PROSPECTIVE CLINICOPATHOLOGICAL STUDIES OF SCHIZOPHRENIA - ACCRUAL AND ASSESSMENT OF PATIENTS

Objective: The purpose of this study was to characterize the neuropsyc hiatric profile of elderly patients with schizophrenia and establish a patient registry for prospective ante-mortem and post-mortem studies. Method: Medical records of all chronically institutionalized patients in eight state hospitals who were over the age of 65 and had a chart diagnosis of schizophrenia (N=528) were reviewed. Of the potential sub jects, 192 were excluded because of clinical histories inconsistent wi th a diagnosis of schizophrenia, 56 because of insufficient informatio n to establish a psychiatric diagnosis, and 122 because of family memb ers' refusal to give consent for autopsy in the event of death. To dat e, 81 of the remaining 158 patients have undergone neuropsychiatric ev aluation with standard assessment instruments. Results: Mini-Mental St ate scores of the 81 patients indicated severe dementia, and Functiona l Assessment Scale scores showed that patients required assistance wit h activities of daily living. All patients were rated as severely ill on the Brief Psychiatric Rating Scale. Ratings on the Scale for the As sessment of Negative Symptoms and the Scale for the Assessment of Posi tive Symptoms indicated a predominance of negative symptoms over posit ive. Of 30 patients who have died to date, research autopsies have bee n conducted on 26. Conclusions: Establishing a well characterized, pro spective patient registry for clinicopathologic studies of schizophren ia is feasible but labor intensive. Diagnosis of schizophrenia with a high degree of confidence can be achieved by means of detailed chart r eview and assessment of current neuropsychiatric functioning with stan dard rating instruments, These data provide a basis for correlations o f clinicopathologic factors.