Opening Doors to Recovery: Recidivism and Recovery Among Persons With Serious Mental Illnesses and Repeated Hospitalizations

OBJECTIVE

Repeated hospitalizations and arrests or incarcerations diminish the ability of individuals with serious mental illnesses to pursue recovery. Community mental health systems need new models to address recidivism as well as service fragmentation, lack of engagement by local stakeholders, and poor communication between mental health providers and the police. This study examined the initial effects on institutional recidivism and measures of recovery among persons enrolled in Opening Doors to Recovery, an intensive, team-based community support program for persons with mental illness and a history of inpatient psychiatric recidivism. A randomized controlled trial of the model is underway.

METHODS

The number of hospitalizations, days hospitalized, and arrests (all from state administrative sources) in the year before enrollment and during the first 12 months of enrollment in the program were compared. Longitudinal trajectories of recovery-using three self-report and five clinician-rated measures-were examined. Analyses accounted for baseline symptom severity and intensity of involvement in the program.

RESULTS

One hundred participants were enrolled, and 72 were included in the analyses. Hospitalizations decreased, from 1.9±1.6 to .6±.9 (p<.001), as did hospital days, from 27.6±36.4 to 14.9±41.3 (p<.001), although number of arrests (which are rare events) did not. Significant linear trends were observed for recovery measures, and trajectories of improvement were apparent across the entire follow-up period.

CONCLUSIONS

Opening Doors to Recovery holds promise as a new service approach for reducing hospital recidivism and promoting recovery in community mental health systems and is deserving of further controlled testing.

Personality domains, duration of untreated psychosis, functioning, and symptom severity in first-episode psychosis

OBJECTIVES

Early-course psychotic disorders have been extensively studied in terms of phenomenology, but little is known about the influence of personality traits on clinical features of first-episode psychosis. The aim of this study was to explore how the "big five" personality domains (neuroticism, extraversion, openness, agreeableness, and conscientiousness) are associated with treatment delay (duration of untreated psychosis, DUP), functioning, and positive and negative symptom severity.

METHODS

Data for these analyses were obtained from 104 participants enrolled from psychiatric inpatient units in Atlanta, Georgia, between August 2008 and March 2011. The NEO Five-Factor Inventory (NEO-FFI) was used to assess personality domains, and all other variables were measured in a standardized and rigorous manner using psychometrically sound instruments. Correlational analyses and multiple linear regressions were carried out to examine the strength of associations between variables of interest.

RESULTS

Findings indicated that except for openness, all of the other personality variables contributed to some extent to the variance in DUP. Conscientiousness was positively correlated with functioning. Agreeableness was independently negatively associated with positive symptom severity and extraversion was independently negatively correlated with negative symptom severity.

CONCLUSIONS

We report the first evidence suggesting that DUP is in part driven by personality domains. Functioning and symptom severity are also associated with those domains. Personality should be taken into account in order to better understand the phenomenology of early-course psychotic disorders as well as treatment-seeking behaviors.

Surveys of Police Chiefs and Sheriffs and of Police Officers About CIT Programs

OBJECTIVE

Two surveys were conducted on the crisis intervention team (CIT) model, a police-based program designed to improve responses to individuals with mental illnesses.

METHODS

Data were collected between July and September 2013 from 171 police chiefs and sheriffs (42 had implemented CIT in their agency), and 353 law enforcement officers (273 had CIT training) in Georgia.

RESULTS

Police chiefs and sheriffs reported barriers to implementing CIT, such as not having enough officers and insufficient access to mental health services. CIT-trained officers differed from non-CIT-trained officers only with regard to being less likely to use force in response to a man with psychotic agitation described in a vignette, when the analysis controlled for whether the officer carried an electronic control device.

CONCLUSIONS

Some hypothesized differences, such as in job satisfaction and work burnout, were not observed. However, CIT-trained officers appeared to be less likely to revert to force in a situation involving psychotic agitation.

A potential role for family members in mental health care delivery: the family community navigation specialist

OBJECTIVE

Opening Doors to Recovery (ODR) in southeast Georgia included a family community navigation specialist (F-CNS) in addition to a peer specialist and a mental health professional. This qualitative study assessed the usefulness of the F-CNS role.

METHODS

Semistructured interviews were conducted with 30 respondents (ten ODR participants with serious mental illnesses; ten family members; and ten ODR leaders and team members, including two F-CNSs). Interviews were recorded and transcribed for qualitative analysis.

