An 8-year follow-up of patients with DSM-III-R psychotic depression, schizoaffective disorder, and schizophrenia.
OBJECTIVE
The purpose of this study was to investigate the long-term outcome of patients with functional psychoses. The functional status of patients with mood-congruent and mood-incongruent psychotic depression, schizoaffective disorder, and schizophrenia was examined.


METHODS
Ninety-two inpatients with nonmanic and nonorganic functional psychoses who had been discharged from the hospital were identified through inpatient records. A blind rater used DSM-III-R criteria to assign research diagnoses to the patients on the basis of the data gathered at admission. Seventy-one patients were located 8 years later, and personal interviews were conducted with them.


RESULTS
Baseline diagnosis was a powerful predictor of long-term outcome, even after controlling for age at onset and duration of episode at admission. Patients with psychotic depression had much better outcomes than patients with schizoaffective disorder or schizophrenia. Fourteen (43.8%) of 32 patients with psychotic depression were free from psychosis at follow-up, in marked contrast to those who had schizoaffective disorder or schizophrenia, none of whom had recovered. Patients with schizoaffective disorder could not be distinguished from patients with schizophrenia.


CONCLUSIONS
The prognosis of patients with major depression with mood-incongruent features most closely resembles that of depressed patients with mood-congruent features, while patients with DSM-III-R schizoaffective disorder have a prognosis resembling that of schizophrenic patients. Patients with psychotic affective disorders have a much higher likelihood of recovering from psychosis than do schizophrenic patients.
Tsuang
D
D
Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City 52242-1057.
Coryell
W
W
D000367:Age Factors; D003866:Depressive Disorder / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008499:Medical Records; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis*; D012559:Schizophrenia / Q000175:diagnosis*