Outcome in untreated schizophrenia: a search for symptoms and traits with prognostic meaning in patients admitted to a mental hospital in the preneuroleptic era.
A cohort of schizophrenic patients consecutively admitted to a mental hospital for the first time in 1925 was investigated in search of symptoms and traits with prognostic meaning. Since Leonhard's diagnostic system was applied, cases with mixed symptoms and a favourable outcome were excluded as being neither schizophrenic nor manic-depressive. Owing to the admission policy then prevailing, cases with clinically less striking and socially less deleterious features were underrepresented. The sample (n = 70), so demarcated, was still considered fairly appropriate for the purpose of a differential study of outcome in nuclear schizophrenia with a life-long follow-up. The best outcome group consisted of 33% of the sample; 24% formed an intermediate group, and 43% profoundly deteriorated with continuous psychotic symptoms and a total loss of social function. Marriage before index admission was the only characteristic related to a favourable outcome. Nuclear schizophrenic symptoms, thought disturbance, blunted affect and all catatonic symptoms listed in DSM-III were related to an unfavourable outcome. When prognostic subgroups were compared pairwise, no favourable trait was detectable, and there were no decisive differences between the group with the best outcome and the intermediate group. When these 2 groups were compared with the group with worst outcome, however, significant differences arose with respect to unfavourable characteristics. Predictions using a discriminant analytic procedure yielded the same results. The hypothesis that affective and atypical signs would also have prognostic meaning in nuclear schizophrenia was disproved.
Jönsson
S A
SA
Department of Psychiatry and Neurochemistry, University of Lund, Sweden.
Jonsson
H
H
D000368:Aged; D014150:Antipsychotic Agents / Q000266:history*; D015331:Cohort Studies; D049673:History, 20th Century; D006760:Hospitalization; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011569:Psychiatric Status Rating Scales / Q000266:history; D012559:Schizophrenia / Q000266:history*; D012565:Schizophrenic Psychology; D013548:Sweden
D014150:Antipsychotic Agents