Course, Prognosis, and Outcomes of Schizophrenia and Related Disorders

2016 ◽  
Author(s):  
Konasale M. Prasad
Keyword(s):  
Treatment Adherence ◽  
Functional Outcomes ◽  
Negative Symptoms ◽  
Good Prognosis ◽  
Positive Symptoms ◽  
Duration Of Untreated Psychosis ◽  
Predictors Of Outcome ◽  
Premorbid Functioning ◽  
Over Time ◽  
Better Than

Course and outcome in schizophrenia and related disorders historically depend on diagnostic conceptualizations, with significant variability even across individuals with the exact same diagnosis. In this chapter, we will review the heterogeneity of course and outcome, providing some context in terms of factors that affect prognosis. Generally speaking, current outcomes are better than previously thought, with three-quarters of individuals having a good prognosis. Although these illnesses cannot be cured, we know that recovery is possible. The best predictors of outcome in schizophrenia are cognitive and negative symptoms (not positive symptoms), along with premorbid functioning, duration of untreated psychosis, and treatment adherence over time. Finally, we will touch on functional outcomes such as risk of violence and suicide, as well as issues around treatment discontinuation.

The core dimensions of schizophrenia

2020 ◽  
pp. 565-573
Author(s):  
Nancy C Andreasen
Keyword(s):  
Intelligence Quotient ◽  
Negative Symptoms ◽  
Three Dimensions ◽  
Psychotic Symptoms ◽  
Outcome Predictors ◽  
Positive Symptoms ◽  
Illness Onset ◽  
Premorbid Adjustment ◽  
High Intelligence ◽  
Over Time

Schizophrenia is a devastating illness that usually affects many aspects of a person’s life. The symptoms may be divided into two groups. ‘Positive’ symptoms include a variety of psychotic symptoms such as delusions and hallucinations. Although severe, they are less handicapping than negative symptoms such as avolition or anhedonia. Positive symptoms involve the presence of things that should be absent, while negative symptoms involve the absence of things that should be present. Dimensional approaches for classifying symptoms have also become popular in current nosology, proposing three dimensions: positive, negative, and disorganized. The course of the illness evolves over time; a prodrome is often present, followed by illness onset and a variable outcome. Good outcome predictors include good premorbid adjustment, high intelligence quotient, and good social relationships. The pathophysiology of the illness includes genetic, neuropathological, and neurodevelopmental components. A possible association with creativity may suggest reasons why the illness has persisted over many centuries.

scholarly journals Cannabis use and abuse correlates in a homogenous South African schizophrenia population

2009 ◽  
Vol 15 (1) ◽  
pp. 5 ◽  
Author(s):  
Liezl Koen ◽  
Regan Jonathan ◽  
Dana JH Niehaus
Keyword(s):  
South African ◽  
Functional Outcomes ◽  
Negative Symptoms ◽  
Age Of Onset ◽  
Cannabis Use ◽  
Positive Symptoms ◽  
International Studies ◽  
Formal Thought Disorder ◽  
Schizophrenic Patients

<p><strong>Objective.</strong> Worldwide, cannabis is the most widely used illicit substance, and it has been identified as a correlate in schizophrenia samples for poorer symptomatic and functional outcomes in many international studies. The object of this retrospective study was to identify the prevalence of cannabis use/abuse and the demographic and clinical correlates therefor in a large homogeneous South African schizophrenia population.</p><p><strong>Methods.</strong> As part of a large genetic study, 547 subjects with a diagnosis of schizophrenia were recruited. Demographic and clinical data were collected and each participant underwent a urinary drug screen. Use/abuse of cannabis was defined as using cannabis more than 21 times in a single year. Subjects with and without cannabis use/abuse were statistically compared. <strong></strong></p><p><strong>Results.</strong> Significant differences between the two groups were found in terms of gender, marital status, age of onset of schizophrenia, number of hospitalisations and relapses, alcohol abuse, smoking, the Scale for the Assessment of Positive Symptoms (SAPS) scores for hallucinations, delusions, bizarre behaviour and formal thought disorder, and the Scale for the Assessment of Negative Symptoms (SANS) score for avolition/apathy. <strong></strong></p><p><strong>Conclusion.</strong> The prevalence of cannabis use/abuse in this study was high, and our findings were comparable with those of previous international studies. Abuse/use started mainly in the teenage years, was more prevalent among males than females, and was associated with negative overall outcomes. There was also a positive correlation between cannabis and nicotine and alcohol use/abuse. Determination of cannabis abuse based solely on history was found to be reliable, and urine cannabis testing appeared to be of limited value in routine management of this group of schizophrenic patients.</p>

