No abstract

To investigate the presence of a full depressive syndrome in schizophrenia years after the acute phase and factors linked to these depressive syndromes, 75 schizophrenia and schizoaffective patients and 32 patients with bipolar affective disorders were studied prospectively at index hospitalization and followed up 4.5 years later as part of the Chicago Followup Study. Over 30 percent of the schizophrenia patients showed full depressive syndromes during the followup year. Schizophrenia patients on neuroleptics were significantly more likely to show full depressive syndromes than those not on neuroleptics during the followup year. This relationship held after the level of posthospital psychosis was controlled. The data suggest that neuroleptic use is one factor linked to the depressive-like syndromes found in the posthospital phase in non-chronic schizophrenia samples. The results did not support the view that these depressive-like syndromes are only a function of akinesia, although they suggest that akinesia is probably one factor involved. The data indicate a strong link between neuroleptic use and anhedonia. These data suggest that one factor involved in the depressive-like symptoms found in schizophrenia patients could be interference by neuroleptics with the mesolimbic dopamine reinforcement system or the dopamine reward system.

To assess the prominence, persistence, and prognostic significance of positive thought disorder in schizophrenia, we studied a large sample of psychiatric inpatients at the acute phase and then followed them up twice--1 1/2-2 years and 4 years after hospital discharge. Positive thought disorder was more prominent at the acute phase in schizophrenic and manic patients than in other types of psychotic and nonpsychotic disorders. At followup, positive thought disorder did not persist for all schizophrenics, but a significantly larger percentage of schizophrenic than other psychotic and nonpsychotic patients followed a course in which positive thought disorder was either persistently or episodically present. Positive thought disorder, when seen after the acute phase, was related to concurrent functioning, and predicted subsequent poorer outcome and functioning for both schizophrenic and nonschizophrenic patients. Positive thought disorder was one of several central features of the active schizophrenic disorder. Among schizophrenics, it was related to other major types of psychopathology, especially delusions, another positive symptom with cognitive-ideational elements. Severe positive thought disorder after the acute phase indicated a sustained episode, and suggested a more severe type of schizophrenia with a poorer prognosis.

This research examined the longitudinal courses of thought disorder in schizophrenia, schizoaffective disorder, and other psychotic and nonpsychotic disorders. One-hundred-eighty young psychiatric inpatients were prospectively diagnosed at an early stage of illness and followed up and evaluated for thought disorder at 2, 4.5, and 7.5 years post-index hospitalization. Patterns of thought disorder were examined in relation to diagnosis, index thought disorder, demographic characteristics, prognostic factors, clinical states of psychosis, outcome at followup, and treatment. Courses of frequent and persistent thought disorder were most frequently found in schizophrenia. The prevalence and course of thought disorder over time in schizoaffective disorder laid between those in schizophrenia and those in other psychotic disorders. Demographic factors were not predictive of the course of thought disorder. Diagnosis, the presence of thought disorder at index, pre-index work and academic competence, and pre-index social functioning were associated with courses of thought disorder (when courses were classified as remitted/infrequent and frequent/persistent). The longitudinal relationships between thought disorder and psychosis suggested that, in schizophrenia, thought disorder is not simply a function of psychosis. Thought disorder appeared more closely tied to the presence of psychosis over time in schizoaffective disorder. Increased inquiry into the factors associated with different courses of thought disorder across psychiatric disturbances appears merited.