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Schizophrenia with Good and Poor Outcome. I: Early Clinical Features, Response to Neuroleptics and Signs of Organic Dysfunction

Published online by Cambridge University Press:  29 January 2018

T. Kolakowska ,
A. O. Williams ,
M. Ardern ,
M. A. Reveley ,
K. Jambor ,
M. G. Gelder  and
B. M. Mandelbrote
T. Kolakowska*
Affiliation:
Department of Psychiatry, University of Oxford, Littlemore Hospital, Oxford OX4 4XN
A. O. Williams
Affiliation:
Department of Psychiatry, University of Oxford, Littlemore Hospital, Oxford OX4 4XN. Present post: Lecturer, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
M. Ardern
Affiliation:
Department of Psychiatry, University of Oxford, Littlemore Hospital, Oxford OX4 4XN. Present post: Consultant in Psychiatry for the Elderly, Collville Health Centre, London W11
M. A. Reveley
Affiliation:
Maudsley Hospital, Denmark Hill, London SE5
K. Jambor
Affiliation:
Littlemore Hospital, Oxford OX4 4XN
M. G. Gelder
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX
B. M. Mandelbrote
Affiliation:
Littlemore Hospital, Oxford OX4 4XN
*
∗Correspondence
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Summary

Seventy-seven patients with diagnosis of schizophrenia (62) or schizoaffective disorder (15) were studied 2–20 years since onset of illness, when in a stable condition. The investigation included clinical assessment, measurement of plasma concentrations of neuroleptics and prolactin, computed tomography brain scan, neuropsychological and neurological examination. Outcome of illness was classified according to the presence of chronic psychiatric symptoms and social impairment, and response to neuroleptics according to the effect of treatment in the most recent psychotic episode. Neither outcome nor response to neuroleptics was related to duration of illness. The groups with good and poor outcome differed in premorbid adjustment, age at onset and symptoms of the initial episode, but not in drug bio-availability or prolactin response. Large cerebral ventricles and cognitive impairment, but not neurological ‘soft’ signs, were associated with unfavourable outcome. The three measures of organicity were not inter-related. No clinical differences were found between chronic patients with and without signs of organic dysfunction. The findings suggest that schizophrenia with good and unfavourable outcome may be separate sub-types. However, the role of organic factors in the latter group remains unclear.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 146 , Issue 3 , March 1985 , pp. 229 - 239
Copyright
Copyright © 1985 The Royal College of Psychiatrists 

