This Article  • References  • Full text PDF  • Correction  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Prognosis and Predictors of Outcome

Alan Breier, MD; Judith L. Schreiber, MSW; Janyce Dyer, MSN; David Pickar, MD

Arch Gen Psychiatry. 1991;48(3):239-246.

Abstract
• We performed a longitudinal study of chronic schizophrenic patients who were hospitalized for research purposes at the National Institute of Mental Health (NIMH) Intramural Program in the 1970s and early 1980s. We assessed present course, outcome and predictor data from the initial cohort of 58 young chronic schizophrenic patients who were followed up for 2 to 12 years following their NIMH index hospitalization. At follow-up, the sample showed substantial functional impairment and levels of symptoms with only about 20% of the sample demonstrating a good outcome. In addition, strong intercorrelation was noted among the symptom and functioning indexes at follow-up. Moreover, neuropsychologic tests of frontal cortical functioning were significantly correlated with outcome levels of negative symptoms and social functioning but not with levels of positive symptoms. During the period from the index hospitalization to the follow-up assessment, 78% of the sample suffered a relapse, 38% attempted suicide and 24% had episodes of major affective illness. Furthermore, levels of positive and negative symptoms ascertained when patients received optimal neuroleptic treatment during the index hospitalization significantly predicted outcome levels of symptoms and functioning and time spent hospitalized during the follow-up period. In contrast, levels of index positive and negative symptoms ascertained during the drugfree state did not predict outcome symptoms or functioning. These data suggest that treatment response is a critical predictor variable. We examined the implication of these data for the course of illness in schizophrenics.

Author Affiliations
From the Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Dr Breier); the Section on Clinical Studies, Clinical Neuroscience Branch, National Institute of Mental Health, Bethesda, Md (Ms Schreiber and Dr Pickar); and the Department of Psychiatry, University of Pittsburgh (Pa) (Ms Dyer).

Footnotes
Accepted for publication April 13, 1990.

Reprint requests to Maryland Psychiatric Research Center, PO Box 21247, Baltimore, MD 21228 (Dr Breier).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Psychiatric Comorbidities and Schizophrenia
Buckley et al.
Schizophr Bull 2009;35:383-402.
ABSTRACT | FULL TEXT  

Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis
Crumlish et al.
Br. J. Psychiatry 2009;194:18-24.
ABSTRACT | FULL TEXT  

Early Experiences of Employing Consumer-Providers in the VA
Chinman et al.
Psychiatr. Serv. 2008;59:1315-1321.
ABSTRACT | FULL TEXT  

Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia
Barnes et al.
Br. J. Psychiatry 2008;193:203-209.
ABSTRACT | FULL TEXT  

Outcomes of public concern in schizophrenia
Kooyman et al.
Br. J. Psychiatry 2007;191:s29-s36.
ABSTRACT | FULL TEXT  

The Camden Schizophrenia Surveys III: Five-Year Outcome of a Sample of Individuals From a Prevalence Survey and the Importance of Social Relationships
Harvey et al.
Int J Soc Psychiatry 2007;53:340-356.
ABSTRACT  

Legal Fallacies of Antipsychotic Drugs
Erickson et al.
J Am Acad Psychiatry Law 2007;35:235-246.
ABSTRACT | FULL TEXT  

References
APPI Online CME 2007;2007:2-2.
FULL TEXT  

Finding A Place in the World: The Experience of Recovery from Severe Mental Illness
Bradshaw et al.
Qualitative Social Work 2007;6:27-47.
ABSTRACT  

Cognitive Predictors of Social Functioning Improvements Following Cognitive Remediation for Schizophrenia
Reeder et al.
Schizophr Bull 2006;32:S123-S131.
ABSTRACT | FULL TEXT  

Negative Symptoms and Cognitive Deficits: What Is the Nature of Their Relationship?
Harvey et al.
Schizophr Bull 2006;32:250-258.
ABSTRACT | FULL TEXT  

Prognostic Variables at Intake and Long-Term Level of Function in Schizophrenia
Siegel et al.
Am. J. Psychiatry 2006;163:433-441.
ABSTRACT | FULL TEXT  

Duration of Untreated Psychosis and Time to Treatment Response for Delusions and Hallucinations
Gunduz-Bruce et al.
Am. J. Psychiatry 2005;162:1966-1969.
ABSTRACT | FULL TEXT  

Negative Symptoms and Specific Cognitive Impairments as Combined Targets for Improved Functional Outcome Within Cognitive Remediation Therapy
Greenwood et al.
Schizophr Bull 2005;31:910-921.
ABSTRACT | FULL TEXT  

