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Determinants of the Extremes of Outcome in Schizophrenia

Published online by Cambridge University Press:  02 January 2018

E. C. Johnstone ,
C. D. Frith ,
F. H. Lang  and
D. G. C. Owens
E. C. Johnstone*
Affiliation:
Department of Psychiatry, Royal Edinburgh Hospital
C. D. Frith
Affiliation:
Cyclotron Unit, Hammersmith Hospital
F. H. Lang
Affiliation:
Department of Psychiatry, Royal Edinburgh Hospital
D. G. C. Owens
Affiliation:
Department of Psychiatry, Royal Edinburgh Hospital
*
Professor E. C. Johnstone, Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF
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Abstract

Background

Although poor prognosis has been considered a defining characteristic of schizophrenia, long-term studies show marked heterogeneity of outcome.

Method

Assessments of positive and negative symptoms, premorbid and current IQ, and months of in-patient care made in an outcome study of 342 schizophrenic patients were categorised by severity. Determinants of these categorisations were sought from the historical variables available, using analysis of variance. Vignettes of patients with the best and worst symptomatic outcomes were then compared.

Results

Negative symptoms were associated with early onset, male sex and poor academic record. Positive symptoms were associated with occupational decline. Cognitive decline was associated with occupational variables, and in-patient care with academic and occupational variables. The vignettes showed that good outcome was associated with family psychiatric history and poor outcome with unavailability of family history.

Conclusions

The findings support the view that the most malignant form of schizophrenia is neurodevelopmental, but poor outcome was clearly associated with family fragmentation.

Type
Papers
Information
The British Journal of Psychiatry , Volume 167 , Issue 5 , November 1995 , pp. 604 - 609
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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