Hostname: page-component-5cf477f64f-tgq86 Total loading time: 0 Render date: 2025-04-04T02:15:21.061Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome studies in schizophrenia

Published online by Cambridge University Press:  13 June 2014

Stephen Browne ,
Conall Larkin  and
Eadbhard O'Callaghan
Stephen Browne
Affiliation:
Department of Psychiatry, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
Conall Larkin
Affiliation:
St John of God Hospital, Stillorgan, Co Dublin, Ireland.
Eadbhard O'Callaghan
Affiliation:
Cluain Mhuire Family Centre, Newtownpark Avenue, Blackrock, Co Dublin, Ireland.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To outline the limitations of traditional studies of outcome in schizophrenia and to review the findings arising from ‘first episode’ psychosis studies.

Method: An extensive literature search was performed and relevant papers were examined and analysed.

Results: Current knowledge regarding outcome predictors in schizophrenia has primarily been derived from a series of ‘consecutive admission’ and ‘long-term follow-back’ studies. However, methodological considerations may limit the generalisability of these studies' findings. The prospective evaluation of first episode cohorts has advanced our knowledge regarding the relative importance of premorbid and intercurrent factors in determining outcome in schizophrenia.

Conclusions: To date, the ‘first episode’ strategy has highlighted some potentially clinically modifiable outcome predictors. These findings may open the way for targeted introduction of measures aimed at preventing poor outcomes in schizophrenia.

