CLINICAL AND BIOLOGICAL MARKERS FOR OUTCOME IN SCHIZOPHRENIA - A REVIEW OF A LONGITUDINAL FOLLOW-UP-STUDY IN UPPSALA SCHIZOPHRENIA RESEARCH-PROJECT

During a 10-year period, 120 drugfree DSM-III-R schizophrenic patients were consecutively and unselectively admitted to a ward for young psy chotic patients and subjected to a battery of examinations including s ymptomatology, cerebrospiral fluid (CSF)-biochemistry, computed tomogr aphy (CT)-scan, neurophysiologic and psychophysiologic (Electrodermal activity, EDA) parameters before antipsychotic treatment was initiated . After discharge, the patients were longitudinally followed with rati ng of outcome (Strauss-Carpenters outcome scale) at years 1, 3, and 5 after index admission. The aim of the study was to find possible early markers for outcome in schizophrenia. At 5 years, 30% of the patients had a good outcome (total score >13) and 15% a poor outcome (total sc ore <8). Poor premorbid adjustment and low level of education as well as negative schizophrenic symptomatology at index admission were assoc iated with a poor outcome 5 years later. Positive symptomatology and a family history of schizophrenia did not predict outcome. Patients wit h a poor outcome (total score <8) had a significantly more deviant CSF HVA/5-HIAA quotient than those with a very good outcome (total score >15) as compared with healthy controls. Further, the CSF-peptides neur opeptide Y, dynorphin A, and CRF were predictable for outcome at the 5 -year follow-up evaluation. Male schizophrenics who were ''nonresponde rs'' on the EDA test showed an almost 100% poor outcome, which was not found in females. In summary, several clinical and biological variabl es seem to have a predictable value for outcome in schizophrenia and, early identification of them might be a challenge for our future treat ment strategies.