RESULTS

Many respondents found the F-CNS to be helpful, providing psychosocial support, serving as a communication liaison, and being a team member dedicated to the family. Aspects that might require improvement include insufficient description of the F-CNS role to participants and the limited experience and training of the F-CNSs.

CONCLUSIONS

The F-CNS represents an unexplored role for family members of persons with serious mental illnesses that may complement the roles of other service providers and strengthen recovery-oriented teams.

Abnormal movements in first-episode, nonaffective psychosis: dyskinesias, stereotypies, and catatonic-like signs

Motor abnormalities represent a neurobehavioral domain of signs intrinsic to schizophrenia-spectrum disorders, though they are commonly attributed to medication side effects and remain understudied. Individuals with first-episode psychosis represent an ideal group to study innate movement disorders due to minimal prior antipsychotic exposure. We measured dyskinesias, stereotypies, and catatonic-like signs and examined their associations with: (1) age at onset of psychotic symptoms and duration of untreated psychosis; (2) positive, negative, and disorganized symptoms; (3) neurocognition; and (4) neurological soft signs. Among 47 predominantly African American first-episode psychosis patients in a public-sector hospital, the presence and severity of dyskinesias, stereotypies, and catatonic-like features were assessed using approximately 30-min video recordings. Movement abnormalities were rated utilizing three scales (Dyskinesia Identification System Condensed User Scale, Stereotypy Checklist, and Catatonia Rating Scale). Correlational analyses were conducted. Scores for each of three movement abnormality types were modestly inter-correlated (r=0.29-0.40). Stereotypy score was significantly associated with age at onset of psychotic symptoms (r=0.32) and positive symptom severity scores (r=0.29-0.41). There were no meaningful or consistent associations with negative symptom severity, neurocognition, or neurological soft signs. Abnormal movements appear to represent a relatively distinct phenotypic domain deserving of further research.

Adapting the Crisis Intervention Team (CIT) model of police-mental health collaboration in a low-income, post-conflict country: curriculum development in Liberia, West Africa

OBJECTIVES

We sought to develop a curriculum and collaboration model for law enforcement and mental health services in Liberia, West Africa.

METHODS

In 2013 we conducted key informant interviews with law enforcement officers, mental health clinicians, and mental health service users in Liberia, and facilitated a 3-day curriculum workshop.

RESULTS

Mental health service users reported prior violent interactions with officers. Officers and clinicians identified incarceration and lack of treatment of mental health service users as key problems, and they jointly drafted a curriculum based upon the Crisis Intervention Team (CIT) model adapted for Liberia. Officers' mental health knowledge improved from 64% to 82% on workshop assessments (t=5.52; P<.01). Clinicians' attitudes improved (t=2.42; P=.03). Six months after the workshop, 69% of clinicians reported improved engagement with law enforcement. Since the Ebola outbreak, law enforcement and clinicians have collaboratively addressed diverse public health needs.

CONCLUSIONS

Collaborations between law enforcement and mental health clinicians can benefit multiple areas of public health, as demonstrated by partnerships to improve responses during the Ebola epidemic. Future research should evaluate training implementation and outcomes including stigma reduction, referrals, and use of force.

Cross-cultural invariance of the factor structure of the Schizotypal Personality Questionnaire across Spanish and American college students

The main goal of this study was to examine the cross-cultural invariance of the factor structure of the Schizotypal Personality Questionnaire (SPQ) (Raine, 1991) in two large samples of Spanish and American young adults. The final sample was made up of 2313 college students (508 men, 22%). Their mean age was 20.5 years (S.D.=3.2). The results indicated that the Stefanis et al. (2004) four-factor model yielded the best goodness-of-fit indices compared to alternative models. Moreover, the results support configural, metric, and partial measurement invariance of the covariances of the SPQ across the two samples. The finding of measurement equivalence across cultures provides essential evidence of construct validity for the schizotypy dimensions and of the cross-cultural validity of SPQ scores. The finding of comparable dimensional structures in cross-cultural samples lends further support to the continuum model of schizotypy and schizophrenia spectrum disorders. Future studies should continue to examine the validity of scores on the SPQ and other schizotypy measures and their variation or consistency across cultures.

Attachment security and problematic substance use in low-income, suicidal, African American women

BACKGROUND AND OBJECTIVES

While secure attachment may buffer the effect of adverse early experiences on the development of behavioral problems in children, whether attachment security may provide resilience against problematic substance use in adulthood is less clear, and addressed by this study.