Keywords

SchizophreniaOutcome studiesMethodological limitationsFirst episode
Type
Reviews
Information
Irish Journal of Psychological Medicine , Volume 16 , Issue 4 , December 1999 , pp. 140 - 144
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kraepelin, E. Lehrbuch der Psychiatrie 4. Auflage. Abel Meixner: Leipzig, 1893.Google Scholar
2.Bleuler, E. Dementia praecox or the group of schizophrenias, (transl. Zinkin, J.). International University Press, New York, 1950.Google Scholar
3.Tsuang, MT, Woolson, RF, Fleming, JA. Long-term outcome of major psychosis. Arch Gen Psych 1979; 36: 1295–301.CrossRefGoogle Scholar
4.McGlashan, TH. The Chestnut Lodge follow-up study II. Long-term outcome of schizophrenia and the affective disorders. Arch Gen Psych 1984; 41: 585–601.CrossRefGoogle ScholarPubMed
5.Harding, CM, Brooks, GW, Asikaga, T, Strauss, T, Brier, A. The Vermount longitudinal study of persons with severe mental illness. In: Methodology, study sample and overall status 32 years later. Am J Psych 1987; 144: 718–26.Google Scholar
6.Bleuler, M. The schizophrenic disorders: long-term patient and family studies (transl. SM, Clemens). New Haven: Yale University Press, 1978.Google Scholar
7.Huber, G, Gross, G, Schuttier, R. Longitudinal studies of schizophrenic patients. Schiz Bull 1980; 6: 593–605.CrossRefGoogle ScholarPubMed
8.Prudo, R, Blum, HM. Five year outcome and prognosis in schizophrenia. Br J Psych 1987; 150: 345–54.CrossRefGoogle ScholarPubMed
9.Harrow, M, Sands, JR, Silverstein, ML, Golberg, JF. Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study. Schiz Bull 1997; 23:287–303.CrossRefGoogle ScholarPubMed
10.Zubin, J, Magaziner, J, Sreinhauer, SR. The metamorphosis of schizophrenia: from chronicity to vulnerability. Psychol Med 1983; 13: 551–71.CrossRefGoogle ScholarPubMed
11.Harrison, G, Mason, P. Schizophrenia – falling incidence and better outcome? Br J Psych 1993; 163: 535–41.CrossRefGoogle ScholarPubMed
12.Hegarty, JD, Baldessarini, RJ, Tohen, M, Waternaux, C, Oepen, G. One hundred years of schizophrenia: A meta-analysis of the outcome literature. Am J Psych 1994; 151: 1409–16.Google ScholarPubMed
13.Carone, BJ, Harrow, M, Wesrermever, JF. Posthospital course and outcome in schizophrenia. Arch Gen Psych 1991; 48: 247–53.CrossRefGoogle ScholarPubMed
14.Breier, A, Schreiber, JL, Dyer, J, Pickar, D. National Institute of Mental Health longitudinal study of chronic schizophrenia. Arch Gen Psych 1991; 48: 239–46.CrossRefGoogle ScholarPubMed
15.McGlashan, TH. Predictors of shorter, medium and longer term outcome in schizophrenia. Am J Psych 1986; 143: 50–5.Google ScholarPubMed
16.Schwartz, F, Terkelsen, KG, Smith, TE. Long-term outcome in chronic schizophrenia. Arch Gen Psych 1992; 49: 502.CrossRefGoogle ScholarPubMed
17.Green, JH. Frequent rehospitalisation and non-compliance with treatment. Hosp Commun Psychiatry 1988; 39: 963–6.Google Scholar
18.Sullivan, G, Wells, KB, Morgenstern, H, Leake, B. Identifying modifiable risk factors for rehospitalisation. Am J Psych 1995; 152: 1749–56.Google Scholar
19.Mueser, KTet al.Prevalence of substance abuse in schizophrenia: demographic and clinical factors. Schiz Bull 1990; 16: 31–56.CrossRefGoogle Scholar
20.Dixon, L, Haas, G, Weiden, PJ, Sweeney, I, Frances, AJ. Drug abuse in schizophrenic patients: clinical correlates and reasons for use. Am J Psych 1991; 148: 224–30.Google ScholarPubMed
21.Martinez-Arevalo, MJ, Calcedo-Ordoniz, A, Varo-Prieto, JR. Cannabis consumption as a prognostic factor in schizophrenia. Br J Psych 1994; 164: 679–81.CrossRefGoogle ScholarPubMed
22.Ram, R, Bromet, EJ, Eaton, W, Pato, C, Schwartz, JE. The natural course of schizophrenia: A review of first admission studies. Schiz Bull 1992; 18: 185–207.CrossRefGoogle ScholarPubMed
23.Strauss, JS, Carpenter, WT. Prediction of outcome in schizophrenia III. Five year outcome and its predictors. Arch Gen Psych 1977; 34: 159–63.CrossRefGoogle ScholarPubMed
24.Shepherd, M, Watt, D, Falloon, I, Smeeton, N. The natural history of schizophrenia: a five year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychol Med 1989; monograph suppl. 15.Google Scholar
25.Wing, JK. Five year outcome in early schizophrenia. Proc Royal Soc Med 1966; 59: 17–8.CrossRefGoogle ScholarPubMed
26.Stephens, JH. Long-term prognosis and follow-up in schizophrenia. Schiz Bull 1978; 4: 25–47.CrossRefGoogle ScholarPubMed
27.Ciompi, L. Caramnestic long-term study on the course of life and ageing of schizophrenics. Schiz Bull 1980; 6: 606–18.CrossRefGoogle ScholarPubMed
28.Wyatt, RJ. Neuroleptics and the natural course of schizophrenia. Schiz Bull 1991; 17: 325–51.CrossRefGoogle ScholarPubMed
