The first episode psychosis outcome study (FEPOS): pre-morbid and baseline characteristics of 704 first episode psychosis patients treated in EPPIC between 1998 and 2000

Background: Study of psychotic disorders is hampered by many potential biases that can be avoided in first episode psychosis (FEP) studies. However, very few studies are based on epidemiological samples. Aims: Description of pre-morbid and baseline clinical and socio-demographic characteristics of a large epidemiological sample of FEP. Methods: Medical records review of patients treated at EPPIC between 1998 and 2000. Results: 704 files were assessed. Pre-morbid evaluation revealed high rates of substance use disorder (74%), history of psychiatric disorder (46%), traumatic events (68%), suicide attempts (14%) and family history of psychiatric illness (55%). Baseline characteristics revealed high intensity of illness, high prevalence of lack of insight and high rate of co-morbidity. Conclusion: Majority of subjects have gone either through traumatic events or episodes of mental illness before treatment for FEP. Such elements must be considered when designing treatment approach since a too narrow focus on positive psychotic symptoms will inevitably lead to incomplete treatment. Additionally, early intervention programs need sufficient range of resources to address the multiple challenges presented by FEP patients such as co-morbidities and high severity of illness. Finally, observation that patients in this cohort developed important level of functional impairment before FEP treatment despite a relatively short duration of untreated psychosis suggests that while early detection of FEP is a necessary step in early intervention, it may not be a sufficient strategy to limit functional impairment and that efforts aimed at identifying people during the prodromal phase of psychotic disorders should be pursued. In this context, the identification of valid biological markers is critical in order to improve the specificity of current early diagnosis strategies