METHODS

We examined relations between attachment security and problematic substance use in 356 African American women recruited for a suicide prevention/intervention study. Problematic substance use was defined as a positive screen on either the Brief Michigan Alcoholism Screening Test or the Drug Abuse Screening Test-10. Attachment security was assessed using the Secure Subscale of the Relationship Scales Questionnaire. Associations between demographic and psychosocial variables (age, education, unemployment, homelessness, attachment security, past childhood maltreatment, current exposure to intimate partner violence, and depressive symptoms) and problematic substance use were determined using logistic regression analyses.

RESULTS

Participants averaged 35.1 ± 10.0 years of age, and exhibited significant psychosocial challenges. More secure attachment was independently associated with a lower likelihood of problematic drug use (OR = .516, 95% CI (.343-.777), p ≤ .01); and the problematic use of either alcohol or drugs (OR = .563, 95% CI (.374-.849), p ≤ .01). Attachment security, along with childhood maltreatment, age, and homelessness, accounted for 25.5% of the variance in problematic substance use.

DISCUSSION AND CONCLUSIONS

Participants who reported greater attachment security were significantly less likely to engage in problematic substance use.

SCIENTIFIC SIGNIFICANCE

Future research should explore attachment security as a resilience factor against problematic substance use.

Latent factor modeling of four schizotypy dimensions with theory of mind and empathy

Preliminary evidence suggests that theory of mind and empathy relate differentially to factors of schizotypy. The current study assessed 686 undergraduate students and used structural equation modeling to examine links between a four-factor model of schizotypy with performance on measures of theory of mind (Reading the Mind in the Eyes Test [MIE]) and empathy (Interpersonal Reactivity Index [IRI]). Schizotypy was assessed using three self-report measures which were simultaneously entered into the model. Results revealed that the Negative factor of schizotypy showed a negative relationship with the Empathy factor, which was primarily driven by the Empathic Concern subscale of the IRI and the No Close Friends and Constricted Affect subscales of the Schizotypal Personality Questionnaire. These findings are consistent with a growing body of literature suggesting a relatively specific relationship between negative schizotypy and empathy, and are consistent with several previous studies that found no relationship between MIE performance and schizotypy.

The Relative Importance of Family History, Gender, Mode of Onset, and Age at Onsetin Predicting Clinical Features of First-Episode Psychotic Disorders

OBJECTIVE

Family history of psychosis, gender, mode of onset, and age at onset are considered prognostic factors important to clinicians evaluating first-episode psychosis; yet, clinicians have little guidance as to how these four factors differentially predict early-course substance abuse, symptomatology, and functioning. We conducted a "head-to-head comparison" of these four factors regarding their associations with key clinical features at initial hospitalization. We also assessed potential interactions between gender and family history with regard to age at onset of psychosis and symptom severity.

METHODS

Consecutively admitted first-episode patients (n=334) were evaluated in two studies that rigorously assessed a number of early-course variables. Associations among variables of interest were examined using Pearson correlations, χ² tests, Student's t-tests, and 2×2 factorial analyses of variance.

RESULTS

Substance (nicotine, alcohol, and cannabis) abuse and positive symptom severity were predicted only by male gender. Negative symptom severity and global functioning impairments were predicted by earlier age at onset of psychosis. General psychopathology symptom severity was predicted by both mode of onset and age at onset. Interaction effects were not observed with regard to gender and family history in predicting age at onset or symptom severity.

CONCLUSIONS

The four prognostic features have differential associations with substance abuse, domains of symptom severity, and global functioning. Gender and age at onset of psychosis appear to be more predictive of clinical features at the time of initial evaluation (and thus presumably longer term outcomes) than the presence of a family history of psychosis and a more gradual mode of onset.

Clinical Correlates of Initial Treatment Disengagement in First-Episode Psychosis

AIM

Early engagement in care is thought to reduce disabling social losses related to the duration of untreated psychosis (DUP), such as school dropout, homelessness, and incarceration, which contribute to chronic disability. Early-intervention services that promote recovery will not be effective if eligible persons drop out of treatment after an initial hospitalization for a psychotic disorder. We had the unique opportunity to examine the treatment disengagement rate of patients with early psychosis after an initial hospitalization.

METHODS

In a predominantly male, African-American, and socioeconomically disadvantaged group of 33 participants with first-episode psychosis assessed at initial hospitalization and six months after discharge, we compared clinical characteristics (medication adherence attitudes and behaviors, knowledge about schizophrenia, insight, symptom severity, and persistence of alcohol and drug use) among those who disengaged and people who engaged in care.

