Exploring the longitudinal course of psychotic illness: A case-study approach

Objective: Thirty-three patients with a diagnosis of a psychotic disorder ( schizophrenia, bipolar disorder, atypical psychosis) according to the Diagn ostic and Statistical Manual of Mental Disorders (DSM-III-R) were studied t o qualitatively assess the longitudinal course of the disorder using a case -study approach. Methods: Weekly fluctuations in patient symptomatology and overall social a nd personal functioning using the Global Assessment Scale were assessed fol lowing index hospitalization. Patients were followed for I year. Results: The emergent courses showed no relationship 20 diagnosis but follo wed 3 general trends. I) positive incline, 2) fluctuating, and 3) stable. I ndividual representations of each course were examined closely, and biologi cal and psychosocial factors associated with each were evaluated. Conclusions: The results supported the longitudinal patterns and individual interactions of Strauss's Interactive Developmental Model. The clinical co urse of psychotic disorders may be represented by 3 patterns. Key factors i n the interaction between patient and environment that generate important c hanges in the evolution of each illness were illustrated.