Social outcome in schizophrenia: a 13-year follow-up

Summary The cohort consists of all psychiatric patients (n=53) admitted for the first time in 1972 from a welldefined catchment area with a population of 582,000 inhabitants aged 15 years and over. Furthermore, they were all registered with the diagnosis schizophrenia in the nation-wide psychiatric register at least once during an observation period from the day of the first admission in 1972 until August 31, 1983. The entire cohort was followed up on average 13 years after their first admission. Poor employment outcome (79%), poor social contact outcome (55%), and poor overall social outcome (76%) characterized the living conditions of the 42 patients alive at follow-up. Good employment outcome was predicted by born in rural area. Good social contact outcome was predicted by full remission at first discharge and poor outcome by male sex. Good overall social outcome was predicted by born in rural area and of marginal significance by high social status at first admission. A comparison of parents' highest social group and patients' social group at follow-up supports previous findings on social drift.     

A 20-year follow-up study on schizophrenia in Singapore

OBJECTIVE: To assess the outcome and predictors of patients with schizophrenia 20 years later. METHOD: The patients, aged 15-39 years, with diagnosis of schizophrenia and first admitted to a national mental hospital in Singapore in 1975 were included. In 1980, 1985, 1990 and 1995, their hospital records were examined and the patients were interviewed to determine their working and treatment status. Possible predictors of good outcome and suicide data were determined. RESULTS: A total of 402 patients were included. Over 20 years, there was lower percentage of patients working full time and proportionately more patients were receiving out-patient treatment. Overall, about two-third of the patients had a good/fair outcome. Shorter illness duration before admission was significantly associated with a good outcome. The suicide rate was the highest in the first 10 years. CONCLUSION: Most patients with schizophrenia had a good/fair outcome at 20 years.     

A 13-year follow-up of an adolescent psychiatric clientele

The objective of the study was to compare development in symptoms, behaviours, treatment and patient satisfaction of a traditional interior and an interior furnished like an ordinary home in a seclusion area. A naturalistic sample of 56 consecutive patients admitted to an acute ward was allocated to two different seclusion areas, one with a traditional interior and one decorated as an ordinary home. Symptoms of psychopathology, therapeutic steps taken, violent episodes, length of patient stay and patient satisfaction were recorded. There were no differences in changes in scores on The Positive and Negative Syndrome Scale for schizophrenia, The Brøset Violence Checklist or the Global Assessment of Function split version scale between the two patient groups. Therapeutic steps taken, number of violent episodes and length of patient stay was also similar. Female patients preferred an ordinary home interior. It was concluded that interior and furnishing like an ordinary home in the seclusion areas created an environment with comparable treatment outcomes to the traditional dismal interior, and had positive effects on many patients’ well-being, at least among the women. The traditional beliefs that a sparsely decorated interior is a method to reduce symptoms of psychopathology and dangerous behaviours were not supported by our data.     

A 13-year follow-up of Finnish patients with Salla disease

Background

Salla disease (SD) is a rare lysosomal storage disorder leading to severe intellectual disability. SD belongs to the Finnish disease heritage, and it is caused by mutations in the SLC17A5 gene. The aim of the study was to investigate the course of neurocognitive features of SD patients in a long-term follow-up.

Methods

Neuropsychological and neurological investigations were carried out on 24 SD patients, aged 16–65 years, 13 years after a similar examination.

Results

The survival analysis showed excess mortality among patients with SD after the age of 30 years. The course of the disease was progressive, but follow-up of SD patients revealed that motor skills improved till the age of 20 years, while mental abilities improved in most patients till 40 years of age. Verbal comprehension skills did not diminish during the follow-up, but productive speech deteriorated because of dyspraxia and dysarthria. Motor deficits were marked. Ataxia was prominent in childhood, but it was replaced by athetotic movements during the teens. Spasticity became more obvious with age especially in severely disabled SD patients.

Conclusions

Younger SD patients performed better in almost every task measuring mental abilities that then seem to remain fairly constant till early sixties. Thus, the results indicate better prognosis in cognitive skills than earlier assumed. There is an apparent decline in motor skills after the age of 20 years. The early neurocognitive development predicts the later course of motor and cognitive development.     

