PREDICTING THE LONG-TERM OUTCOME OF SCHIZOPHRENIA

Predictors of long-term (13 year) outcome of schizophrenia are reporte d for a representative cohort of 'treated incidence' patients ascertai ned on their first contact with Nottingham psychiatric services betwee n 1978-80. An initial (baseline) model including previously reported p redictors of 2-year outcome (age, gender, ever married, acuteness of o nset) and length of untreated illness was used to predict a range of o utcome measures covering the domains of disability, psychopathology, h ospitalization, employment, social activity, and global outcome. This model demonstrated significant prognostic ability across all non-hospi talization outcomes under both ICD-10 and ICD-9 diagnoses of schizophr enia, but was attenuated under broad (ICD-9 and CATEGO S, P or O) and restrictive (S+) diagnostic classifications. Female gender predicted m ore favourable outcome under all diagnostic classifications except S+. In an extended analysis, the addition of initial 2-year course type s ubstantially increased the prognostic ability of the model under all d iagnostic classifications and enabled over 30% of the variance in glob al ratings of disability and symptoms to be predicted. In this extende d model female gender predicted more favourable outcome over and above the effect of course type, across most domains under ICD-10, and for disability and psychopathology under other diagnostic classifications. The inclusion of measures of psychopathology at the time of first ass essment, pre-morbid functioning, and duration of index admission confe rred only marginal additional predictive ability for respective outcom es in the domains of psychopathology, social activity, employment and hospitalization. Hospitalization during the past year was the most dif ficult outcome to predict under any model suggesting that resource uti lization represents the 'administrative outcome' of schizophrenia and serves as a poor proxy for broader concerns in the era of community ca re. These data demonstrate that key demographic variables and the mode of onset influence the long-term course of schizophrenia, but that ea rly course type is a particularly strong predictor.