Toxic psychosis? Duration of untreated psychosis, symptomatology and cognitive deterioration in first episode psychosis

2007 ◽  
Vol 24 (4) ◽  
pp. 145-148 ◽  
Author(s):  
Richard Lawoyin ◽  
Keith Gaynor ◽  
Barbara Dooley ◽  
Elizabeth Lawlor ◽  
Mary Clarke ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Cognitive Deterioration ◽  
Duration Of Untreated Psychosis ◽  
Episode Psychosis ◽  
The Relationship ◽  
Linear Regressions ◽  
Positive And Negative Symptoms

AbstractObjectives: To examine the relationship between cognitive deficits, the duration of untreated psychosis (DUP) and positive and negative symptoms in a first episode psychosis sample.Method: We assessed a consecutive sample of first episode psychosis participants from a catchment area service with a comprehensive neuropsychology battery, a family and service-user based measure of DUP and measures of symptomatology.Results: Using correlations and stepwise linear regressions, we found strong relationships between measures of DUP and positive symptomatology. We found that positive and negative symptoms were associated with different time periods within DUP. However, we did not find evidence of a relationship between DUP and cognitive factors.Conclusions: There was no evidence of a relationship between DUP and cognitive deterioration. However, there does appear to be evidence of a relationship between positive symptoms and aspects of DUP. These results highlight the importance of the heterogeneity of DUP and the potential to reduce positive symptoms through early intervention.

Treatment of the patient with long-term schizophrenia

1997 ◽  
Vol 3 (6) ◽  
pp. 339-346 ◽  
Author(s):  
Ann Mortimer
Keyword(s):  
Negative Symptoms ◽  
Chronic Illnesses ◽  
First Episode ◽  
Positive Symptoms ◽  
Loss Of Self ◽  
Appropriate Treatment ◽  
Community Skills ◽  
First Episode Of Schizophrenia ◽  
Over Time

At most, 15% of patients in Western countries remain free of relapse after their first episode of schizophrenia (Crow et al, 1986). Like many chronic illnesses, schizophrenia can be controlled by appropriate treatment, but there may be a gradual deterioration over time. This encompasses problems such as loss of self-care, communication and community skills; negative symptoms of poverty of affect and ideation; cognitive impairment; behaviour problems such as aggression; and poorly controlled positive symptoms.

scholarly journals Premorbid adjustment in first-episode non-affective psychosis: Distinct patterns of pre-onset course

2004 ◽  
Vol 185 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Tor K. Larsen ◽  
Svein Friis ◽  
Ulrik Haahr ◽  
Jan Olav Johannessen ◽  
Ingrid Melle ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
Affective Psychosis ◽  
Premorbid Adjustment ◽  
Episode Psychosis ◽  
Premorbid Functioning ◽  
Shed Light

BackgroundKnowledge about premorbid development in psychosis can shed light upon theories about aetiology and schizophrenic heterogeneity, and form a basis for early detection initiatives.AimsTo identify and validate patterns of premorbid functioning in first-episode psychosis.MethodThe Premorbid Adjustment Scale was used to examine 335 patients.ResultsSocial and academic function constituted fairly independent dimensions. Cluster analysis identified groups varying both in level and course. Patients with a stable social course compared with a deteriorating one had a shorter duration of untreated psychosis, were older, had more friends and less negative symptoms. Good childhood academic function correlated with more education, more meaningful activities and better working memory. Patients with a stable academic course were older at admission.ConclusionsPatterns of premorbid development suggest both neuro-developmental and neuroregressive pathways to illness.

Positive and Negative Symptom Course in Chronic Community-Based Patients

1995 ◽  
Vol 166 (5) ◽  
pp. 634-641 ◽  
Author(s):  
Donald M. Quinlan ◽  
David Schuldberg ◽  
Hal Morgenstern ◽  
William Glazer
Keyword(s):  
Maintenance Treatment ◽  
Negative Symptoms ◽  
Positive Symptoms ◽  
Community Based ◽  
Symptom Profile ◽  
Schizophrenic Patients ◽  
Positive And Negative Symptoms ◽  
Over Time

BackgroundThe long-term symptom profile of chronic out-patients was studied.Method. 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over out-patient maintenance treatment.ResultsOverall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P< 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change.ConclusionSupport is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of ‘progressive downward course’ in schizophrenia.

