PSYCHOPATHOLOGICAL SYNDROMES IN THE FUNCTIONAL PSYCHOSES - ASSOCIATIONS WITH COURSE AND OUTCOME

The aim of this study was to identify underlying dimensions of psychop athology in a cohort of patients with functional psychosis of recent o nset, and to examine their prognostic value. Factor analysis of the ps ychopathological 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 diagn osis; (ii) associations with other prognostic factors; and (iii) assoc iations with the baseline values of outcome variables. The most striki ng associations were shown for an early and insidious onset syndrome w ith affective flattening, which predicted a more disabled course of il lness on three of four outcome dimensions, and which was more common i n 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 cour se, as well as with poor pre-morbid social functioning. A third syndro me, characterized by positive psychotic symptoms was to a lesser degre e associated with poorer outcome, whereas a fourth syndrome distinguis hed by manic symptomatology predicted a more benign illness course. A fifth syndrome identified by lack of insight predicted more time in ho spital and admission under a section of the Mental Health Act during t he follow-up period.A further finding was that dimensional representat ions of psychopathological features were considerably more useful than categorical representations (DSM-III-R and ICD-10) as predictors of i llness course and treatment decisions.