SYMPTOMS AT INDEX ADMISSION AS PREDICTOR FOR 1-5 YEAR OUTCOME IN SCHIZOPHRENIA

A total of 107 drug-free schizophrenic patients (76 males and 31 femal es) were consecutively admitted to an emergency ward and rated for psy chotic symptoms by means of 32 items from the Comprehensive Psychopath ological Rating Scale (CPRS). They were followed prospectively with ra tings of social functioning by use of Strauss-Carpenter's outcome scal e at 1, 3 and 5 years after index admission with the aim of determinin g possible early symptoms that are predictors of social outcome. In to tal, 59 of the patients were first admissions and had never been treat ed. At index admission, no difference was found in total CPRS scores b etween first-admission patients and chronic readmitted patients, or be tween male and female subjects. When subscales for positive symptoms ( flights of ideas, feeling controlled, disrupted thoughts, auditory hal lucinations, ideas of persecution) and negative symptoms (indecision, withdrawal, reduced speech, lack of appropriate emotions, slowness of movements) from the CPRS were applied, no relationship between the two subscales and outcome scores was found. However, in patients with a d uration of the disorder of less than 24 months before index admission, high scores on both negative and positive subscales were significantl y correlated with a poor 5-year outcome. No correlation was found in t he group with a duration of illness of more than 24 months before inde x admission. It is concluded that symptoms at index admission have a p redictive value for outcome in schizophrenic patients. Negative sympto ms measured by use of a subscale of the CPRS have a predictive value f or outcome up to 5 years after index admission, but high scores on bot h positive and negative symptoms are more strongly associated with a p oor outcome. The duration of the symptoms before admission, as well as the kind of neuroleptic treatment given (clozapine vs. classical neur oleptics), seem to be important factors for prediction of outcome. Our data support the view that early negative symptoms in particular have a predictive value for the prognosis in schizophrenia for up to 5 yea rs.