BRIEF
COMMUNICATIONS
Manic-Depressive BY
The
\1lCtl.EL
TYlA)I1.
\L\
authors
diagnosi.v poor
Illness
examined prognostic
\1.I).,
for signs
Good
Nl)
88 patient.c
ofschizophrenia
clinical
and
with the
RICII%I1I)
an
related
ABR\IS.
admission
presence
and
Prognosis
ofgood
and
theirfindings
to
the clinicalpresentation, response to somatic treatments, and prevalence of illness in first-degree relatives. The results augment the growing evidence that good and poor prognosis
good
schizophrenia
prognosis
indistinguishable
.schizoph from
are
different
renia
illnesses
and
that
NEED TO clinically differentiate remitting from deteniorating schizophrenia has led numerous investigators to relate various clinical features to prognosis. Robins and Guze ( I ) reviewed this literature and selected specific prognostic features which predicted outcome in approximately 85 percent of patients diagnosed as schizophrenic. They concluded that remitting schizophrenia was a different illness from deteriorating schizophrenia. McCabe and associates (2) compared symptom differences between schizophrenics with good versus poor prognostic signs and concluded that the former were more likely to have diagnosable mania or depression than the latter. A recent family interview study by Fowler and associates (3) demonstrated a significant excess of affective illness over schizophrenia in the first-degree family members of good prognosis schizophnenics and the reverse in family members of poor prognosis patients; these findings were consistent with the results generally found
reported
family
history
these authors. In a recent investigation of 247 admissions, we observed and tabulated prognostic signs of Robins and Guze
Drs. Taylor and Abrams are Associate partment of Psychiatry. State University Address reprint requests to Dr. Taylor N.Y. 10530.
studies
reviewed
admission diagnoses of schizophrenia. This report describes their clinical presentation, response to treatment, and family illness patterns.
This report is part of a larger study done at a municipal hospital in New York City during the seven months ending in March 1973. After admission to the hospital, each patient was examined by one of us during a semistructured interview and information was obtained for
illnes.c.
THE
in previously
\I.I).
METHOL)
is jreq uen dv
manic-depressive
Schizophrenia
by
consecutive hospital the good and poor (I) for patients with
Professors of Psychiatry, Deof New York at Stony Brook. at 9 Covent Place. Hartsdale.
the tal
following discharge
variables: diagnosis
admission (where
diagnosis, applicable),
prior hospidemographic
characteristics, the phenomenology of the index admission, past personal history, and illness patterns in first-degIee relatives. A research diagnosis was then made according to previously described criteria (4). After the patient was discharged from the hospital, the treatment outcome was rated by an investigator who was presented with a description of the patient’s condition on admission and at time of discharge. All information had been deleted concerning admission and research diagnosis, treatment received, demograph ic characteristics, family history, and symptom form (e.g., the terms “delusions,”
“hallucinations,”
“thought
disorder,”
and
“ab-
normal motor behavior” were used but the type of delusion, hallucination, etc., was not specified). Treatment response was rated on a four-point global scale (minimal, moderate, marked, remission). For the present report, we selected all patients with an index admission diagnosis of schizophrenia and divided them into two groups-those with good prognostic signs and
those
with
poor
prognostic
signs.
The criteria for good prognosis schizophrenia included sudden onset (less than three months) plus any two of the following: precipitating event, clouded consciousness or oneiroid state, broad affective range, and/or good premorbid adjustment. The criteria for poor prognosis schizophrenia included
AmJ
Psychiatry
132:7.July
1975
741
BRIEF
COMMUNICATIONS
insidious
onset
(greater
than
three
months)
plus
any
two
of the following: no precipitating event, clear consciousness, blunted affective range, and/or schizoid or paranoid premorbid personality. Differences between means were tested by t tests; frequency distributions were determined by chi-square tests with Yates’ correction where df= I . All tests were twotailed.
RES
U LTS
The admitting psychiatrists were usually attending physicians or psychiatric residents under the supervision of an attending physician, and their diagnostic criteria generally reflected the standard American texts used by major teaching hospitals in the United States. A total of 104 patients were admitted with the diagnosis of schizophrenia. Excluding 8 readmissions during the study period (so as not to count the same patient twice) and 8 patients with incomplete data for this phase of the study, there was a final sample of 88 patients) Sixty-four patients exhibited good prognostic signs and 24 exhibited poor prognostic signs. There was an excess of men in the poor prognosis group (x2 = 6. 12, p < .01 ), but no significant differences between groups were observed for racial distribution, ages at index admission and at illness
onset,
duration
of
illness,
number
of
hospitaliza-
tions, or number ofepisodes ofillness per ill patient year. A comparison of the frequency of various symptoms for the two groups revealed that good prognosis patients exhibited a significant excess of flight of ideas (x2=4.74, p
COMMUNICATIONS
Manic-Depressive BY
The
\1lCtl.EL
TYlA)I1.
