Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment

Angelo Cocchi 1, *, Giorgio Cerati 2, Antonio Lora 3, Anna Meneghelli 1, Emiliano Monzani 1, Mauro Percudani 4, Lorenzo Petrovich 5, Fiorino Mirabella 6, Angelo Picardi 6, Antonio Preti 1
1 Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Milan, Italy
2 Dipartimento di Salute Mentale, Azienda Ospedaliera Ospedale Civile di Legnano, Italy
3 Dipartimento Salute Mentale, Azienda Ospedaliera della Provincia di Lecco, Italy
4 Dipartimento di Salute Mentale - A.O. "G. Salvini", Garbagnate Milanese, Italy
5 Comitato Tecnico per le Innovazioni in Salute Mentale. Direzione Generale Sanità - Regione Lombardia, Milan, Italy
6 Reparto Salute Mentale, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
7 Dipartimento di Psicologia, Università di Cagliari, Italy

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© Cocchi et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the A.O. Ospedale Niguarda Ca’ Granda, Programma 2000 - Via Livigno, 3, 20128 Milan, Italy; Tel: +39 02 64445554 - +39 02 66809801; Fax: +39 02 66809809; E-mails: and


Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.

Keywords: First episode psychosis, schizophrenia, early intervention, duration of untreated psychosis. .