RESULTS

More than half (18, 54.5%) attended <3 outpatient appointments in the six months after hospital discharge and, of those, nearly all (15, 83.3%) attended no outpatient appointments. Disengaged people were much less adherent to medications in the past month and six months, and scored lower on medication adherence attitudes, knowledge about psychosis, and insight. They had greater positive symptom severity and a higher likelihood of continuing drug use. Clinical Relevancy: Initial treatment disengagement is very common among young people with first-episode psychosis and is associated with poorer clinical status. More research is needed on the causes of disengagement during this critical period and ways to improve initial treatment engagement among people with first-episode psychosis.

Cross-cultural invariance of the factor structure of the Schizotypal Personality Questionnaire across Spanish and American college students

The main goal of this study was to examine the cross-cultural invariance of the factor structure of the Schizotypal Personality Questionnaire (SPQ) (Raine, 1991) in two large samples of Spanish and American young adults. The final sample was made up of 2313 college students (508 men, 22%). Their mean age was 20.5 years (S.D.=3.2). The results indicated that the Stefanis et al. (2004) four-factor model yielded the best goodness-of-fit indices compared to alternative models. Moreover, the results support configural, metric, and partial measurement invariance of the covariances of the SPQ across the two samples. The finding of measurement equivalence across cultures provides essential evidence of construct validity for the schizotypy dimensions and of the cross-cultural validity of SPQ scores. The finding of comparable dimensional structures in cross-cultural samples lends further support to the continuum model of schizotypy and schizophrenia spectrum disorders. Future studies should continue to examine the validity of scores on the SPQ and other schizotypy measures and their variation or consistency across cultures.

Developing visually based, low-literacy health education tools for African Americans with psychotic disorders and their families

Schizophrenia presents particular challenges to health literacy, partly due to associated neurocognitive deficits. In order to develop engaging, recovery-oriented, visually based psychoeducational tools pertaining to psychotic disorders, thirty-nine individuals, consisting of mental health service users with serious mental illnesses, family members, and mental health professionals, participated in informal discussions. Using suggestions from these groups, the first two psychoeducational booklets of a planned series were developed in collaboration with a graphic designer and visual artist. Content of the booklets was developed addressing four components: knowledge, self-efficacy/self-management, incorporating a workbook format, and planning/contracting. In a follow-up discussion group, mental health service users provided positive feedback on the completed booklets. The finished booklets are practical, accessible, engaging, and low-literacy. These and other innovative approaches are needed to enhance mental health care, promote self-efficacy/empowerment, and encourage communication between service users, family members, and providers, especially in light of limited health literacy, illness-related neurocognitive impairments, and stigma.

The influence of neighborhood characteristics on police officers' encounters with persons suspected to have a serious mental illness

OBJECTIVE

Police officers' decisions and behaviors are impacted by the neighborhood context in which police encounters occur. For example, officers may use greater force and be more likely to make arrests in disadvantaged neighborhoods. We examined whether neighborhood characteristics influence police encounters with individuals suspected to have a serious mental illness, addictive disorder, or developmental disability.

METHOD

We obtained data on 916 encounters from 166 officers in six jurisdictions in Georgia, USA and abstracted geographical data pertaining to the location of these encounters from United States Decennial Census data. Encounters were nested within 163 census tracts. Officer-reported data covered general encounter characteristics, the officer's perception of the subject's condition, subject demographics, use of force, and disposition of the encounter (e.g., arrest v. referral or transport to treatment services). Geographical data included 17 variables representing population and housing characteristics of the census tracts, from which three indices pertaining to neighborhood income, stability, and immigration status were derived using factor-analytic techniques. We then examined associations of these indices with various encounter-related variables using multi-level analysis.

RESULTS

Encounters taking place in higher-income and higher-stability census tracts were more likely to be dispatch-initiated and take place in a private home compared to those in lower-income and lower-stability neighborhoods. In higher-income neighborhoods, encounters were more likely to involve a subject suspected to have a mental illness (as opposed to an addictive disorder or developmental disability) and less likely to involve a subject suspected to have alcohol problems. The officer's level of force used was not associated with neighborhood factors. Regarding disposition, although the likelihood of arrest was unrelated to neighborhood characteristics, encounters taking place in higher-immigrant neighborhoods were more likely to result in referral or transport to services than those in lower-immigrant neighborhoods.

