First acute psychotic episode: Factors associated with evolution to schizophrenia

Introduction The acute psychotic episode have often a dramatic expression. Although it is easily diagnosed, it is not easy to predict the evolution and much less the prognosis that are of concern both for the therapist and the patients’ families. Aims To describe the profile of a population of patients with a first psychotic episode. To identify factors correlated with evolution to schizophrenia. Methods This is a retrospective study conducted among 55 patients hospitalized for a first acute psychotic episode, in the psychiatry B department during the period extending between January 2010 and December 2015. Results The average age of patients was 26.5. The majority was single male. The prodromal phase was present with predominantly psychotic symptoms (80%). Schizophrenia was the most frequently encountered scalable diagnosis (38%). Some factors are associated with the evolution to schizophrenia. We can mention male gender ( P  = 0.004) and premorbid schizoid personality ( P  = 0.047). About correlated clinical factors, we have found an initial symptomatology dominated by loss of interest ( P  = 0.05), withdrawal and isolation ( P  = 0.017), impulsivity ( P  = 0.011), breaking with the usual functioning ( P  = 0.04), mental automatism ( P  = 0.033), the delusions of persecution ( P  = 0.025) and intuitive mechanism ( P  = 0.023). Conclusion When a first acute delusional experience occurs in a young adult, it is always a test of uncertain outcome. However, schizophrenia remains the most feared evolutionary. A better understanding of poor prognosis and early and appropriate management seem paramount to reduce the prevalence of this dreaded evolution.