The psychopathological and psychosocial outcome of early-onset schizophrenia: Preliminary data of a 13-year follow-up

Background

Pediatric liaison services attending to the psychological health needs of children with chronic physical illness are limited or virtually non-existent in Nigeria and most sub-Saharan African countries, and psychological problems complicate chronic physical illness in these children and their mothers. There exist needs to bring into focus the public health importance of developing liaison services to meet the psychological health needs of children who suffer from chronic physical illness in this environment. Sickle cell disease (SCD) and juvenile diabetes mellitus (JDM) are among the most common chronic physical health conditions in Nigerian children. This study compared the prevalence and pattern of emotional disorders and suicidal behavior among Nigerian children with SCD, JDM and a group of healthy children. Psychological distress in the mothers of these children that suffer chronic physical illness was also compared with psychological distress in mothers of healthy control children.

Methods

Forty-five children aged 9 to 17 years were selected for each group of SCD, JDM and controls. The SCD and JDM groups were selected by consecutive clinic attendance and the healthy children who met the inclusion criteria were selected from neighboring schools. The Youth version of the Computerized Diagnostic Interview Schedule for Children, version IV (C- DISC- IV) was used to assess for diagnosis of emotional disorders in these children. Twelve-item General Health Questionnaire (GHQ – 12) was used to assess for psychological distress in mothers of these children and healthy control children.

Results

Children with JDM were significantly more likely to experience DSM – IV emotional disorders than children with SCD and the healthy group (p = 0.005), while children with JDM and SCD were more likely to have 'intermediate diagnoses' of emotional disorders (p = 0.0024). Children with SCD and JDM had higher rates of suicidal ideation when compared to healthy control children and a higher prevalence of maternal psychological distress was found in their mothers when compared to the mothers of healthy children (p = 0.035).

Conclusion

The higher prevalence of emotional disorders and suicidal ideation among children with SCD and JDM points to a need for development of liaison services in pediatric facilities caring for children with chronic physical illness to ensure holistic approach to their care. The proposed liaison services would also be able to provide family support interventions that would address the psychological distress experienced by the mothers of these children.     

On the prognostic relevance of ego-psychopathology in schizophrenia: A 2.5-year follow-up

Summary Based on a calibration sample comprising 552 schizophrenic patients, ego-psychopathology was modelled in terms of three empirical scales. For this purpose, a special assessment instrument (EPIS) had been designed which measures the phenomena of self-experience in psychotic individuals. Within the scope of these investigations, a 2.5-year follow-up study was carried out with 85 schizophrenic patients. The principal goal of this study was to test the predictive power of typical patterns of self-experience with respect to social functioning. In order to analyse the homogeneity of the data multidimensional scaling and cluster analysis was employed. The results derived from the initial interview suggested a partitioning of the population into two extreme groups termed, according to our model, high-risk and low-risk cases. The predictive power of ego-psychopathology with regard to the social situation was then tested by comparing the outcome of both groups after 2.5 years. The analyses yielded no indication that there is a strong relationship between ego-psychopathology and social adaptation. Only a tendency could be found suggesting that subjects with few ego-psychopathological disturbances have a better occupational behaviour.This study was supported by the Swiss National Fund Foundation (project no. 3200-009314)     

利培酮与氯氮平维持治疗精神分裂症三年随访对照研究

目的比较利培酮与氯氛平治疗精神分裂症的长期效果。方法对经利培酮与氯氮平治疗出院的精神分裂症患者各58例进行3年随访,以总体印象量表（CGI）、副反应量表（TESS）及社会功能缺陷量表（SDSS）评估两种药物长期维持治疗时的临床疗效、药物副反应及社会功能康复状况。结果CGI中的疗效指数EI：利培酮组高于氯氮平组,两者存在显著差异（P〈0．05）;TESS评分：利培酮组与氯氮平两者无显著差异;SDSS评分：利培酮组与氯氮平组存在显著差异（P〈0．001）。同时,利培酮与氯氮平治疗患者3年内复发率为25．9％和39．6％,再住院率分别为10．6％和53．1％,x2=8．3,P〈0．01,两者间具有显著性差异。结论利培酮比氯氮平更适合精神分裂症患者的长期维持治疗．     

