First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull 2005; 31: 650–71

The burgeoning interest in investigating the first episode of schizophrenia and related disorders provides an opportunity to examine how this approach has assisted our understand-ing of the heterogeneity of psychopathology of this disorder and the trajectories of its outcome. We present a review of relevant literature on categorical versus dimen-sional perspectives on psychopathology, with special refer-ence to early signs, its relationship with other patient- and system-related characteristics, and the status and determi-nants of functional outcome and quality of life. The findings from longitudinal studies of the dimensional psychopathol-ogy of first-episode psychosis suggest continuity of some psychopathological dimensions from premorbid through prodromal to post-onset phases of psychosis and some aspects of longer-term course. Short-term functional out-come improves after treatment of the first episode, but longer-termoutcomeremains relatively poor fora substantial proportion of patients and is associated with preadolescent onset, poor premorbid adjustment, poor cognitive function-ing, cerebral asymmetry, and negative symptoms during prodromal and post-onset phases. Poor quality of life is re-lated to residual psychopathology, long delays in treatment, and poor premorbid adjustment. The potential effects of im-proved treatment and/or early intervention on functional outcome and quality of life have not been adequately exam-ined, nor have the interrelationships between predictors and the underlying processes involved in determining variations in outcome. Studies of functional outcome still lack the rigor of operational definitions, choice of specific instruments for measurement, and use of large enough samples to generate meaningful results. Key words: outcome/first episode/psychosis/functiona