The Long-Term Course of Remission and Recovery in Psychotic Disorders

Background: Understanding prognosis is critical to anticipating future public health needs, and to providing clinical care to individuals with psychotic disorders. However, the long-term course of remission and recovery in psychotic disorders remains unclear. In this cohort of 628 individuals followed for 25 years since first admission for psychosis, we describe the most common trajectories of illness course among those with psychotic disorders. Methods: Participants are from the Suffolk County Mental Health Project, an epidemiological study of first-admission psychosis. Participants were recruited from all 12 inpatient facilities in Suffolk County, New York between 1989 and 1995. 628 participants met criteria for the baseline sample. Data for the present study reflects remission and recovery at the 6-month, 24-month, 48-month, 10-year, 20-year, and 25-year follow-ups. 321 individuals were assessed at the 25-year follow-up. Common patterns of remission and recovery were assessed in both the baseline sample of 628 individuals, as well as the subsample of those observed at the 25-year follow up.Results: Common patterns of remission and recovery were assessed. In the baseline sample and 25-year subsample, among those with schizophrenia, the most common trajectory was one of no remission and no recovery. Among those with other psychotic disorders, in both baseline sample and the 25-year subsample, the modal pattern was one of intermittent remission and recovery. Those with psychotic disorders other than schizophrenia were more likely to experience stable remission (10.9%) and stable recovery (23.6%), than those with schizophrenia, where these outcomes were rare (0% and 0.7%, respectively). Discussion: These patterns emphasize the importance of sustained, long-term case for individuals with schizophrenia spectrum disorder and other psychoses. Though people with other psychoses often have periods of remission and recovery, the model longitudinal pattern is one of multiple episodes. Engagement in a long-term health care plan may help individuals detect and respond to these changes. Sustained remission and recovery are rare among people with schizophrenia spectrum disorders, and efforts should be put towards ensuring continual access to care, especially as they enter old age.