Schizophrenia: a 13-year follow-up. Diagnostic and psychopathological aspects

In Denmark about 11-12 per 100,000 population are diagnosed as schizophrenics for the first time each year. Less than half of these receive this diagnosis at first admission and therefore only 5-6 per 100,000 are included in the official schizophrenia incidence figures. In a cohort (n = 53), predictors for diagnosis of schizophrenia at the first admission were analysed (vs. first schizophrenia diagnosis only at a later admission). In accordance with the Danish concept of schizophrenia, affective flattening was found to have a significant correlation with the initial diagnosis of schizophrenia. Long duration of disease prior to the initial admission was also significantly correlated, indicating that a criterion of chronicity forms part of the Danish concept of schizophrenia. Schneider's first-rank symptoms also were more weakly correlated with the initial schizophrenia diagnosis. The probands were followed up personally and by case records (13 years). Good outcome was found in 23% of the probands and poor outcome in 50%. Affective flattening and Schneiderian first-rank symptoms at initial admission were correlated with poor outcome (NS). Schneiderian first-rank symptoms and social unease at initial admission were significantly correlated with schizophrenia as follow-up diagnosis. The initial clinical diagnosis of schizophrenia was not correlated with clinical outcome or with follow-up diagnosis.     

Psychopathology and outcome in first-admission schizophrenia: a 13-year follow-up study at a medical school hospital]

BACKGROUND: The course and outcome of 'dementia praecox' have attracted considerable attention since it was first described. However, studies in which schizophrenic patients have been followed for more than ten years are rare. In this study, the course and outcome of first-admission schizophrenic patients in Jichi Medical School Hospital was investigated. METHOD: The subjects were 62 schizophrenic patients, 29 females and 33 males (the mean age at first hospitalization was 25.2 +/- 7.4 years), who were consecutively discharged from the Department of Psychiatry, Jichi Medical School Hospital, between June 1983 and May 1988. The mean interval between first-admission and follow-up was thirteen years. The social outcome was measured using Eguma's Social Adjustment Scale. The subjects were divided into two groups according to Eguma's Scale: a favorable outcome group and an unfavorable outcome group. The following data were obtained from clinical records and analyzed: sex, family history of mental disorders, educational background, job experience, marital status, age at first contact to a psychiatrist, age at first hospitalization, type of onset, subtype of schizophrenia (paranoid, catatonic, hebephrenic types) and symptoms at the time of first hospitalization. Symptoms at the time of first hospitalization included delusions, hallucinations, disorders of ego consciousness, thought disorders, emotional disturbances, lack of spontaneity, catatonic symptoms, hypochondriac-cenestopathic symptoms, disorganized behavior, and suicide attempts. RESULT: Fifty-six of the 62 patients were followed-up. Six patients could not be contacted. Nine of the 56 patients follow-up were dead; two had died suddenly and seven had committed suicide. Forty-seven patients were alive, eight of which were not under psychiatric treatment, while 39 patients were receiving treatment (33 as outpatients, 6 as inpatients). The 47 patients who were still living were divided into two groups: 22 were included in the favorable outcome group, and 25 in the unfavorable outcome group. No significant differences in premorbid status were found. The unfavorable outcome group had an earlier age at first contact and age at first admission than the favorable outcome group. In the favorable outcome group, acute onset was more common than chronic onset. A comparison of psychopathological symptoms at the time of first hospitalization between the favorable and unfavorable outcome groups revealed significant differences in lack of spontaneity and hypochondriac-cenestopathic symptoms. No significant differences were found for any other symptoms. In the favorable outcome group, paranoid type was more common than hebephrenic type. DISCUSSION: Lack of spontaneity may reflect negative symptomatology, which has been suggested to be a predictor of an unfavorable outcome. While hypochondriac-cenestopathic symptoms may reflect an insufficient psychic container for the body, which has been hypothesized to work as an enabler of body image or imaginary body and an enabler of ego function as well. CONCLUSION: First-admission schizophrenic patients followed up after a mean period of thirteen years, and of this group data could be obtained on 90% of them. Two symptoms (a lack of spontaneity and hypochondriac-cenestopathic symptoms) present at the time of first hospitalization were observed more frequently in the unfavorable outcome group than in the favorable outcome group.     

