Comorbidity in psychosis at first hospitalization

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 Structural 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 affective 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. (Am J Psychiatry 1993; 150:752-757)