29.Mojtabai, R, Nicholson, RA, Carpenter, BN. Role of psychosocial treatments in management of schizophrenia: A meta-analytic review of controlled outcome studies. Schiz Bull 1998; 24: 569–87.CrossRefGoogle ScholarPubMed
30.Strauss, JS, Carpenter, WT. The prediction of outcome in schizophrenia II. Relationships between predictor and outcome variables. Arch Gen Psych 1974; 31: 37–42.CrossRefGoogle ScholarPubMed
31.Carpenter, WT, Strauss, JS. The prediction of outcome in schizophrenia IV: 11 year follow-up of the IPSS cohort. J Nerv Ment Dis 1991; 179: 517–25.CrossRefGoogle ScholarPubMed
32.Harrow, M, Carone, BI, Westermeyer, JF. Subjective conclusions about schizophrenia. Arch Gen Psych 1992; 49: 75Google Scholar
33.Achte, KA. On prognosis and rehabilitation in schizophrenia and paranoid psychoses: A comparative study of two series of patients first admitted to hospital in 1950 and 1960 respectively. Acta Psychiatr Scand 1967; 43: 5–125.Google Scholar
34.Postrado, LT, Lehman, AF. Quality of life and clinical predictors of rehospitalisation of persons with severe mental illness. Psychiatr Serv 1995; 46: 1161–5.Google Scholar
35.Ni, Nuallain M, O'Hare, A, Walsh, D. Incidence of schizophrenia in Ireland. Psychol Med 1987; 17: 743–8.Google Scholar
36.Aberg-Wistedt, A, Cressell, T, Lidberg, Y, Liljenberg, B, Osby, U. Two-year outcome of team-based intensive case management for patients with schizophrenia. Psychiatr Serv 1995; 46: 1263–6.Google ScholarPubMed
37.Collins, EJ, Hogan, TP, Desai, H. Measurement of therapeutic response in schizophrenia. Schiz Res 1991; 5: 249–53.CrossRefGoogle ScholarPubMed
38.Green, MRWhat are the functional consequences of neurocognitive deficits in schizophrenia. Am J Psych 1996; 153: 321–30.Google ScholarPubMed
39.Norman, Ret al.Symptoms and cognition as predictors of community functioning: A prospective analysis. Am J Psych 1999; 156: 400–5.CrossRefGoogle ScholarPubMed
40.Browne, Set al.Quality of life in schizophrenia: its relationship to symptomatology, sociodemographic factors and tardive dyskinesia. Acta Psych Scand 1996; 94: 118–24.CrossRefGoogle ScholarPubMed
41.Browne, S, Garavan, J, Roe, M, Gervin, M, Larkin, C, O'Callaghan, E. Quality of life in schizophrenia; insight and subjective response to neuroleptics. J Nerv Ment Dis 1998; 186: 74–8.CrossRefGoogle ScholarPubMed
42.Van, Putten T. Why do schizophrenic patients refuse to take their drugs?. Arch Gen Psych 1974; 31: 67–72.Google Scholar
43.Hogan, TP, Awad, AG. Subjective response to neuroleptics and outcome in schizophrenia: a re-examination comparing two measures. Psychol Med 1992; 22: 347–52.CrossRefGoogle ScholarPubMed
44.Kemp, R, Dvid, A. Psychological predictors of insight and compliance in psychotic patients. Br J Psych 1996; 169: 444–50.CrossRefGoogle ScholarPubMed
45.Garavan, Jet al.Compliance with neuroleptic medication in outpatients with schizophrenia; its relationship to insight, subjective response to neuroleptics and attitudes to medication. Comp Psych 1998; 39: 215–8.CrossRefGoogle ScholarPubMed
46.Meitzer, HY. Dimensions of outcome with clozapine. Br J Psych 1992; 160 (suppl. 17): 46–53.CrossRefGoogle Scholar
47.Van, Os J, Wright, P, Murray, RM. Follow- up studies of schizophrenia I: natural history and non- psychopathological predictors of outcome. Eur Psych 1997; 12 (suppl. 5):327s–341s.CrossRefGoogle Scholar
48.Report of Working Group on Outcome Indicators for Severe mental illness. HMSO,London, 1999.Google Scholar
49.Lieberman, JA, Matthews, S, Kirch, DG. First episode psychosis. Schiz Bull 1992; 18:349–50.CrossRefGoogle Scholar
50.Mason, P, Harrison, G, Glazebrook, C, Medley, I, Croudace, T. The course of schizophrenia over 13 years. Br J Psych 1996; 169: 580–6.CrossRefGoogle ScholarPubMed
51.Westermeyer, JF, Harrow, M, Marengo, JTRisk of suicide in schizophrenia and other psychotic and non-psychotic disorders. J Nerv Ment Dis 1991; 179: 259–66.CrossRefGoogle Scholar
52.Robinson, DGet al.Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psych 1999; 156: 544–9.CrossRefGoogle ScholarPubMed
53.Sheitman, BB, Lee, H, Strauss, R, Lieberman, JA. The evaluation and treatment of first-episode psychosis. Schiz Bull 1997; 23: 653–61.CrossRefGoogle ScholarPubMed
54.Remington, G, Kapur, S, Zipursky, RB. Pharmacotherapy of first episode schizophrenia. Br J Psych 1998; 172 (suppl 33): 66–70.CrossRefGoogle ScholarPubMed
55.Kane, JM. Schizophrenia. N Eng J Med 1996; 334: 34–9.CrossRefGoogle ScholarPubMed
56.Kopala, LC. Spontaneous and drug induced movement disorders in schizophrenia. Acta Psychiatr Scand 1996; 389: 12–7.CrossRefGoogle ScholarPubMed
57.Lieberman, Jet al.Time course and biological correlates of treatment response in first-episode schizophrenia. Arch Gen Psych 1993; 50: 369–76.CrossRefGoogle ScholarPubMed