利培酮治疗精神分裂症患者出院后3年随访研究

目的 探讨精神分裂症患者出院后利培酮使用状况及有效性、安全性及相关问题。方法 对128例经利培酮治疗出院的精神分裂症患者，每1～2个月门诊随访一次，视病情调整治疗方案，共随访三年。临床疗效总评量表(CGI)评定疗效。结果 共有90例患者完成了3年的随访观察，其中30例患者利培酮治疗3年。对维持治疗效果良好中断治疗的因素有多种。结论 利培酮长期治疗精神分裂症有效、安全。中断治疗易复发或加重，应针对相关原因和问题对精神分裂症患者出院后的维持治疗进行干预。     

Outcome in males with first-episode schizophrenia: 7-year follow-up

Abstract

Family, twin, and segregation analytic studies indicate a complex genetic contribution to panic disorder with an estimated heritability of 48%. Angiotensin-converting enzyme (ACE) degrades substance P, which has been implicated in anxiety-related behaviour. ACE has been suggested as a potential risk factor in the pathogenesis of panic attacks. A functional insertion deletion (I/D) polymorphism in the ACE gene was suggested to be associated with panic disorder in a potentially gender-specific way (). The present study aimed to replicate this finding and thereby to further elucidate the role of ACE gene variation in the pathomechanism of panic disorder. The ACE I/D polymorphism was genotyped in a sample of 102 German patients with panic disorder with or without agoraphobia as well as a healthy German control group matched with regard to age and sex (n = 102). In the male subgroup (n = 43) of panic patients a significant association of the ACE I allele (P = 0.0474) and genotypes containing the I allele (P = 0.0195), respectively, was observed. The present results provide further support for a potentially male-specific role of the less active ACE I allele in the pathogenesis of panic disorder, possibly by altering substance P levels.     

A 16-year follow-up study of schizophrenia and related disorders in Sofia,Bulgaria

A total of 60 patients with functional non-affective psychoses were assessed 16 years after their inclusion in the WHO co-ordinated study on reduction and assessment of psychiatric disability. All patients at inclusion had a recent onset of a psychotic disorder. About one-third of the patients had a good outcome. The rest showed moderate to severe psychiatric symptoms and social disability. Comparison with other similar studies suggested that our results show a low mortality rate, high levels of clinical symptoms, high levels of social disability and a low percentage of institutionalized patients. These findings are discussed in the context of the high level of family involvement in patients' care, which could reflect a cultural factor.     

A prospective 2-year follow-up study of neurocognitive functioning in patients with first-episode schizophrenia

To investigate the temporal stability, or progressivity, of neuropsychological (NP) impairment in schizophrenia, 50 patients with first episode (FE) schizophrenia and 50 healthy controls were given a battery of tests at the outset of the study and after a two-year interval. Both patient and control groups were balanced with respect to age, gender, education and parental socioeconomic status. Summary rating scales for semantic memory (SEM), visual memory (VIM), verbal learning (VBL), visual-motor processing and attention (VSM) and abstraction/flexibility (ABS) were constructed. FE schizophrenics showed improvement in VBL, stability of function in SEM, VSM and ABS and absence of improvement in VIM. While performance in VSM and VIM is influenced by medication status, SEM seems to be trait-related and stable; VBL, however, seems to be state-related. Our data suggest that there is no proof for the assumption of progressive deterioration in NP functioning during the first few years of illness.     

Neurocognitive decline in early-onset schizophrenia compared with ADHD and normal controls: evidence from a 13-year follow-up study

The issue of neurodegeneration in schizophrenia is controversial. Although most studies indicate that neurocognitive deficits are relatively stable over the course of the illness, conclusions are limited by relatively short follow-up periods and absence of age-matched control groups. Furthermore, nearly all studies deal with adult-onset schizophrenia, and few studies have considered the possible effect of age of onset. The current study represents the first attempt to compare groups of adolescents with schizophrenia, attention deficit/hyperactivity disorder (ADHD), and normal controls on a comprehensive neurocognitive test battery in a longitudinal design over 13 years. In the baseline study, adolescents with schizophrenia were examined with a broad battery of neurocognitive tests. The comparison groups consisted of adolescents with ADHD and adolescents without a psychiatric diagnosis, between 12 and 18 years of age. In the follow-up study, the schizophrenia group consisted of 15 of the initial 19 individuals, the ADHD group of 19 of the 20 individuals, and the normal comparison group of all 30 individuals. They were reevaluated with the neurocognitive test battery and clinical measures. Subjects with schizophrenia showed a significant decline or arrest in neurocognitive functioning compared with the other 2 groups, particularly in verbal memory, attention, and processing speed. The impairments may be specific to early-onset schizophrenia due to interaction between ongoing brain maturation during adolescence and disease-related mechanisms and/or secondary to neuroleptic treatment in young age and/or social isolation.     

