Prognostically unfavorable clinical and psychopathological factors in first-episode psychosis

Introduction. The clinical heterogeneity of schizophrenic spectrum disorders demonstrates a direct relationship between prognostically unfavorable clinical and psychopathological factors and low treatment efficacy. Emerging evidence suggests that these factors may exert greater detrimental effects than the psychopathological structure of the disorder itself. Aims. This prospective study aimed to analyze the association between the severity, psychotic structure, and course of first-episode psychosis (FEP) and adverse clinical and psychopathological predictors, informing the development of the IMPULSE psychosocial rehabilitation program. Materials and methods. The study enrolled 79 male FEP patients from the First-Episode Psychosis Unit (Regional Clinical Specialized Neuropsychiatric Hospital, Chelyabinsk, Russia). Results. Statistical analysis demonstrated significant correlations between clinical and psychopathological factors and FEP course. The most unfavorable predictors included the absence of established family, negative familial attitude toward illness and unemployment at admission. Patients with social decline showed higher rates of autistic features and repeated hospitalizations. Patients with antisocial behaviors were characterized by repeated hospitalizations, involuntary hospitalizations, aggressive/self-harm behaviors, psychopathic traits, and suicidal tendencies. Unstable remission and repeated seizures were associated with repeated hospitalizations, psychopathic behavior and severe imperative/hostile pseudohallucinations. These findings enable early identification and inform targeted interventions to modify disease trajectory, optimizing treatment strategies and psychosocial rehabilitation approaches. Conclusion. The identification of adverse clinical and psychopathological factors enables accurate determination of illness trajectory and progression patterns in FEP within schizophrenic spectrum disorders. Early intervention targeting these modifiable prognostic factors may prevent unfavorable disease outcomes, thereby optimizing clinical management strategies and enhancing the effectiveness of rehabilitation programs.