Twelve-Month Outcome After a First Hospitalization for Affective Psychosis
Stephen M. StrakowskiPaul E. KeckSusan L. McElroyScott A. WestKenji W. SaxJ.M. HawkinsGeri F. KmetzVidya H. UpadhyayaKaren C. TugrulMichelle L. Bourne
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Background: We studied the 12-month course of illness after a first hospitalization for affective psychosis to identify potential outcome predictors in this rarely studied patient population.Methods: For this study, 109 patients consecutively admitted for their first psychiatric hospitalization for treatment of affective psychosis were recruited.Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization and at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional outcome predictors.Factors associated with outcome were identified by means of multivariate analyses.Results: Fifty-six percent of the patients achieved syndromic recovery during the 12-month follow-up.Full treatment compliance was associated with more frequent and rapid syndromic recovery.Forty-six habitual users of cannabis, who had been treated for psychosis during the years 1966-1970, were reported following an inquiry sent to Swedish psychiatric clinics and mental hospitals. Twenty-four of these cases had had psychotic episodes generally lasting 1-5 weeks, whereas 22 cases were running a chronic course. In 14 chronic cases an endogenous psychosis seemed to have been present before the drug debut. Seven of these showed a marked aggravation of the psychotic symptoms during periods of cannabis abuse. Eight cases of chronic psychosis occurred in earlier nonpsychotic subjects.Thirty cases occurred in formerly nonpsychotic individuals, though 23 of them had shown psychoneurotic traits. In seven of these, relapse into a second psychotic episode occurred following renewed cannabis abuse. The symptomatology reminded one of schizophrenic or manic-depressive endogenous psychoses in most instances, but confusional states were also seen. Evidence supporting the existence of a cannabis-induced psychosis has been discussed.
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