Remission in schizophrenia: a community-based 6-year follow-up study in Bali

Aim: The purpose of this naturalistic study was to investigate the rate and predictors of remission at medium‐term follow up of individuals with schizophrenia in a community setting in Bali. Methods: Subjects comprised 37 individuals with schizophrenia, including 19 never‐treated cases, screened from 8546 general residents. Outcome was evaluated using the standardized symptomatic remission criteria based on Positive and Negative Syndrome Scale scores and operational functional remission criteria at 6‐year follow up. Results: Ten individuals (27%) achieved symptomatic remission, 12 (32%) achieved functional remission, and 10 (27%) achieved complete remission (i.e. symptomatic and functional remission). Lower Positive and Negative Syndrome Scale negative symptom score at baseline and receipt of psychiatric treatment for more than half of the follow‐up period were predictors of complete remission. Conclusions: The majority of community‐screened individuals with schizophrenia failed to achieve complete remission at the 6‐year follow up. These results suggest that strategies promoting mental health service utilization among individuals with schizophrenia are essential in Bali.     

Brain volume changes in first-episode schizophrenia: a 1-year follow-up study

BACKGROUND: Imaging studies of patients with schizophrenia have demonstrated that brain abnormalities are largely confined to decreases in gray matter volume and enlargement of the lateral and third ventricles. Global gray matter volume has been reported to progressively decrease in childhood-onset and chronic schizophrenia. Global gray matter volumes have not been examined longitudinally in patients with first-episode schizophrenia. One would expect global gray matter to decrease progressively, particularly in first-episode patients, because clinical deterioration is greatest in the early stages of the disease. METHODS: Patients with first-episode schizophrenia who had taken antipsychotic medication for 0 to 16 weeks (n = 34) and matched healthy comparison subjects (n = 36) were included in the study. For all subjects, magnetic resonance imaging scans of the whole brain were obtained at inclusion and after 1 year (mean [SD], 12.7 [1.1] months). Outcome was measured 2 years after inclusion. To compare morphological changes over time between patients and healthy comparison subjects, multiple repeated-measures analyses of variance were conducted with intracranial volume as a covariate. Outcome and cumulative antipsychotic medication were related to changes in patients' brain volumes. RESULTS: Total brain volume (-1.2%) and gray matter volume of the cerebrum (-2.9%) significantly decreased and lateral ventricle volume significantly increased (7.7%) in patients. The decrease in global gray matter volume significantly correlated with outcome and, independently of that, with higher cumulative dosage of antipsychotic medication. CONCLUSIONS: The loss of global gray matter in schizophrenia is progressive, occurs at an early stage of the illness, and is related to the disease process and antipsychotic medication.     

Disability in schizophrenia: clinical correlates and prediction over 1-year follow-up

Schizophrenia may cause disability leading to restrictions on many domains of daily life such as hygiene, self-management, vocational and leisure activities, and family and social relationships. The aim of this study was to assess the level of disability with the Brief Disability Questionnaire (BDQ), developed by the World Health Organization, and to identify the clinical correlates and predictors of disability during a 1-year follow-up period in 382 patients with schizophrenia. All patients were assessed at the beginning of the study, and 168 (44%) of them were re-evaluated after 1 year. Total disability scores of the patients with schizophrenia were significantly decreased at follow-up. Female patients seemed to be more disabled than males. Disability showed a positive correlation with the total, positive symptoms and negative symptoms scores on the Brief Psychiatric Rating Scale, as well as scores on the UKU Side Effects Rating Scale. Patients with the disorganized subtype of schizophrenia and residual symptoms were more disabled than patients with other subtype diagnoses. Negative symptoms and duration of untreated psychosis were significant predictors of disability after 1 year. Early-onset schizophrenia had a twofold increased risk for developing disability. Disability in schizophrenia is a clinical phenomenon closely linked to negative symptoms and poor outcome.