ArticleThe American journal of psychiatry2017
Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project.
Article in The American journal of psychiatry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 3 of them syntheses that pooled it.
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45 citing papers in PubMed, 3 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- "Short" Versus "Long" Duration of Untreated Psychosis in People with First-Episode Psychosis: A Systematic Review and Meta-Analysis of Baseline Status and Follow-Up Outcomes.Schizophrenia bulletin · 2025Pooled it
- Neurostructural, Neurofunctional, and Clinical Features of Chronic, Untreated Schizophrenia: A Narrative Review.Schizophrenia bulletin · 2025Pooled it
- Schizophrenia spectrum stigma in healthcare: a systematic review.Frontiers in psychiatry · 2025Pooled it
- Predictors of Mortality Following a Schizophrenia Spectrum Diagnosis: Evidence From the 20-Year Follow-up of the OPUS Randomized Controlled Trial.Schizophrenia bulletin · 2023Trial
- Trial
- Auditory event-related potentials and psychosis dimensions.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026Article
- Neural Responses to Reward and Psychosis Dimensions.Schizophrenia bulletin · 2026Article
- The Danish Region Midt Schizophrenia Cohort - Representative, long-term follow-up of first-episode schizophrenia spectrum disorder.Acta neuropsychiatrica · 2026Article
- Adaptation of Narrative Enhancement and Cognitive Therapy for Youth Receiving Services for a First Episode of Psychosis.Early intervention in psychiatry · 2026Article
- Social exclusion as a major outcome domain of psychotic disorders: early predictors, and associations with non-recovery and clinical staging 21 years after a first episode of psychosis.Social psychiatry and psychiatric epidemiology · 2025Observational
- Race and Ethnicity and Diffusion of Telemedicine in Medicaid for Schizophrenia Care After Onset of the COVID-19 Pandemic.JAMA network open · 2025Article
- Intraindividual Variability of Event-Related Potentials in Psychosis: A Registered Report.Biological psychiatry global open science · 2025Article
- Psychosis superspectrum I: Nosology, etiology, and lifespan development.Molecular psychiatry · 2024Review
- Validation of behavioral measures of social cognition in individuals diagnosed with schizophrenia.Frontiers in psychology · 2024Article
- Mismatch negativity and clinical trajectories in psychotic disorders: Five-year stability and predictive utility.Psychological medicine · 2023Article
- Inferring Trajectories of Psychotic Disorders Using Dynamic Causal Modeling.Computational psychiatry (Cambridge, Mass.) · 2023Article
- Article
- Searching for diagnoses and subgroups: a suggestion for criteria.Frontiers in psychiatry · 2023Article
- Pleasant and unpleasant odor identification ability is associated with distinct dimensions of negative symptoms transdiagnostically in psychotic disorders.Schizophrenia research · 2022Article
- Dynamic interplay between life events and course of psychotic disorders: 10-year longitudinal study following first admission.Psychological medicine · 2022Article
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11 authors at 3 institutions in 2 countries.
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Abstract
objectiveKraepelin considered declining course a hallmark of schizophrenia, but others have suggested that outcomes usually stabilize or improve after treatment initiation. The authors investigated this question in an epidemiologically defined cohort with psychotic disorders followed for 20 years after first hospitalization.
methodThe Suffolk County Mental Health Project recruited first-admission patients with psychosis from all inpatient units of Suffolk County, New York (response rate, 72%). Participants were assessed in person six times over two decades; 373 completed the 20-year follow-up (68% of survivors); 175 had schizophrenia/schizoaffective disorder. Global Assessment of Functioning (GAF), psychotic symptoms, and mood symptoms were rated at each assessment. Month 6, when nearly all participants were discharged from the index hospitalization, was used as a reference.
resultsIn the schizophrenia group, mean GAF scores declined from 49 at month 6 to 36 at year 20. Negative and positive symptoms also worsened (Cohen's d values, 0.45-0.73). Among participants without schizophrenia, GAF scores were higher initially (a mean of approximately 64) but declined by 9 points over the follow-up period. Worsening began between years 5 and 8. Neither aging nor changes in antipsychotic treatment accounted for the declines. In all disorders, depression improved and manic symptoms remained low across the 20 years.
conclusionsThe authors found substantial symptom burden across disorders that increased with time and ultimately may undo initial treatment gains. Previous studies have suggested that better health care delivery models may preempt this decline. In the United States, these care needs are often not met, and addressing them is an urgent priority.
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