Determinants of the extremes of outcome in schizophrenia.
E C Johnstone, C D Frith, F H Lang, D G Owens


BACKGROUND Although poor prognosis has been considered a defining characteristic of schizophrenia, long-term studies show marked heterogeneity of outcome.

METHOD Assessments of positive and negative symptoms, premorbid and current IQ, and months of in-patient care made in an outcome study of 342 schizophrenic patients were categorised by severity. Determinants of these categorisations were sought from the historical variables available, using analysis of variance. Vignettes of patients with the best and worst symptomatic outcomes were then compared.

RESULTS Negative symptoms were associated with early onset, male sex and poor academic record. Positive symptoms were associated with occupational decline. Cognitive decline was associated with occupational variables, and in-patient care with academic and occupational variables. The vignettes showed that good outcome was associated with family psychiatric history and poor outcome with unavailability of family history.

CONCLUSIONS The findings support the view that the most malignant form of schizophrenia is neurodevelopmental, but poor outcome was clearly associated with family fragmentation.