58.Szymanski, S, Cannon, T, Gallacher, F, Erwin, RI, Gur, RE. Course of treatment response in first-episode and chronic schizophrenia. Am J Psych 1996; 153: 519–25.Google ScholarPubMed
59.Saykin, Alet al.Neuropsychological deficits in neuroleptic naive patients with first episode schizophrenia. Arch Gen Psych 1994; 51: 124–31.CrossRefGoogle ScholarPubMed
60.Hoff, AL, Riordan, H, O' Donneil, DW, Morris, L, De, Lisi LE. Neuropsychological functioning of first episode schizophreniform patients. Am J Psych 1992; 149: 898–902.Google ScholarPubMed
61.Barnes, TRE. Commentary. Response to Professor Kirwan. Psychiatr Bull 1996; 20: 26–9.CrossRefGoogle Scholar
62.Sharma, T. Cognitive effects of conventional and atypical antipsychotics in schizophrenia. Br J Psych 1999; 174 (suppl 38): 44–51.CrossRefGoogle Scholar
63.Zipursky, RB, Zhang, Wong J, Lambe, EK, Bean, G, Beiser, M. MRI correlates of treatment response in first episode psychosis. Schiz Res 1997; 30: 81–90.CrossRefGoogle Scholar
64.Johnstone, BC, MacMillan, F, Frith, CD, Benn, DK, Crow, TJ. Further investigation of the predictors of outcome following first episode schizophrenic episodes. Br J Psych 1990; 157: 182–9.CrossRefGoogle ScholarPubMed
65.Birchwood, M, Mc, Gorry P, Jackson, H. Early intervention in schizophrenia. Br J Psych 1997; 170: 2–5.CrossRefGoogle ScholarPubMed
66.Beiser, M, Erickson, D, Fleming, JA, Iacono, WG. Establishing the onset of psychotic illness. Am J Psych 1993; 150: 1349–54.Google ScholarPubMed
67.Humphreys, MS, Johnstone, BC, MacMillan, IF, Taylor, PJ. Dangerous behaviour preceding first admissions for schizophrenia. Br J Psych 4992; 161: 501–5.CrossRefGoogle Scholar
68.Crow, TJ, MacMillan, JF, Johnson, AL, Johnstone, BC. A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psych 1986; 448: 120–27.CrossRefGoogle Scholar
69.Loebel, AD, Lieberman, JA, Alvir, JM, Mayerhoff, D, Geisler, SH, Szymanski, S. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psych 1992; 149: 1183–8.Google ScholarPubMed
70.Haas, GL, Garratt, LS, Sweeney, JA. Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. J Psychiatr Res 1998; 32: 151–9.CrossRefGoogle ScholarPubMed
71.McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ. EPPIC: An evolving system of early detection and optimal treatment. Schiz Bull 1996; 22: 305–25.CrossRefGoogle Scholar
72.Harrison, G, Croudace, T, Mason, P, Glazebrook, C, Medley, I. Predicting the long-term outcome of schizophrenia. Psychol Med 1996; 26: 697–705.CrossRefGoogle ScholarPubMed
73.McGlashan, TH, Johannessen, JO. Early detection and intervention with schizophrenia: rationale. Schiz Bull 1996; 22: 201–22.CrossRefGoogle ScholarPubMed
74.Larsen, TK, McGlashan, TH, Moe, LC. First episode schizophrenia: early course parameters. Schiz Bull 1996; 22: 241–56.CrossRefGoogle ScholarPubMed
75.Verdoux, Het al.Prediction of duration of psychosis before first admission. Eur Psych 1998; 13: 346–52.CrossRefGoogle ScholarPubMed
76.Birchwood, M, Cochrane, R, MacMillan, F, Copestake, S, Kucharska, J, Cariss, M. The influence of ethnicity and family structure on relapse in first episode schizophrenia. Br J Psych 1992; 161: 783–90.CrossRefGoogle ScholarPubMed
77.The Scottish Schizophrenia Research Group. The Scottish First Episode Schizophrenia Study V. One-year follow-up. Br J Psych 1988; 152: 470–6.CrossRefGoogle Scholar
78.Robinson, Det al.Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psych 1999; 56: 241–7.CrossRefGoogle ScholarPubMed
79.Hambrecht, M, Hafner, H. Substance abuse and the onset of schizophrenia. Biol Psych 1996; 40: 1155–63.CrossRefGoogle ScholarPubMed
80.Cantwell, Ret al.Prevalence of substance misuse in first episode psychosis. Br J Psych 1999; 174: 150–3.CrossRefGoogle ScholarPubMed
81.Kovasznay, B, Fleischer, J, Tanenberg-Karant, M, Jandorf, L, Miller, A, Bromet, E. Substance use disorder and the early course of illness in schizophrenia and affective psychosis. Schiz Bull 1997; 23: 195–201.CrossRefGoogle ScholarPubMed
82.Addington, J, Addington, D. Effect of substance misuse in early psychosis. Br J Psych 1998; 172 (suppl 33): 134–6.CrossRefGoogle ScholarPubMed
83.Jackson, H, et al.Cognitively orientated psychotherapy for early psychosis (COPE). Br J Psych 1998; 172 (suppl 33): 93–100.CrossRefGoogle ScholarPubMed
84.Haddock, G, Morrison, AP, Hopkins, R, Lewis, S, Tarrier, N. Individual cognitive-behavioural interventions in early psychosis. Br J Psych 1998; 172 (suppl 33): 101–6.CrossRefGoogle ScholarPubMed
85.Linszen, DH, Dingemans, PM, Lenior, ME. Cannabis abuse and the course of recent onset schizophrenic disorders. Arch Gen Psych 1994; 51: 273–9.CrossRefGoogle ScholarPubMed