Prognosis and Outcome Using Broad (DSM-II) and Narrow (DSM-III) Concepts of Schizophrenia

Abstract

The classical prognostic indicators of Vaillant and Stephens, the acute onset of psychotic symptoms, and key demographic factors were investigated as predictors of outcome in a prospective study of 153 schizophrenic patients defined using broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia. Findings indicate: Several established prognostic items did not show strong predictive utility in DSM-II or DSM-III schizophrenia when young, nonchronic patients were studied. For both DSM-II and DSM-III schizophrenic patients, longitudinal assessments of psychotic symptoms, work history, and social functioning predicted their respective assessments at followup. However, the predictive utility of some key prognostic indicators shifted for narrow vs. broad concepts of schizophrenia. Most importantly, sex, which was the most powerful predictor of overall outcome among patients with DSM-II schizophrenia, failed to predict outcome among patients with DSM-III schizophrenia, primarily because many women with favorable outcome did not meet the DSM-III criteria for schizophrenia. DSM-III schizophrenia comprises a more homogeneous group of poor prognosis patients in comparison to DSM-II schizophrenia. Educational level, age at first hospitalization, and work history were successful predictors of outcome (p less than .01) when a new, narrow concept of schizophrenia was used.

A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia

“…Thus there are multiple potential factors which could influence posthospital work functioning for patients with schizophrenia, and these were assessed. These include prehospital work history, prehospital social adjustment, education, marital status, acute onset, precipitating events, and blunted affect from the scales of Vaillant and Stephens (Vaillant, 1962; Vaillant, 1978; Westermeyer and Harrow, 1984; Stephens et al, 1997), and the scales of Zigler (Zigler and Glick, 2001), as well as posthospital positive symptoms and posthospital negative symptoms. The goal was to control or parcel out the combined influence of these factors when studying work functioning over time in medicated vs unmedicated patients with schizophrenia.…”

“…The first scale is from the studies of Vaillant (Vaillant, 1962; Vaillant, 1978) and Stephens (Westermeyer and Harrow, 1984; Stephens et al, 1997). It assesses the influence of prognostic characteristics related to later outcome for schizophrenia patients.…”

The Mental Health Recovery Measure Can Be Used to Assess Aspects of Both Customer-Based and Service-Based Recovery in the Context of Severe Mental Illness

“…Validity measures were also calculated and, as expected, were adequate (see below and Table 2 ). Because socio-demographic variables have been found to modulate the prognosis of schizophrenia (Westermeyer and Harrow, 1984; Wieselgren et al, 1996), discriminant validity was assessed across categories of age, education and disease duration, and found to be robust (Supplementary Table 5). …”

“…Clinical psychiatry has traditionally defined recovery based on symptoms and several dimensions of function (service-based, objective, or clinical recovery – SBR), while consumer movements advocate for recovery to be defined as the process that involves overcoming mental illness, regaining self-control and establishing a meaningful and fulfilling life (customer-based, subjective, or personal recovery – CBR) (Schrank and Slade, 2007). In patients suffering from schizophrenia, recovery has many predicting factors, including socio-demographic variables, among others (Westermeyer and Harrow, 1984; Wieselgren et al, 1996). Specifically, age and functional status at onset, better cognitive functioning at stabilization, shorter duration of psychosis and early remission seem to best predict functional SBR (Robinson et al, 2004; Lambert et al, 2008).…”

Putting the person first : an examination of thought disorder and personality heterogeneity in schizophrenia.

“…Research has found significant associations between thought disorder and outcome as well as personality and outcomes, however, these are only a few of the many potential variables which may influence outcome. Functioning is also likely to be related to a number of factors such as symptom profile, environmental factors, and personal history (Pogue-Geile & Harrow 1985;Westermeyer & Harrow, 1984). Future work should focus on disentangling the intricate relations between personality, thought disorder, and outcomes.…”