title: Prognostic value of initial subtype in schizophrenic disorders.
abstract: The prognostic value of the subtype diagnosis at the initial episode was investigated in 148 narrowly defined schizophrenic patients. Every initial episode was classified according to multiple criteria: DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first rank symptoms. Patients were followed up on average 23 years later (range 10-50 years). Different aspects of long-term outcome were evaluated (global functioning, social adjustment, negative social consequences). In 93% of the patients persisting alterations were found at the end of the observation time. The influence of the predominant clinical features at the initial episode on various aspects of long-term outcome was found to differ depending on which of the four diagnostic systems was used. The highest power for discrimination was found for the subtypes of DSM-III-R, while the presence of first rank symptoms had no prognostic value. It was found that patients with an initial paranoid or positive episode had a significantly better long-term outcome than patients initially having a disorganised/hebephrenic or catatonic episode. The frequency of negative social consequences was not influenced by the initial subtype, with the exception of permanent hospitalisation.
authors.affiliation: Psychiatric Department, University of Bonn, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Deister
authors.forename: A
authors.initials: A
authors.lastname: Marneros
mesh_terms: D000293:Adolescent; D000328:Adult; D001288:Attention; D003702:Delusions / Q000523:psychology / Q000534:rehabilitation; D003863:Depression / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006212:Hallucinations / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000145:classification* / Q000175:diagnosis / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D012917:Social Adjustment