OBJECTIVE: The authors sought to determine the prevalence and effects of
medical and psychiatric comorbidity on initial outcome in a group of
patients experiencing a first episode of psychosis. METHOD: Patients with a
first episode of psychosis who were consecutively admitted to a hospital (N
= 102) were examined for the presence of psychiatric and medical disorders.
Patients were given psychiatric diagnoses with the use of the Structured
Clinical Interview for DSM-III-R and were rated weekly on symptom rating
scales. Outcome variables at discharge were final symptom rating scale
scores, length of hospitalization, and recovery on the basis of
operationalized criteria. RESULTS: Comorbid diagnoses were present in 52.0%
(N = 53) of the patients, and 37.7% (N = 20) had multiple comorbid
diagnoses. The most common comorbid diagnosis was substance abuse. Patients
with affected psychoses were significantly more likely than those with
nonaffective psychoses to have a comorbid substance abuse diagnosis.
Patients with psychiatric comorbidity had poorer initial outcomes, while
those with medical comorbidity had fewer symptoms at discharge.
CONCLUSIONS: Comorbidity is common and may be a useful predictor of the
outcome of a first episode of psychosis.