: 10.1016/j.ejpsy.2023.100234
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• Resumen

  • Background and objectives: Almost half of the individuals with a first-episode of psychosis who initially meet criteria for acute and transient psychotic disorder (ATPD) will have had a diagnostic revision during their follow-up, mostly toward schizophrenia. This study aimed to determine the proportion of diagnostic transitions to schizophrenia and other long-lasting non-affective psychoses in patients with first-episode ATPD, and to examine the validity of the existing predictors for diagnostic shift in this population.

    Methods: We designed a prospective two-year follow-up study for subjects with first-episode ATPD. A multivariate logistic regression analysis was performed to identify independent variables associated with diagnostic transition to persistent non-affective psychoses. This prediction model was built by selecting variables on the basis of clinical knowledge.

    Results: Sixty-eight patients with a first-episode ATPD completed the study and a diagnostic revision was necessary in 30 subjects at the end of follow-up, of whom 46.7% transited to longlasting non-affective psychotic disorders. Poor premorbid adjustment and the presence of schizophreniform symptoms at onset of psychosis were the only variables independently significantly associated with diagnostic transition to persistent non-affective psychoses.

    Conclusion: Our findings would enable early identification of those inidividuals with ATPD at most risk for developing long-lasting non-affective psychotic disorders, and who therefore should be targeted for intensive preventive interventions.