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References

Andreasen, N. C., Smith, M. R., Jacoby, C. G., Dennert, J. W. & Olsen, S. A. (1982) Ventricular enlargement in schizophrenia. Definition and prevalence. American Journal of Psychiatry, 139, 292–296.Google Scholar
Bland, G. & Orn, H. (1979) Schizophrenia: Diagnostic criteria and outcome. British Journal of Psychiatry, 134, 34–38.Google Scholar
Bleuler, M. (1972) Die schizophrenen Geistesstorungen im Lichte Pangjahriger Kranken- und Familiengeschichter. Translated 1978 as The Schizophrenic Disorders: Long-Term Patient and Family Studies by Clements, S. M. London & New Haven: Yale University Press.Google Scholar
Brockington, I. F., Kendell, R. E., Kellett, J. M., Curry, S. H. & Wainwright, S. (1978) Trials of lithium, chlorpromazine and amitriptyline in schizo-affective patients. British Journal of Psychiatry, 133, 162–168.Google Scholar
Carpenter, W. T., Bariko, J. J., Strauss, M. D. & Hawk, A. B. (1978) Signs and symptoms as predictors of outcome: A report from the international pilot study of schizophrenia. American Journal of Psychiatry, 135, 940–945.Google Scholar
Ciompi, L. C. (1980) The natural history of schizophrenia. British Journal of Psychiatry, 136, 413–420.Google Scholar
Golden, C. J., Moses, J. A., Zelazowski, R., Graber, B., Zatz, L. M., Horvath, T. B. & Berner, P. A. (1980) Cerebral ventricular size and neuropsychological impairment in young chronic schizophrenics: Measurements by the standardised Luria-Nebraska Neuropsychological Battery. Archives of General Psychiatry, 37, 619–623.Google Scholar
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. Rockville, Maryland: National Institute for Mental Health.Google Scholar
Hawk, A.B., Carpenter, W. T. & Strauss, J. S. (1975) Diagnostic criteria and five-year outcome in schizophrenia. Archives of General Psychiatry, 32, 343–347.CrossRefGoogle ScholarPubMed
Higgins, J. (1969) Process–Reactive schizophrenia. Journal of Nervous and Mental Disease, 149, 450–472.Google Scholar
Huber, G., Gross, G. & Schutter, R. (1975) A long-term follow-up study of schizophrenia: Clinical course and prognosis. Acta Psychiatrica Scandinavica, 52, 49–57.Google Scholar
Jackson, H. J. (1931) Selected Writings. London: Hodder & Stoughton.Google Scholar
Johnstone, E. C., Crow, T. J., Frith, C. D., Stevens, K. & Husband, J. (1976) Cerebral ventricular size and cognitive impairment in chronic schizophrenia. Lancet, i, 924–926.CrossRefGoogle Scholar
Johnstone, E. C., Crow, T. J., & Husband, J., Frith, C. D., Gold, A. & Stevens, K. (1979) The outcome of severe acute schizophrenic illness after one year. British Journal of Psychiatry, 134, 28–33.Google Scholar
Kendell, R. E., Brockington, I. F. & Leff, J. P. (1979) Prognostic implications of six alternative definitions of schizophrenia. Archives of General Psychiatry, 36, 25–31.CrossRefGoogle ScholarPubMed
Kolakowska, T. & Gelder, M. (1980) A model to separate drug-related and illness-related outcomes of neuroleptic treatment. In Phenothiazines and Structurally Related Drugs, ed. Usdin, E., Eckert, H. & Forrest, I. Amsterdam: Elsevier.Google Scholar
Kolakowska, T. & Gelder, M., Orr, M. W., Gelder, M. G., Heggie, M., Wiles, D. H. & Franklin, M. (1979) Clinical significance of plasma drug and prolactin levels during acute chlorpromazine treatment: A replication. British Journal of Psychiatry, 135, 352–359.Google Scholar
Kolakowska, T. & Gelder, M., Heggie, M., Wiles, D. H. & Franklin, M., Gelder, M. G. & Orr, M. W. (1980) Drug-related and illness-related factors in the outcome of chlorpromazine treatment: Testing a model. Psychological Medicine, 10, 335–343.Google Scholar
Kolakowska, T. & Gelder, M., Heggie, M., Wiles, D. H. & Franklin, M., Gelder, M. G. & Orr, M. W., Williams, A. O., Jambor, K. & Arden, M. (1985) Schizophrenia with good and poor outcome. III: Neurological ‘soft’ signs, cognitive impairment and their clinical significance. British Journal of Psychiatry, 146, in press.CrossRefGoogle ScholarPubMed
Langfeldt, G. (1937) The prognosis in schizophrenia and the factors influencing the course of the disease. Acta Psychiatrica Scandinavica, Suppl.13, 1–228.Google Scholar
Mackay, A. V. P. & Crow, T. J. (1980) Positive and negative schizophrenic symptoms and the role of dopamine. British Journal of Psychiatry, 137, 379–386.Google Scholar
Malec, J. (1978) Neuropsychological assessment of schizophrenia versus brain damage: A review. Journal of Nervous and Mental Disease, 166, 507–516.Google Scholar
National Institute of Mental Health (1964) Phenothiazine treatment in schizophrenia. Archives of General Psychiatry, 10, 246–261.Google Scholar
Nelson, H. E. & O'Connell, A. D. (1978) Dementia: The estimation of premorbid intelligence levels using the New Adult Reading Test. Cortex, 14, 234–244.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799–812.Google Scholar
Procci, W. R. (1976) Schizo-affective psychosis: Fact or fiction? Archives of General Psychiatry, 33, 1167–1178.Google Scholar
Ouitkin, F., Rifkin, A. & Klein, D. F. (1976) Neurologic soft signs in schizophrenia and character disorders. Archives of General Psychiatry, 33, 845–853.Google Scholar
Ries, R. K., Wilson, L., Bokan, J. A. & Chiles, J. A. (1981) ECT in medication-resistant schizoaffective disorder. Comprehensive Psychiatry, 22, 167–173.Google Scholar
Rochford, J. M., Detre, T., Tucker, G. J. & Harrow, M. (1970) Neuropsychological impairments in functional psychiatric diseases. Archives of General Psychiatry, 22, 114–119.Google Scholar
Simpson, G. H. & Angus, J. W. S. (1970) A rating scale for extrapyramidal side-effects. Acta Psychiatrica Scandinavica, Suppl. 212, 11–19.Google Scholar
Smith, R. C., Crayton, J. W., Tamminga, C., Dekrmenjian, H. & Schoolar, J. C. (1979) Blood levels of neuroleptic drugs, clinical response, and plasma prolactin in chronic non-responding schizophrenic patients. In The Kinetics of Psychiatric Drugs, ed. Schoolar, J. C. & Claghom, J. L. New York: Brunner/Mazel.Google Scholar
Spitzer, R. L., Endicott, J. J. & Robins, E. (1975) Research Diagnostic Criteria. New York: New York State Psychiatric Institute.Google Scholar
Stephens, J. H. (1978) Long-term prognosis and follow-up in schizophrenia. Schizophrenia Bulletin, 4, 25–47.CrossRefGoogle ScholarPubMed
Weinberger, D. R., Wagner, R. L. & Wyatt, R. J. (1983) Neuropathological studies of schizophrenia: A selective review. Schizophrenia Bulletin, 9, 193–212.Google Scholar
Wiles, D. H. & Franklin, M. (1978) Radioimmunoassay for fluphenazinc in human plasma. British Journal of Clinical Pharmacology, 5, 265–268.CrossRefGoogle ScholarPubMed
Williams, A. O., Reveley, M. A., Kolakowska, T., Ardern, M. & Mandelbrote, B. M. (1985) Schizophrenia with good and poor outcome. II Cerebral ventricular size and clinical significance. British Journal of Psychiatry, 146, 237–244.CrossRefGoogle ScholarPubMed
Wing, J. K. (1966) Five-year outcome in early schizophrenia. Proceedings of the Royal Society, 59, 17–23.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
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