Psychopathological syndromes in the functional psychoses: associations with course and outcome

Abstract

SynopsisThe aim of this study was to identify underlying dimensions of psychopathology in a cohort of patients with functional psychosis of recent onset, and to examine their prognostic value. Factor analysis of the psychopathological features of 166 consecutively admitted patients with functional psychosis of recent onset revealed seven psychopathological dimensions, which explained 63% of the variance. Five of these seven syndromes bore differential associations with subsequent treatment and illness course, independent of: (i) associations with DSM-III-R diagnosis; (ii) associations with other prognostic factors; and (iii) associations with the baseline values of outcome variables. The most striking associations were shown for an early and insidious onset syndrome with affective flattening, which predicted a more disabled course of illness on three of four outcome dimensions, and which was more common in males and unmarried individuals. A second syndrome, characterized by bizarre behaviour, inappropriate affect, catatonia, and poor rapport showed similar, slightly less striking, associations with illness course, as well as with poor pre-morbid social functioning. A third syndrome, characterized by positive psychotic symptoms was to a lesser degree associated with poorer outcome, whereas a fourth syndrome distinguished by manic symptomatology predicted a more benign illness course. A fifth syndrome identified by lack of insight predicted more time in hospital and admission under a section of the Mental Health Act during the follow-up period.A further finding was that dimensional representations of psychopathological features were considerably more useful than categorical representations (DSM-III-R and ICD-10) as predictors of illness course and treatment decisions.

Dopamine receptor D2 Ser/Cys 311 variant is associated with delusion and disorganization symptomatology in major psychoses

“…[37][38][39][40][41] Family studies evidenced a moderate but significant heritability for all psychopathological factors. [42][43][44][45][46][47][48] The factors are stable over time 49 and they are correlated with regional anatomical abnormalities. 50 We have previously detected and replicated an association of the DRD2 S311C variant with disorganized symptomatology of schizophrenia.…”

The enigmatic phenotype: Relevant signs and symptoms in schizophrenia

“…The first includes bizarre behaviour, catatonia, inappropriate affect and difficult rapport (inappropriate-catatonia), the second delusions of passivity, bizarre delusions, thought interference and hallucinations (delusions-hallucinations), the third mania, grandiose delusions and relationship psychotic/affective symptoms (mania), the fourth insidious onset, blunting of affect and age of onset (insidious-blunting), the fifth depression and depressive delusions (depression) and the last two lack of insight and paranoid delusions respectively. In a study including 66 patients with schizophrenia, Cardno et al (1997) found even eight factors that are to some extent quite different from the seven described by Van Os et al (1996). In a mixed sample of psychotic and depressed patients, Serretti et al (1996) identified on the basis of 38 items three psychosis-factors (excitement, disorganization and delusion) and one affective factor (depression).…”

“…By using 20 items, Van Os et al (1996) demonstrated seven underlying structures that accounted for 63% of the variance. The first includes bizarre behaviour, catatonia, inappropriate affect and difficult rapport (inappropriate-catatonia), the second delusions of passivity, bizarre delusions, thought interference and hallucinations (delusions-hallucinations), the third mania, grandiose delusions and relationship psychotic/affective symptoms (mania), the fourth insidious onset, blunting of affect and age of onset (insidious-blunting), the fifth depression and depressive delusions (depression) and the last two lack of insight and paranoid delusions respectively.…”

“…There are some indications that negative symptoms moderately predict poor quality of life in the early course of schizophrenia (Wieselgren et al 1996, Ho et al 1998). The few results obtained with the OPCRIT indicate that several symptom dimensions correlate with outcome measures, albeit that the percentage explained variance is rather low (Van Os et al 1996, Rosenman et al 2003.…”

Early Antipsychotic Response Predictors in Schizophrenia: A Naturalistic Study

“…Overall, it reduces the individual lifespan by on average of 15-20 years [2]. Schizophrenia is characterized by a heterogeneous outcome, with a smaller proportion (20-50%) of patients experiencing recovery or significant improvement, compared to a majority of them with a course characterized by multiple episodes and increasing impairment [3].…”