DETERMINANTS OF THE EXTREMES OF OUTCOME IN SCHIZOPHRENIA

Background. Although poor prognosis has been considered a defining cha racteristic of schizophrenia, long-term studies show marked heterogene ity of outcome. Method. Assessments of positive and negative symptoms, premorbid and current IQ, and months of in-patient care made in an ou tcome study of 342 schizophrenic patients were categorised by severity . Determinants of these categorisations were sought from the historica l variables available, using analysis of variance. Vignettes of patien ts with the best and worst symptomatic outcomes were then compared. Re sults. Negative symptoms were associated with early onset, male sex an d poor academic record. Positive symptoms were associated with occupat ional decline. Cognitive decline was associated with occupational vari ables, and in-patient care with academic and occupational variables. T he vignettes showed that good outcome was associated with family psych iatric history and poor outcome with unavailability of family history. Conclusions. The findings support the view that the most malignant fo rm of schizophrenia is neurodevelopmental, but poor outcome was clearl y associated with family fragmentation.