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Cognitive functioning in early psychosis has also been extensively investigated. However, cognitive capacity is not the only determinant of educational success. 48,54 Though cognitive performance accounts for 23%42% of the genetic contribution to educational attainment,55 genetic factors associated with traits other than intelligence, such as openness to experience55 and self efficacy,56 also influence educational attainment. Importantly, educational attainmentmore than performance on cognitive tests within a controlled settingis the real world outcome of greater interest for patients and their families. In this study, we investigated the rates of successful return to college among patients in the McLean OnTrack outpatient FEP program located at McLean Hospital in Belmont, MA, and henceforth abbreviated as OnTrack and the factors that predict successful college return. Functional trajectories have historically been used to differentiate affective psychotic disorders, such as bipolar disorder BP, from schizophrenia and other primary psychotic disorders. 57 However, a growing body of evidence suggests that the clinical course of affective psychotic disorders is often cumulative and potentially deteriorating. 5860 As such, OnTrack takes a transdiagnostic approach to treating FEP. Yet, it remains unclear how patients with first episode affective psychotic disorders FEAP compare to patients with first episode primary psychotic disorders FEPP with respect to college related outcomes. Cognitive deficits have been found in both FEPP and FEAP, but they typically emerge earlier, prior to illness onset, and are more severe in schizophrenia than BP. 6163 Given these differences in cognitive profiles, poorer college participation and performance might be expected in FEPP relative to FEAP. However, educational attainment in BP appears to be more complex, with studies discrepant on whether individuals with BP are at higher33,38 or lower risk36 of terminating education prior to college graduation relative to their healthy peers. More generally, the current literature on outcomes in FEP shows highly heterogenous patterns of recovery,64,65 and it is difficult to accurately predict which FEP patients are likely to do well with college reintegration. Therefore, we examined whether having a FEPP vs a FEAP diagnosis, along with other predictors, differentially impact the time to college return after FEP. 5 years. OnTrack treats young adults ages 1830 years who have experienced a FEP, estimated by symptom onset, within the prior 12 months. 66 OnTrack employs a multidisciplinary team based model, integrating psychotherapy, recreational and process groups, peer support, family therapy/support, psychopharmacologic treatment, and case management. While OnTrack provides support toward the attainment of educational and other functional goals, the clinical team did not include licensed vocational counselors or supported education programs during the study period. As investigating the effect of specialized FEP care in OnTrack was not this studys aim, we did not include a comparison group of FEP patients in standard, community care. We extracted data from patients who entered OnTrack between May 3, 2012 intake date of first patient and October 1, 2017, following them through April 1, 2018 6 mo after the cutoff date for study inclusion. We set the date of the intake evaluation date as the survival start time and extracted data about baseline characteristics from that visit. Using subsequent psychotherapy and psychopharmacology progress notes, we also extracted data for every 6 month period following intake ie, 6, 12, 18, mo, etc. ; see supplementary material for data dictionary. We selected 6 month periods because most patients receiving treatment in OnTrack will have been seen at least once in a 6 month period, and we felt that 6 month intervals would capture the event of interest return to college for all students whether specific colleges adhered to a quarter or semester academic calendar. 2 mean 22. 4, SD 17. Outpatient notes at McLean Hospital were written and maintained in paper charts until the hospital transitioned to the Meditech electronic health records system in October 2014 and then to EPIC in July 2017. We used all available sources of medical information, not just electronic health records. To ensure consistency and reliability, all record reviews were completed by P. B. C. Cox, et al. , "Teacher Rated Family Involvement andChildren's Social and Academic Outcomes in Kindergarten," EarlyEducation and Development, Vol. 14, No. 2, 2003, pp. 179 200.