Developing Drugs for Cognitive Impairment in Schizophrenia
Breier
Schizophr Bull 2005;31:816-822.
ABSTRACT | FULL TEXT  

Predictors of the Early 5-Year Course of Schizophrenia: A Path Analysis
Lenior et al.
Schizophr Bull 2005;31:781-791.
ABSTRACT | FULL TEXT  

Defining and Measuring Clinical Effectiveness in the Treatment of Schizophrenia
Nasrallah et al.
Psychiatr. Serv. 2005;56:273-282.
ABSTRACT | FULL TEXT  

Predictive Values of Neurocognition and Negative Symptoms on Functional Outcome in Schizophrenia: A Longitudinal First-Episode Study With 7-Year Follow-Up
Milev et al.
Am. J. Psychiatry 2005;162:495-506.
ABSTRACT | FULL TEXT  

A Randomized, Controlled Trial of Cognitive Behavioral Social Skills Training for Middle-Aged and Older Outpatients With Chronic Schizophrenia
Granholm et al.
Am. J. Psychiatry 2005;162:520-529.
ABSTRACT | FULL TEXT  

The Lifetime Risk of Suicide in Schizophrenia: A Reexamination
Palmer et al.
Arch Gen Psychiatry 2005;62:247-253.
ABSTRACT | FULL TEXT  

Cognitive Strategies Versus Self-Management Skills as Adjunct to Vocational Rehabilitation
Vauth et al.
Schizophr Bull 2005;31:55-66.
ABSTRACT | FULL TEXT  

Schizophrenia and Other Psychotic Disorders
Jibson et al.
Focus 2004;2:17-30.
ABSTRACT | FULL TEXT  

Two-Year Outcome in First-Episode Schizophrenia: Predictive Value of Symptoms for Quality of Life
Ho et al.
Focus 2004;2:131-137.
ABSTRACT | FULL TEXT  

Executive Control Function: A Review of Its Promise and Challenges for Clinical Research. A Report From the Committee on Research of the American Neuropsychiatric Association
Royall et al.
J. Neuropsychiatry Clin. Neurosi. 2002;14:377-405.
ABSTRACT | FULL TEXT  

Correlates of Change in Functional Status of Institutionalized Geriatric Schizophrenic Patients: Focus on Medical Comorbidity
Friedman et al.
Am. J. Psychiatry 2002;159:1388-1394.
ABSTRACT | FULL TEXT  

A 23-Year-Old Man With Schizophrenia
Goff
JAMA 2002;287:3249-3257.
FULL TEXT  

The psychopathology, medical management and dental implications of schizophrenia
FRIEDLANDER and MARDER
Journal of the American Dental Association 2002;133:603-610.
ABSTRACT | FULL TEXT  

Characteristics of Psychotic Disorder Due to Traumatic Brain Injury: An Analysis of Case Studies in the Literature
Fujii and Ahmed
J. Neuropsychiatry Clin. Neurosi. 2002;14:130-140.
ABSTRACT | FULL TEXT  

The Social Construction of Disability in Schizophrenia
Williams and Collins
Qual Health Res 2002;12:297-309.
ABSTRACT  

Social functioning and the course of early-onset schizophrenia: Five-year follow-up of a psychosocial intervention
LENIOR et al.
Br. J. Psychiatry 2001;179:53-58.
ABSTRACT | FULL TEXT  

Suicide and schizophrenia
Siris
J Psychopharmacol 2001;15:127-135.
ABSTRACT  

Relative Risk of Attention Deficits in Siblings of Patients With Schizophrenia
Egan et al.
Am. J. Psychiatry 2000;157:1309-1316.
ABSTRACT | FULL TEXT  

Differential Efficacy of Olanzapine for Deficit and Nondeficit Negative Symptoms in Schizophrenia
Kopelowicz et al.
Am. J. Psychiatry 2000;157:987-993.
ABSTRACT | FULL TEXT  

Untreated Initial Psychosis: Its Relation to Quality of Life and Symptom Remission in First-Episode Schizophrenia
Ho et al.
Am. J. Psychiatry 2000;157:808-815.
ABSTRACT | FULL TEXT  

Drug treatments for schizophrenia
Adams et al.
Qual Saf Health Care 2000;9:73-79.
FULL TEXT  

Effects of Clozapine on Psychiatric Symptoms, Cognition, and Functional Outcome in Schizophrenia
Manschreck et al.
J. Neuropsychiatry Clin. Neurosi. 1999;11:481-489.
ABSTRACT | FULL TEXT  

Pharmacologic Efficacy in Neuropsychiatry: A Review of Placebo-Controlled Treatment Trials
Rummans et al.
J. Neuropsychiatry Clin. Neurosi. 1999;11:176-189.
ABSTRACT | FULL TEXT  