CONCLUSION

Neighborhood characteristics are important to consider in research on police interactions with individuals with serious mental illnesses, addictive disorders, or developmental disabilities. Such research could inform departmental training policies and procedures based on the needs of the jurisdictions served.

Criminal justice settings as possible sites for early detection of psychotic disorders and reducing treatment delay

OBJECTIVE

Interventions to reduce the duration of untreated psychosis should target institutions and key figures that may interact with individuals who have emerging or untreated psychosis. These individuals may come into contact with criminal justice settings, such as jails and prisons. This study sought to determine the frequency of arrests and incarcerations during the duration of untreated psychosis.

METHODS

Retrospective data were collected from an urban, largely African-American group of 191 patients hospitalized for first-episode psychosis.

RESULTS

Thirty-seven percent of participants were incarcerated at some point during their duration of untreated psychosis. Patients who had been incarcerated during this period had a much longer treatment delay, more severe positive symptoms (specifically, hallucinations), and poorer premorbid academic adjustment. For this group, the mean number of incarcerations during the duration of untreated psychosis was 2.0±1.5, the median number of days detained was 30.5, and most were detained for nonviolent, often petty, crimes.

CONCLUSIONS

Interventions to identify young people with untreated psychosis in jails and prisons and to refer these individuals to appropriate psychiatric care may reach some who would otherwise experience very long delays in treatment initiation. Crisis intervention team training of police officers could serve as one of several approaches for identifying these young people and diverting them into treatment.

Measuring insight through patient self-report: an in-depth analysis of the factor structure of the Birchwood Insight Scale

Little research has focused on item analysis and factor structure of the most commonly used measures of insight. We examined the factorial structure of the Birchwood Insight Scale (BIS), a brief, easy-to-administer, self-report measure. We studied the BIS in 327 first-episode psychosis patients, including a test sample (n=163) and a validation sample (n=164). We then used data from 100 patients with chronic serious mental illnesses as a second, external validation sample. Exploratory factor analysis was conducted with the test subsample, and confirmatory factor analyses with the two validation samples. Confirmatory factor analyses (in both the first-episode psychosis validation sample and the chronic serious mental illness sample) indicated that a single-factor solution, with seven items loading on a single factor-with item 1 ("Some of your symptoms are made by your mind") eliminated-was the best-fitting model. Seven of the eight original BIS items loading on a single factor fit the data well in these samples. Researchers using this efficient measure of patient-reported insight should assess the item distributions and factor structure of the BIS in their samples, and potentially consider eliminating item 1.

Development, implementation, and preliminary evaluation of a recovery-based curriculum for community navigation specialists working with individuals with serious mental illnesses and repeated hospitalizations

A recovery-oriented curriculum for training the Community Navigation Specialists (CNSs) of the new Opening Doors to Recovery in Southeast Georgia program was developed, implemented, and preliminarily evaluated. This new mental health program provides mobile, community-based support services to individuals with serious mental illnesses and a history of psychiatric inpatient recidivism (and commonly past incarcerations and homelessness). Teams of CNSs include a licensed social worker, a family member of an individual with a serious mental illness, and a peer specialist with lived experience. In two courses held in February and June of 2011, 14 newly hired CNSs participated in the new training. A pre-training/post-training evaluation demonstrated statistically significant improvements in pertinent knowledge and self-efficacy for working in a community navigation role. As the recovery paradigm continues to be implemented in diverse real-world mental health treatment settings, recovery-based training curricula should be carefully constructed and evaluated.

The police-based crisis intervention team (CIT) model: I. Effects on officers' knowledge, attitudes, and skills

OBJECTIVE

Individuals with serious mental illnesses are very likely to interact with police officers. The crisis intervention team (CIT) model is being widely implemented by police departments across the United States to improve officers' responses. However, little research exists on officer-level outcomes. The authors compared officers with or without CIT training on six key constructs related to the CIT model: knowledge about mental illnesses, attitudes about serious mental illnesses and treatments, self-efficacy for deescalating crisis situations and making referrals to mental health services, stigmatizing attitudes, deescalation skills, and referral decisions.

METHODS

The sample included 586 officers, 251 of whom had received the 40-hour CIT training (median of 22 months before the study), from six police departments in Georgia. In-depth, in-person assessments of officers' knowledge, attitudes, and skills were administered. Many measures were linked to two vignettes, in written and video formats, depicting typical police encounters with individuals with psychosis or with suicidality.

