Clinical outcomes in first-episode psychoses: does age at admission matter?

Introduction: The aim of this retrospective study was to identify differences in terms of clinical presentation and outcomes of First Episode Psychosis (FEP) patients admitted to the "Parma Early Psychosis program" (Pr-EP), which accepts FEP up to age 54, considering age at admission. Methods: Individuals aged 18-54 years, with an affective or non-affective FEP diagnosis, were compared for sociodemographic and clinical characteristics both at baseline and after 1 and 2 years based on sex (M vs F) and age (≤35 vs 36+) at admission. Regression analysis and time by age model was used to identify predictors of clinical recovery and overall clinical severity measured by the Health of the Nation Outcome Scale - Mental Health Clustering Tool (HoNOS-MHCT). Results: A total of 447 individuals were included, most were males (65.1%). At baseline, the 36+ group had higher illness severity (mean HoNOS total score 26 vs 22.4, p=0.002), particularly on social functioning. In the 2 year follow up, those 36+ presented more severe symptoms and more functional disabilities vs those ≤35s. At both follow-ups, 36+ attended CBT sessions less frequently than those ≤35, whilst attending more CBT sessions was a positive predictor of clinical recovery. At 2 years but not at 1 year follow up, being prescribed a higher antipsychotic dose was a negative predictor of clinical recovery (OR 0.89, CI 0.80-0.97, p=0.018), as being in the 36+ group (OR 0.44, CI 0.20-0.92, p=0.035). Conclusions: This study confirmed that FEP patients have different characteristics in terms of their pathways to care and clinical presentation based on their sex and age at admission to services, which might affect outcomes and requires targeted intervention.