\L\
authors
diagnosi.v poor
Illness
examined prognostic
\1.I).,
for signs
Good
Nl)
88 patient.c
ofschizophrenia
clinical
and
with the
RICII%I1I)
an
related
ABR\IS.
admission
presence
and
Prognosis
ofgood
and
theirfindings
to
the clinicalpresentation, response to somatic treatments, and prevalence of illness in first-degree relatives. The results augment the growing evidence that good and poor prognosis
good
schizophrenia
prognosis
indistinguishable
.schizoph from
are
different
renia
illnesses
and
that
NEED TO clinically differentiate remitting from deteniorating schizophrenia has led numerous investigators to relate various clinical features to prognosis. Robins and Guze ( I ) reviewed this literature and selected specific prognostic features which predicted outcome in approximately 85 percent of patients diagnosed as schizophrenic. They concluded that remitting schizophrenia was a different illness from deteriorating schizophrenia. McCabe and associates (2) compared symptom differences between schizophrenics with good versus poor prognostic signs and concluded that the former were more likely to have diagnosable mania or depression than the latter. A recent family interview study by Fowler and associates (3) demonstrated a significant excess of affective illness over schizophrenia in the first-degree family members of good prognosis schizophnenics and the reverse in family members of poor prognosis patients; these findings were consistent with the results generally found
reported
family
history
these authors. In a recent investigation of 247 admissions, we observed and tabulated prognostic signs of Robins and Guze
Drs. Taylor and Abrams are Associate partment of Psychiatry. State University Address reprint requests to Dr. Taylor N.Y. 10530.
studies
reviewed
admission diagnoses of schizophrenia. This report describes their clinical presentation, response to treatment, and family illness patterns.
This report is part of a larger study done at a municipal hospital in New York City during the seven months ending in March 1973. After admission to the hospital, each patient was examined by one of us during a semistructured interview and information was obtained for
illnes.c.
THE
in previously
\I.I).
METHOL)
is jreq uen dv
manic-depressive
Schizophrenia
by
consecutive hospital the good and poor (I) for patients with
Professors of Psychiatry, Deof New York at Stony Brook. at 9 Covent Place. Hartsdale.
the tal
following discharge
variables: diagnosis
admission (where
diagnosis, applicable),
prior hospidemographic
characteristics, the phenomenology of the index admission, past personal history, and illness patterns in first-degIee relatives. A research diagnosis was then made according to previously described criteria (4). After the patient was discharged from the hospital, the treatment outcome was rated by an investigator who was presented with a description of the patient’s condition on admission and at time of discharge. All information had been deleted concerning admission and research diagnosis, treatment received, demograph ic characteristics, family history, and symptom form (e.g., the terms “delusions,”
“hallucinations,”
“thought
disorder,”
and
“ab-
normal motor behavior” were used but the type of delusion, hallucination, etc., was not specified). Treatment response was rated on a four-point global scale (minimal, moderate, marked, remission). For the present report, we selected all patients with an index admission diagnosis of schizophrenia and divided them into two groups-those with good prognostic signs and
those
with
poor
prognostic
signs.
The criteria for good prognosis schizophrenia included sudden onset (less than three months) plus any two of the following: precipitating event, clouded consciousness or oneiroid state, broad affective range, and/or good premorbid adjustment. The criteria for poor prognosis schizophrenia included
AmJ
Psychiatry
132:7.July
1975
741
BRIEF
COMMUNICATIONS
insidious
onset
(greater
than
three
months)
plus
any
two
of the following: no precipitating event, clear consciousness, blunted affective range, and/or schizoid or paranoid premorbid personality. Differences between means were tested by t tests; frequency distributions were determined by chi-square tests with Yates’ correction where df= I . All tests were twotailed.
RES
U LTS
The admitting psychiatrists were usually attending physicians or psychiatric residents under the supervision of an attending physician, and their diagnostic criteria generally reflected the standard American texts used by major teaching hospitals in the United States. A total of 104 patients were admitted with the diagnosis of schizophrenia. Excluding 8 readmissions during the study period (so as not to count the same patient twice) and 8 patients with incomplete data for this phase of the study, there was a final sample of 88 patients) Sixty-four patients exhibited good prognostic signs and 24 exhibited poor prognostic signs. There was an excess of men in the poor prognosis group (x2 = 6. 12, p < .01 ), but no significant differences between groups were observed for racial distribution, ages at index admission and at illness
onset,
duration
of
illness,
number
of
hospitaliza-
tions, or number ofepisodes ofillness per ill patient year. A comparison of the frequency of various symptoms for the two groups revealed that good prognosis patients exhibited a significant excess of flight of ideas (x2=4.74, p