RESULTS

CIT-trained officers had consistently better scores on knowledge, diverse attitudes about mental illnesses and their treatments, self-efficacy for interacting with someone with psychosis or suicidality, social distance stigma, deescalation skills, and referral decisions. Effect sizes for some measures, including deescalation skills and referral decisions pertaining to psychosis, were substantial (d=.71 and .57, respectively, p<.001).

CONCLUSIONS

CIT training of police officers resulted in sizable and persisting improvements in diverse aspects of knowledge, attitudes, and skills. Research should now address potential outcomes at the system level and for individuals with whom officers interact.

The police-based crisis intervention team (CIT) model: II. Effects on level of force and resolution, referral, and arrest

OBJECTIVE

The crisis intervention team (CIT) model is a widely implemented police-based program to improve officers' responses to individuals with behavioral disorders. The authors examined levels of force used by officers with or without CIT training and disposition decisions in a large sample of encounters with individuals whom they suspected of having a serious mental illness, a drug or an alcohol problem, or a developmental disability.

METHODS

A total of 180 officers (91 with CIT training and 89 without) in six departments reported on 1,063 encounters, including level of force and disposition (resolution at the scene, referral or transport to services, or arrest).

RESULTS

CIT training status was generally not predictive of level of force, although CIT-trained officers were significantly more likely to report verbal engagement or negotiation as the highest level of force used (odds ratio [OR]=2.00, p=.016). For CIT-trained officers, referral or transport was a more likely outcome (OR=1.70, p=.026) and arrest was less likely (OR=.47, p=.007) than for officers without CIT training; these findings were most pronounced when physical force was necessary. Analyses of disposition differences by officers' perceptions of subjects' primary problem (for example, mental illness only versus a drug or an alcohol problem) found some effects of CIT training status.

CONCLUSIONS

CIT training appears to increase the likelihood of referral or transport to mental health services and decrease the likelihood of arrest during encounters with individuals thought to have a behavioral disorder. Research should address subject- and system-level outcomes that complement this early evidence of successful prebooking jail diversion.

Community navigation to reduce institutional recidivism and promote recovery: initial evaluation of opening doors to recovery in Southeast Georgia

New approaches for preventing repeated inpatient psychiatric stays, detention in jails and prisons, and homelessness among individuals with serious mental illnesses with established histories of such recidivism, while promoting recovery, are direly needed. We present findings from an initial program evaluation of a new community-based, recovery-oriented "community navigation" program in southeast Georgia, called Opening Doors to Recovery. Twenty-three in-depth interviews were conducted with key stakeholders, program participants, community navigation specialist team members, and referring mental health professionals to identify hopes and strengths, challenges and weaknesses, and recommendations pertaining to the new program. Cited strengths included teamwork and pooling of resources from various partners, as well as the novel recovery-based, community navigation team approach. An initial lack of fidelity processes across teams and an ongoing scarcity of safe and affordable housing were identified as weaknesses, with the latter seen as a liability of the overall mental health and social service systems rather than the program itself. Findings from this evaluation highlight strengths and opportunities of this new community navigation approach, including those related to the involvement of certified peer specialists and multiple community partners.

Subtyping first-episode non-affective psychosis using four early-course features: potentially useful prognostic information at initial presentation

AIM

Heterogeneity of symptoms, course and outcomes in primary psychotic disorders complicates prognosis, treatment and diverse aspects of research. This study aimed to identify interpretable subtypes of first-episode non-affective psychosis based on four early-course features (premorbid academic functioning, premorbid social functioning, duration of the prodrome and age at onset of psychosis).

METHODS

Data from 200 well-characterized patients hospitalized in public-sector inpatient units for first-episode non-affective psychosis were used in latent profile analyses. Derived subtypes were then compared along a number of clinical dimensions using analyses of variance.

RESULTS

Using four early-course features, three classes were derived. A good premorbid/short prodrome subtype was characterized by a lower severity of positive symptoms, better social/occupational/global functioning, and a shorter duration of untreated psychosis; a poor premorbid/early onset subtype demonstrated greater negative and preoccupation symptoms, as well as greater psychosocial problems; and a long prodrome/late onset subtype was characterized by greater dysphoric symptoms.

CONCLUSIONS

Findings indicate a need for further research with first-episode samples on the utility of subtyping based on early-course (premorbid, prodromal and onset-related) characteristics. Such efforts could enhance the parsing of heterogeneity, thereby advancing clinical practice and research.