Pathways to functional outcomes in schizophrenia: The role of premorbid functioning, negative symptoms and intelligence

2009 ◽  
Vol 110 (1-3) ◽  
pp. 40-46 ◽  
Author(s):  
N. Brill ◽  
S.Z. Levine ◽  
A. Reichenberg ◽  
G. Lubin ◽  
M. Weiser ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Negative Symptoms ◽  
Premorbid Functioning

Stability of positive and negative symptoms in schizophrenic patients: a 3-year follow-up study

1995 ◽  
Vol 10 (5) ◽  
pp. 228-236 ◽  
Author(s):  
S Dollfus ◽  
M Petit
Keyword(s):  
Negative Symptoms ◽  
Strong Stability ◽  
Positive Symptom ◽  
Positive Symptoms ◽  
Acute Group ◽  
Thought Disorders ◽  
Number Of Patients ◽  
Schizophrenic Patients ◽  
The Mean ◽  
Over Time

SummaryThe course of negative and positive symptoms was studied in neuroleptic-treated patients over a 3-year period, in consideration also of the initial phase of illness (post-acute or chronic). This study was carried out in a broadly defined schizophrenic sample, in order not to give preference to one diagnostic subgroup over another. Forty-six patients were evaluated every year for 3 years, 23 in the post-acute group and 23 in the chronic group. Aggravations of the Clinical Global Impression (CGI) and of the SANS total score were observed, regardless of the group (chronic or post-acute). This global aggravation confirmed Kraepelin's concept of dementia praecox; moreover, this aggravation was not due to an increase in the number of patients relapsing, or to an aggravation of akinesia. Three types of negative and positive symptom courses were observed: i) the mean sub-scores of positive symptoms, such as hallucinations, delusions, positive formal thought disorders, and of negative symptoms such as flattening affect, avolition/apathy and attentional impairment, did not vary significantly over time in either group; ii) the mean sub-scores of bizarre behavior and alogia fluctuated over time (p < 0.05) and only poverty of speech was perfectly stable among the items constituting alogia; iii) the mean subscores of anhedonia/asociality worsened significantly over time irrespective of the groups (p < 0.05), and among the items constituting anhedonia, recreational interest-activities and intimacy-closeness abilities worsened (p < 0.05 and p < 0.01, respectively). This aggravation was neither due to an increase in neuroleptic doses nor to the duration and chronicity of illness. However, negative symptoms, except anhedonia, can be reversible in some patients. The very strong stability of anhedonia, whatever the group, emphasize the importance of taking anhedonia into account in future diagnostic classifications.

Performance of patients with different schizophrenia subtypes on the Synthetic House–Tree–Person Test

2019 ◽  
Vol 47 (11) ◽  
pp. 1-8 ◽  
Author(s):  
AiBao Zhou ◽  
Pei Xie ◽  
ChaoChao Pan ◽  
Zhe Tian ◽  
Junwei Xie
Keyword(s):  
Negative Symptoms ◽  
Positive Symptoms ◽  
Study Results ◽  
Symptom Type ◽  
Positive And Negative Symptoms

We explored differences in performance on the Synthetic House–Tree–Person Test between people with mainly positive symptoms and those with mainly negative symptoms of schizophrenia and, further, aimed to provide a basis for the diagnosis of schizophrenia symptom type. Participants were 58 people receiving treatment for schizophrenia, and we asked them to complete the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Synthetic House–Tree–Person Test. There were significant differences in results on the Synthetic House–Tree–Person Test between the group with positive symptoms, the group with a mix of positive and negative symptoms, and the group with negative symptoms. There were 12 features of participants' drawings, such as big hands, which were correlated with hallucinations and delusions in positive symptoms, and 9 features, such as trees in a landscape, which were correlated with avolition and anhedonia in negative symptoms. Our study results suggest differences in performance on the Synthetic House–Tree–Person Test between these different symptom subtypes of schizophrenia; hence, the features that appear in drawings made during the test may contribute to the diagnosis of symptoms of people with schizophrenia.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

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