First episode psychosis: register-based study of comorbid psychiatric disorders and medications before and after

Abstract

Comorbid psychiatric disorders are common in first episode psychosis. We investigated comorbid disorders before, at, and after a first hospital-treated psychosis in a naturalistic nation-wide cohort (n = 2091) with a first psychosis hospitalization between 2007 and 2011, and at ages between 16 and 25. Swedish population registers were used to identify the cohort and to collect data on diagnoses at hospitalizations and medications. The proportions of cases with hospitalizations or medications increased year by year before and decreased in the years after the first psychosis hospitalization. In the 2 years before, 30% had hospitalizations with other psychiatric diagnoses and 60% had psychiatric medications. At the first psychosis hospitalization, 46% had other comorbid psychiatric diagnoses or self-harm. In the 2 years before or at the first psychosis hospitalization, 17% had anxiety or stress disorders at hospitalizations, 12% depressive disorders, 5.4% manic or bipolar disorders, 8.6% personality disorders, 26% substance use disorders, and 15% neurodevelopmental disorders. 8.2% had hospitalizations for self-harm. At most, around 30% of the cases were estimated not to have had any comorbid psychiatric disorders before or at the first psychosis presentation. Early comorbid affective, anxiety or personality disorders or self-harm were associated with a worse outcome, as measured by new psychiatric hospitalizations. The outcome was worst for personality disorders with 73% re-hospitalizations within 1 year and for patients with self-harm with 70% re-hospitalizations. In conclusion, most cases with a first psychosis hospitalization had clinical presentations indicating comorbid psychiatric disorders. Cases with comorbidity had a higher risk for re-hospitalizations.

Keywords: Affective disorder; Anxiety; Personality disorder; Schizophrenia; Self-harm.

Fig. 1

Proportion of cases with hospitalizations or medications from 5 years before the first psychosis hospitalization until 5 years after. The full cohort was used for the calculations from 2 years before until 2 years after. Only cases with full years of observation were included in the analyses of earlier or later years, see under methods. “FEP” indicate the first psychosis hospitalization

Fig. 2

Outcome in terms of new hospitalizations with any psychiatric diagnoses, with psychosis diagnoses or with other psychiatric diagnoses in the first year after the index hospitalization. Proportions of cases with new hospitalizations are presented for groups with different comorbid psychiatric disorders at hospitalizations in the 2 years preceding or co-occurring with the index hospitalization. The “No early comorbidity” group includes the 25% of the cases with no psychiatric hospitalizations or medications in the 2 years preceding, or comorbid psychiatric disorders at the index hospitalization. 95% confidence intervals for the proportions are indicated as error bars. Significance levels for the differences in proportions between groups with early comorbid disorders and the group with no early comorbidity are presented as * for a p value < 0.05, **for a p value < 0.01, and ***for p value of < 0.001