Illness progression as a function of independent and accumulating poor prognosis factors in outpatients with XXXX in the United States.

@entity1 @entity162 @entity308 @entity28 @entity148 @entity221 @entity734
OBJECTIVE: Many @entity1 with @entity162 in the United States experience a deteriorating course of @entity221 despite naturalistic treatment in the community. We examined a variety of factors associated with this pattern of @entity221 progression. METHOD: From 1995 to 2002, we studied 634 adult outpatients with @entity162 (mean age of 40 years) emanating from 4 sites in the United States. @entity1 gave informed consent and completed a detailed questionnaire about demographic, vulnerability, and course-of- @entity221 factors and indicated whether their @entity221 had shown a pattern of increasing frequency or severity of @entity162 or @entity308 episodes. Fifteen factors previously linked in the literature to a poor outcome were examined for their relationship to @entity221 progression using Kruskal-Wallis test, followed by a 2-sample Wilcoxon rank sum (Mann-Whitney) test,   (2), and logistical regression. RESULTS: All of the putative poor prognosis factors occurred with a high incidence, and, with the exception of @entity28 , were significantly (P < .05) associated with @entity221 progression. These factors included indicators of genetic and psychosocial risk and loss of social support, early onset, long delay to first treatment, @entity148 and @entity734 comorbidity, rapid cycling in any year, and the occurrence of more than 20 prior episodes prior to entering the network. A greater number of factors were linearly associated with the likelihood of a progressively worsening course. CONCLUSIONS: Multiple genetic, psychosocial, and @entity221 factors were associated with a deteriorating course of @entity162 from onset to study entry in adulthood. The identification of these factors provides important targets for earlier and more effective therapeutic intervention in the hope of achieving a more benign course of @entity162 .