Symptoms and Cognition as Predictors of Community Functioning: A Prospective Analysis
Norman et al.
Am. J. Psychiatry 1999;156:400-405.
ABSTRACT | FULL TEXT  

Effects of Clozapine for Non-Treatment-Resistant Patients With Schizophrenia
Galletly et al.
Psychiatr. Serv. 1999;50:101-103.
ABSTRACT | FULL TEXT  

Two-Year Outcome in First-Episode Schizophrenia: Predictive Value of Symptoms for Quality of Life
Ho et al.
Am. J. Psychiatry 1998;155:1196-1201.
ABSTRACT | FULL TEXT  

Rehab Rounds : Predicting Rehabilitation Outcome Among Patients With Schizophrenia
Ferdinandi et al.
Psychiatr. Serv. 1998;49:907-909.
ABSTRACT | FULL TEXT  

A Group Cognitive-Behavioral and Process-Oriented Approach to Treating the Social Impairment and Negative Symptoms Associated With Chronic Mental Illness
Daniels
J. Psychother. Pract. Res. 1998;7:167-176.
ABSTRACT | FULL TEXT  

Diagnosis, Neurobiology, and Treatment of First-episode Schizophrenia
Jarboe and Kilts
J Am Psychiatr Nurses Assoc 1998;4:S2-S9.
ABSTRACT  

Childhood-Onset Schizophrenia: A Double-blind Clozapine-Haloperidol Comparison
Kumra et al.
Arch Gen Psychiatry 1996;53:1090-1097.
ABSTRACT  

Enrollment Duration, Service Use, and Costs of Care for Severely Mentally Ill Members of a Health Maintenance Organization
McFarland et al.
Arch Gen Psychiatry 1996;53:938-944.
ABSTRACT  

Increased Rate of P300 Latency Prolongation With Age in Schizophrenia: Electrophysiological Evidence for a Neurodegenerative Process
O'Donnell et al.
Arch Gen Psychiatry 1995;52:544-549.
ABSTRACT  

Long-term Treatment for Lifetime Disorders?
Greden and Tandon
Arch Gen Psychiatry 1995;52:197-200.
ABSTRACT  

Predictors of Employment Status of Treated Patients With DSM-III-R dIagnosis. Can Logistic Regression Model Find a Solution?
Daradkeh and Karim
Int J Soc Psychiatry 1994;40:141-149.
ABSTRACT  

Cannabis Abuse and the Course of Recent-Onset Schizophrenic Disorders
Linszen et al.
Arch Gen Psychiatry 1994;51:273-279.
ABSTRACT  

The outcome of targeting community mental health services: evidence from the West Lambeth schizophrenia cohort
Conway et al.
BMJ 1994;308:627-630.
ABSTRACT | FULL TEXT  

Maintenance Imipramine Therapy for Secondary Depression in Schizophrenia: A Controlled Trial
Siris et al.
Arch Gen Psychiatry 1994;51:109-115.
ABSTRACT  

A 2- to 7-Year Follow-up Study of 54 Obsessive-Compulsive Children and Adolescents
Leonard et al.
Arch Gen Psychiatry 1993;50:429-439.
ABSTRACT  

Long-term Outcome in Chronic Schizophrenia
Schwartz et al.
Arch Gen Psychiatry 1992;49:502-502.
ABSTRACT  

Long-term Outcome in Chronic Schizophrenia-Reply
Breier et al.
Arch Gen Psychiatry 1992;49:503-503.
ABSTRACT  

Clinical and Biologic Response to Clozapine in Patients With Schizophrenia: Crossover Comparison With Fluphenazine
Pickar et al.
Arch Gen Psychiatry 1992;49:345-353.
ABSTRACT  

Negative Symptoms Are Related to Both Frontal and Nonfrontal Neuropsychological Measures in Chronic Schizophrenia
Perlick et al.
Arch Gen Psychiatry 1992;49:245-246.
ABSTRACT  

The Positive-Negative Distinction in Schizophrenia: Review of Natural History Validators
McGlashan and Fenton
Arch Gen Psychiatry 1992;49:63-72.
ABSTRACT  

Subjective Conclusions About Schizophrenia
PURYEAR et al.
Arch Gen Psychiatry 1992;49:74-74.
ABSTRACT  

Subjective Conclusions About Schizophrenia-Reply
HARROW et al.
Arch Gen Psychiatry 1992;49:75-76.
ABSTRACT  

Subjective Conclusions About Schizophrenia-Reply
BREIER et al.
Arch Gen Psychiatry 1992;49:74-75.
ABSTRACT