Comorbidity in psychosis at first hospitalization

Am J Psychiatry. 1993 May;150(5):752-7. doi: 10.1176/ajp.150.5.752.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Cohort Studies
  • Comorbidity
  • Delusions / diagnosis
  • Delusions / epidemiology
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Female
  • Follow-Up Studies
  • Hospitalization*
  • Humans
  • Male
  • Prevalence
  • Prognosis
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / epidemiology*
  • Schizophrenia / diagnosis
  • Schizophrenia / epidemiology
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology