Psychological Medicine

Original Articles

Predictors of 10-year outcome of first-episode psychosis

C. Whitea1, J. Stirlinga2 c1, R. Hopkinsa1, J. Morrisa1, L. Montaguea1, D. Tantama3 and S. Lewisa1

a1 Division of Psychiatry, University of Manchester, Manchester, UK

a2 Department of Psychology and Speech Pathology, Manchester Metropolitan University, Manchester, UK

a3 Centre for Mental Health, University of Sheffield, Sheffield, UK


Background Predictors of outcome for psychosis are poorly understood. Duration of untreated psychosis (DUP) appears to predict short-term outcome although its medium- to long-term role remains unclear. Neurodevelopmental indices such as pre-morbid function and/or neurological soft signs may predict longer-term outcome. We aimed to assess the impact of a range of clinical and demographic variables on long-term outcome of a geographically defined, epidemiological first-episode psychosis cohort.

Method A 10-year follow-up was undertaken of a consecutively presenting sample of 109 cases of first-episode psychosis aged 16–50 years. Baseline assessments included positive, negative and depression symptoms, DUP, neurological soft signs and pre-morbid functioning. Multi-dimensional outcomes were assessed blind to baseline data.

Results All participants were traced at a mean of 10.5 years post-index admission: 11 had died, 10 from non-natural causes. Of the surviving cases, 70% were comprehensively re-assessed by interview. Summary data on the remainder were collected from their family practitioner and chart review. Poor 10-year outcomes were predicted independently by poor pre-morbid functioning, baseline negative symptoms and longer DUP. The same measures, plus neurological soft signs, appeared to predict outcomes in a DSM-IV schizophrenia/schizo-affective subgroup.

Conclusions Poor pre-morbid functioning, baseline symptoms, DUP and neurological soft signs at onset independently predict poor long-term outcome in first-episode psychosis.

(Received January 22 2008)

(Revised November 12 2008)

(Accepted December 11 2008)

(Online publication February 03 2009)


c1 Address for correspondence: J. Stirling, D.Phil., Department of Psychology and Speech Pathology, Manchester Metropolitan University, Hathersage Road, Manchester M13 0JA, UK. (Email: