Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-27T13:38:33.043Z Has data issue: false hasContentIssue false
  • English
  • Français

Predicting the long-term outcome of schizophrenia

Published online by Cambridge University Press:  09 July 2009

G. Harrison ,
T. Croudace ,
P. Mason ,
C. Glazebrook  and
I. Medley
G. Harrison*
Affiliation:
Department of Psychiatry, University of Nottingham
T. Croudace
Affiliation:
Department of Psychiatry, University of Nottingham
P. Mason
Affiliation:
Department of Psychiatry, University of Nottingham
C. Glazebrook
Affiliation:
Department of Psychiatry, University of Nottingham
I. Medley
Affiliation:
Department of Psychiatry, University of Nottingham
*
1Address for correspondence: Professor Glynn Harrison, Department of Psychiatry, University of Nottingham Professorial Unit, Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Predictors of long-term (13 year) outcome of schizophrenia are reported for a representative cohort of ‘treated incidence’ patients ascertained on their first contact with Nottingham psychiatric services between 1978–80. An initial (baseline) model including previously reported predictors of 2-year outcome (age, gender, ever married, acuteness of onset) and length of untreated illness was used to predict a range of outcome measures covering the domains of disability, psychopathology, hospitalization, employment, social activity, and global outcome. This model demonstrated significant prognostic ability across all non-hospitalization outcomes under both ICD-10 and ICD-9 diagnoses of schizophrenia, but was attenuated under broad (ICD-9 and CATEGO S, P or O) and restrictive (S+) diagnostic classifications. Female gender predicted more favourable outcome under all diagnostic classifications except S+. In an extended analysis, the addition of initial 2-year course type substantially increased the prognostic ability of the model under all diagnostic classifications and enabled over 30% of the variance in global ratings of disability and symptoms to be predicted. In this extended model female gender predicted more favourable outcome over and above the effect of course type, across most domains under ICD-10, and for disability and psychopathology under other diagnostic classifications. The inclusion of measures of psychopathology at the time of first assessment, pre-morbid functioning, and duration of index admission conferred only marginal additional predictive ability for respective outcomes in the domains of psychopathology, social activity, employment and hospitalization. Hospitalization during the past year was the most difficult outcome to predict under any model suggesting that resource utilization represents the ‘administrative outcome’ of schizophrenia and serves as a poor proxy for broader concerns in the era of community care. These data demonstrate that key demographic variables and the mode of onset influence the long-term course of schizophrenia, but that early course type is a particularly strong predictor.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 4 , July 1996 , pp. 697 - 705
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Angermeyer, M. C. & Kuhn, L. (1988). Gender differences in age at onset of schizophrenia. European Archives of Psychiatry and Neurological Sciences 237, 351–364.CrossRefGoogle ScholarPubMed
Angermeyer, M. C., Goldstein, J. M. & Kuhn, L. (1989). Gender differences in schizophrenia: rehospitalization and community survival. Psychological Medicine 19, 365–382.CrossRefGoogle ScholarPubMed
Angermeyer, M. C., Kuhn, L. & Goldstein, J. M. (1990). Gender and the course of schizophrenia differences in treated outcomes. Schizophrenia Bulletin 16, 293–307.Google ScholarPubMed
Angst, J. (1988). European long-term followup studies of schizophrenia. Schizophrenia Bulletin 14, 501–513.CrossRefGoogle ScholarPubMed
Atakan, Z., Cliff, G. & Cooper, J. E. (1990). Can psychiatrists predict the one-year outcome of schizophrenia? Social Psychiatry and Psychiatric Epidemiology 25, 117–124.CrossRefGoogle ScholarPubMed
Bardenstein, K. K. & McGlashan, T. H. (1990). Gender differences in affective, schizoaffective and schizophrenic disorders a review. Schizophrenia Research 3, 159–172.CrossRefGoogle ScholarPubMed
Bartko, J. J., Carpenter, W. T. & McGlashan, T. H. (1988). Statistical issues in long-term followup studies. Schizophrenia Bulletin 14, 575–587.CrossRefGoogle ScholarPubMed
Biehl, H., Maurer, K., Jablensky, A., Cooper, J. E. & Tomov, T. (1989). The WHO Psychological Impairments Rating Schedule (WHO/PIRS). British Journal of Psychiatry 155 (Supplement) 7, 68–70.CrossRefGoogle Scholar
Bland, R. & Orn, H. (1980). Schizophrenia: Schneider's first-rank symptoms and outcome. British Journal of Psychiatry 137, 63–68.CrossRefGoogle ScholarPubMed
Bleuler, M. (1974). The long-term course of the schizophrenic psychoses. Psychological Medicine 4, 244–254.CrossRefGoogle Scholar
Bleuler, M. (1978). The Schizophrenic Disorders: Long-term Patient and Family Studies. (Translated by Clemens, S..) Yale University Press: New Haven.Google Scholar
Castle, D. J., Abel, K., Takei, N. & Murray, R. M. (1995). Gender differences in schizophrenia: hormonal effect or subtypes. Schizophrenia Bulletin 21, 1–12.CrossRefGoogle ScholarPubMed
Ciompi, L. (1980). The natural history of schizophrenia in the long term. British Journal of Psychiatry 136, 413–420.CrossRefGoogle ScholarPubMed
Ciompi, L. & Muller, C. (1976). Lebensweg und alter schizophrenen. Eine latamestische lonzeitstudies bis ins senum. (The Life Course and Ageing in Schizophrenia: A Catamnestic Longitudinal Study into Advanced Age). Springer-Verlag: Berlin.Google Scholar
Cooper, J. E., Goodhead, D., Craig, T., Harris, M., Howat, J. & Korer, J. (1987). The incidence of schizophrenia in Nottingham. British Journal of Psychiatry 151, 619–626.CrossRefGoogle ScholarPubMed
Dalkin, T., Walder, C., Murphy, P., Medley, I. & Harrison, G. (1994). Pre-morbid personality in a representative sample of first onset psychotic patients. British Journal of Psychiatry 164, 202–207.CrossRefGoogle Scholar
Dauncey, K., Giggs, J., Baker, K. & Harrison, G. (1993). Schizophrenia in Nottingham – lifelong residential mobility of a cohort. British Journal of Psychiatry 163, 613–619.CrossRefGoogle ScholarPubMed
Davidge, M., Elias, M., Jayes, S., Wood, K. & Yates, J. (1993). Survey of British Mental Illness Hospitals March 1993. Health Services Management Centre: Birmingham.Google Scholar
Deister, A. & Marneros, A. (1991). Prognostic value of initial subtype in schizophrenic disorders. Schizophrenia Research 12, 145–157.CrossRefGoogle Scholar
Fenton, W. & McGlashan, T. H. (1991). Natural history of schizophrenia subtypes. I. Positive and negative symptoms and long-term course. Archives of General Psychiatry 48, 978–986.CrossRefGoogle ScholarPubMed
Giggs, J. A. & Cooper, J. E. (1987). Ecological structure and the distribution of schizophrenia and affective psychoses in Nottingham. British Journal of Psychiatry 151, 627–633.CrossRefGoogle ScholarPubMed
Goldstein, J. M. (1988). Gender differences in the course of schizophrenia. American Journal of Psychiatry 145, 684–689.Google ScholarPubMed
Häfner, H., Riecher-Rossler, A., An Der Heiden, W., Maurer, K., Fatkenheuer, B. & Loffler, W. (1993). Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychological Medicine 23, 295–940.Google ScholarPubMed
Harding, C. M., Brooks, G. W., Ashikaga, T., Strauss, J. S. & Breier, A. (1987). The Vermont longitudinal study of persons with severe mental illness. II. Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry 144, 727–735.Google ScholarPubMed
Harrison, G. & Mason, P. (1993). Schizophrenia – falling incidence and better outcome? British Journal of Psychiatry 163, 535–541.CrossRefGoogle ScholarPubMed
Harrison, G., Mason, P., Glazebrook, C., Medley, I., Croudace, T. & Docherty, S. (1994). Residence of incident cohort of psychotic patients after 13 years of follow-up. British Medical Journal 308, 813–816.CrossRefGoogle ScholarPubMed
Hegarty, J. D., Baldessarini, R. J., Tohen, M., Waternaux, C. & Oepen, G. (1994). One hundred years of schizophrenia a meta-analysis of the outcome literature. American Journal of Psychiatry 151, 1409–1416.Google ScholarPubMed
Huber, G., Gross, G. & Schuttler, R. (1975). A long-term follow-up study of schizophrenia psychiatric course of illness and prognosis. Acta Psychiatrica Scandinavica 52, 49–57.CrossRefGoogle ScholarPubMed
Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A. & Cooper, J. E. (1992). Schizophrenia Manifestations, Incidence and Course in Different Cultures. A World Health Organization Ten Country Study. Psychological Medicine Monograph Supplement 20. Cambridge University Press: Cambridge.Google Scholar
Lewis, S. (1992). Sex and schizophrenia: vive la difference. British Journal of Psychiatry 161, 445–450.CrossRefGoogle ScholarPubMed
Loranger, A. W. (1984). Sex difference in age of onset of schizophrenia. Archives of General Psychiatry 41, 157–161.Google ScholarPubMed
McGlashan, T. H. (1986 a). Predictors of shorter-, medium-, and longer-term outcome in schizophrenia. American Journal of Psychiatry 143, 50–55.Google ScholarPubMed
McGlashan, T. H. (1986 b). The predition of outcome in chronic schizophrenia. IV. The Chestnut Lodge follow-up study. Archives of General Psychiatry 43, 167–176.CrossRefGoogle Scholar
McGlashan, T. H. (1988). A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophrenia Bulletin 14, 515–542.CrossRefGoogle ScholarPubMed
McGlashan, T. H., Carpenter, W. T. & Bartko, J. J. (1988). Issues of design and methodology in long-term follow-up studies. Schizophrenia Bulletin 14, 569–574.CrossRefGoogle Scholar
Marneros, A. (1992). The long-term course and outcome of schizophrenia. Triangle 31, 155–161.Google Scholar
Marneros, A., Deister, A., Rohde, A., Steinmeyer, E. M. & Junemann, H. (1989 a). Long-term outcome of schizoaffective and schizophrenic disorders a comparative study. I. Definitions, methods, psychopathological and social outcome. European Archives of Psychiatry and the Neurological Sciences 238, 118–125.CrossRefGoogle ScholarPubMed
Marneros, A., Steinmeyer, E. M., Deister, A., Rohde, A. & Junemann, H. (1989 b). Long-term outcome of schizoaffective and schizophrenic disorders a comparative study. III. Social consequences. European Archives of Psychiatry and the Neurological Sciences 238, 135–139.CrossRefGoogle ScholarPubMed
Mason, P., Harrison, G., Glazebrook, G., Medley, I., Dalkin, T. & Croudace, T. J. (1995). The characteristics of outcome in schizophrenia at 13 years. British Journal of Psychiatry 167, 596–603.CrossRefGoogle Scholar
Opjordsmoen, S. (1991). Long-term clinical outcome of schizophrenia with special reference to gender differences. Acta Psychiatrica Scandinavica 83, 307–313.CrossRefGoogle ScholarPubMed
Pogue-Geile, M. (1989). The prognostic significance of negative symptoms in schizophrenia. British Journal of Psychiatry 155 (supplement 7), 123–127.CrossRefGoogle Scholar
Ram, R., Bromet, E. J., Eaton, W. W., Pato, C. & Schwartz, J. E. (1992). The natural course of schizophrenia a review of first-admission studies. Schizophrenia Bulletin 18, 185–207.CrossRefGoogle ScholarPubMed
Riecher-Rossler, A., Fatkenheuer, B., Loffler, W., Maurer, K. & Hafner, H. (1992). Is age of onset in schizophrenia influenced by marital status? Some remarks on the difficulties and pitfalls in the systematic testing of a ‘simple’ question. Social Psychiatry and Psychiatric Epidemiology 27, 122–128.CrossRefGoogle ScholarPubMed
Sartorious, N., Gulbinat, W., Harrison, G., Laska, G. & Siegel, C. (1996). Long-term follow-up of schizophrenia in ten countries. Social Psychiatry and Psychiatric Epidemiology (in the press).Google Scholar
Seeman, M. V. (1986). Current outcome in schizophrenia: women versus men. Acta Psychiatrica Scandinavica 73, 609–617.CrossRefGoogle Scholar
Seeman, M. V. & Lang, M. (1990). The role of estrogens in schizophrenia gender differences. Schizophrenia Bulletin 16, 185–194.CrossRefGoogle ScholarPubMed
Stein, L. I. & Test, M. A. (1980). Alternative to mental health treatment I: conceptual model, treatment program, clinical evaluation. Archives of General Psychiatry 37, 392–397.CrossRefGoogle ScholarPubMed
Steinmeyer, E. M., Marneros, A., Deister, A., Rohde, A. & Junemann, H. (1989). Long-term outcome of schizoaffective and schizophrenic disorders a comparative study II. Causal-analytical investigations. European Archives of Psychiatry and the Neurological Sciences 238, 126–134.CrossRefGoogle ScholarPubMed
Stephens, J. H. (1970). Long-term course and outcome in schizophrenia. Seminars in Psychiatry 2, 464–485.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1972). The prediction of outcome in schizophrenia. Archives of General Psychiatry 31, 37–42.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1978). The prognosis of schizophrenia: rationale for a multi-dimensional construct. Schizophrenia Bulletin 4, 56–67.CrossRefGoogle Scholar
Westermeyer, J. F. & Harrow, M. (1984). Prognosis and outcome using broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia. Schizophrenia Bulletin 10, 624–637.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (eds.) (1974). Measurement and Classification of Psychiatric Symptoms; An Instruction Manual for PSE and CATEGO Program. Cambridge University Press: London.Google Scholar
World Health Organization (1978). Psychiatric and Personal History Schedule. World Health Organization: Geneva.Google Scholar
World Health Organization (1988). Psychiatric Disability Assessment Schedule. World Health Organization: Geneva.Google Scholar
World Health Organization (1992). The Life-Chart Schedule. World Health Organization: Geneva.Google Scholar
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.Google Scholar