Exploring the longitudinal course of psychotic illness: a case-study approach.
OBJECTIVE
Thirty-three patients with a diagnosis of a psychotic disorder (schizophrenia, bipolar disorder, atypical psychosis) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) were studied to qualitatively assess the longitudinal course of the disorder using a case-study approach.


METHODS
Weekly fluctuations in patient symptomatology and overall social and personal functioning using the Global Assessment Scale were assessed following index hospitalization. Patients were followed for 1 year.


RESULTS
The emergent courses showed no relationship to diagnosis but followed 3 general trends: 1) positive incline; 2) fluctuating; and 3) stable. Individual representations of each course were examined closely, and biological and psychosocial factors associated with each were evaluated.


CONCLUSIONS
The results supported the longitudinal patterns and individual interactions of Strauss's Interactive Developmental Model. The clinical course of psychotic disorders may be represented by 3 patterns. Key factors in the interaction between patient and environment that generate important changes in the evolution of each illness were illustrated.
Cortese
L
L
Department of Psychiatry, University of Western Ontario, London Health Sciences Centre. Leonardo.Cortese@lhsc.on.ca
Malla
A K
AK
McLean
T
T
Diaz
J F
JF
D000328:Adult; D003156:Community Mental Health Services; D018450:Disease Progression; D004777:Environment; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation