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Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study

Published online by Cambridge University Press:  26 February 2014

C. Morgan ,
J. Lappin ,
M. Heslin ,
K. Donoghue ,
B. Lomas ,
U. Reininghaus ,
A. Onyejiaka ,
T. Croudace ,
P. B. Jones  and
R. M. Murray
...Show all authors
C. Morgan*
Affiliation:
Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
J. Lappin
Affiliation:
National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
M. Heslin
Affiliation:
Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
K. Donoghue
Affiliation:
Addictions Department, Institute of Psychiatry, King's College London, UK
B. Lomas
Affiliation:
Division of Psychiatry, University of Nottingham, UK
U. Reininghaus
Affiliation:
Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
A. Onyejiaka
Affiliation:
Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
T. Croudace
Affiliation:
Department of Health Sciences, University of York, UK
P. B. Jones
Affiliation:
Department of Psychiatry, University of Cambridge, UK
R. M. Murray
Affiliation:
National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
P. Fearon
Affiliation:
Department of Psychiatry, Trinity College, Dublin, Ireland
G. A. Doody
Affiliation:
Division of Psychiatry, University of Nottingham, UK
P. Dazzan
Affiliation:
National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: Dr C. Morgan, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, Box P063, De Crespigny Park, London SE5 8AF, UK. (Email: craig.morgan@kcl.ac.uk)
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Abstract

Background

Studies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare.

Method

AESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews.

Results

At follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1–4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London.

Conclusions

Sustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover.

Keywords

AESOP-10 studycourse and outcomepsychotic disordersrecoveryremission
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2713 - 2726
Copyright
Copyright © Cambridge University Press 2014 

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