Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T06:40:29.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychopathological syndromes in the functional psychoses: associations with course and outcome

Published online by Cambridge University Press:  09 July 2009

J. Van Os ,
T. A. Fahy ,
P. Jones ,
I. Harvey ,
P. Sham ,
S. Lewis ,
P. Bebbington ,
B. Toone ,
M. Williams  and
R. Murray
J. Van Os*
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
T. A. Fahy
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
P. Jones
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
I. Harvey
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
P. Sham
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
S. Lewis
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
P. Bebbington
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
B. Toone
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
M. Williams
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
R. Murray
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
*
1Address for correspondence: Dr Jim van Os, Department of Psychiatry, Section of Social Psychiatry and Psychiatric Epidemiology, University of Limburg, PO Box 616, 6200 MD Maastricht, The Netherlands.
Get access Rights & Permissions [Opens in a new window]

Synopsis

The aim of this study was to identify underlying dimensions of psychopathology in a cohort of patients with functional psychosis of recent onset, and to examine their prognostic value. Factor analysis of the psychopathological features of 166 consecutively admitted patients with functional psychosis of recent onset revealed seven psychopathological dimensions, which explained 63% of the variance. Five of these seven syndromes bore differential associations with subsequent treatment and illness course, independent of: (i) associations with DSM-III-R diagnosis; (ii) associations with other prognostic factors; and (iii) associations with the baseline values of outcome variables. The most striking associations were shown for an early and insidious onset syndrome with affective flattening, which predicted a more disabled course of illness on three of four outcome dimensions, and which was more common in males and unmarried individuals. A second syndrome, characterized by bizarre behaviour, inappropriate affect, catatonia, and poor rapport showed similar, slightly less striking, associations with illness course, as well as with poor pre-morbid social functioning. A third syndrome, characterized by positive psychotic symptoms was to a lesser degree associated with poorer outcome, whereas a fourth syndrome distinguished by manic symptomatology predicted a more benign illness course. A fifth syndrome identified by lack of insight predicted more time in hospital and admission under a section of the Mental Health Act during the follow-up period.

A further finding was that dimensional representations of psychopathological features were considerably more useful than categorical representations (DSM-III-R and ICD-10) as predictors of illness course and treatment decisions.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 1 , January 1996 , pp. 161 - 176
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bartko, G., Herczeg, I. & Zador, G. (1988). Clinical symptomatology and drug compliance in schizophrenic patients. Acta Psychiatrica Scandinavica 77, 74–76.CrossRefGoogle ScholarPubMed
Bland, R. (1982). Predicting the outcome in schizophrenia. Canadian Journal of Psychiatry 27, 52–62.CrossRefGoogle ScholarPubMed
Bland, R. & Orn, H. (1980). Schizophrenia: Schneider's first rank symptoms and outcome. British Journal of Psychiatry 137, 63–68.CrossRefGoogle ScholarPubMed
Brockington, I., Kendell, R. E. & Leff, J. (1978). Definitions of schizophrenia: concordance and prediction of outcome. Psychological Medicine 8, 387–398.CrossRefGoogle ScholarPubMed
Brockington, I., Roper, A., Edmunds, E., Kaufman, C. & Meltzer, H. (1992). A longitudinal psychopathological schedule. Psychological Medicine 22. 1035–1043.CrossRefGoogle ScholarPubMed
Brown, K. &White, T. (1992). Syndromes of schizophrenia and some clinical correlates. British Journal. of Psychiatry 161, 317–322.CrossRefGoogle ScholarPubMed
Buchanan, A. (1992). A two-year prospective study of treatment compliance in patients with schizophrenia. Psychological Medicine 22, 787–797.CrossRefGoogle ScholarPubMed
Carpenter, W., Bartko, J., Strauss, J. & Hawk, A. (1978). Signs and symptoms as predictors of outcome: a report for the international pilot study of schizophrenia. American Journal of Psychiatry 135, 940–945.Google ScholarPubMed
Castle, D. & Murray, R. (1991). The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine 21, 565–575.CrossRefGoogle ScholarPubMed
Castle, D., Phelan, M., Wessely, S. & Murray, M. (1993). Which schizophrenics are not admitted at first psychiatric contact? An analysis of 484 patients. Schizophrenia Research 9, 130.Google Scholar
Cloninger, C., Martin, R., Guze, S. & Clayton, P. (1985). Diagnosis and prognosis in schizophrenia. Archives of General Psychiatry 42, 15–25.CrossRefGoogle ScholarPubMed
Costello, C. (1992). Research on symptoms versus research on syndromes. Arguments in favour of allocating more research time to the study of symptoms. British Journal of Psychiatry 160, 304–308.CrossRefGoogle Scholar
David, T. (1990). Insight and psychosis. British Journal of Psychiatry 157, 774–775.CrossRefGoogle Scholar
Dunn, G., Sham, P. & Hand, D. (1993). Statistics and the nature of depression. Psychological Medicine 23, 871–889.CrossRefGoogle ScholarPubMed
Endicott, J., Nee, J., Cohen, J., Fleiss, J. & Simon, R. (1986). Diagnosis of schizophrenia. Prediction of short-term outcome. Archives of General Psychiatry 43, 13–19.CrossRefGoogle ScholarPubMed
Everitt, B., Gourlay, A. & Kendell, R. E. (1971). An attempt at validation of traditional psychiatric syndromes by cluster analysis. British Journal of Psychiatry 119, 399–412.CrossRefGoogle ScholarPubMed
Fenton, W. & McGlashan, T. (1991). Natural history of schizophrenia subtypes. II. Positive and negative symptoms and long-term course. Archives of General Psychiatry 48, 978–986.CrossRefGoogle ScholarPubMed
Fleiss, J., Gurland, B. & Cooper, J. (1971). Some contributions to the measurement of psychopathology. British Journal of Psychiatry 119, 647–656.CrossRefGoogle Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Hirsch, S. (1991). Affective symptoms in schizophrenia, basic, prodromal and residual: implications for a functional approach to diagnosis. In Concepts of Mental Disorder: A Continuing Debate (ed. Kerr, A. and McClelland, H.), pp. 66–74. Gaskell: London.Google Scholar
Huber, G., Gross, G., Schüttler, R. & Linz, M. (1980). Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin 6, 592–605.CrossRefGoogle ScholarPubMed
Iager, A. C., Kirch, D. G. & Wyatt, R. J. (1985). A negative symptom rating scale. Psychiatry Research 16, 27–36.CrossRefGoogle ScholarPubMed
Jablensky, A., Schwartz, R. & Tomov, T. (1980). WHO collaborative study of impairments and disabilities associated with schizophrenic disorders. A preliminary communication. Objective and methods. Acta Psychiatrica Scandinavica, suppl. 285, 152–163.CrossRefGoogle Scholar
Johnstone, E. C., Crow, T. J., Frith, C. D. & Owens, D. G. (1988). The Northwick Park ‘functional’ psychosis study: diagnosis and treatment response. Lancet ii, 119–125.CrossRefGoogle Scholar
Kay, S. & Murrill, L. (1990). Predicting outcome of schizophrenia: significance of symptom profiles and outcome dimensions. Comprehensive Psychiatry 31, 91–102.CrossRefGoogle ScholarPubMed
Kendell, R. (1975). The Role of Diagnosis in Psychiatry. Blackwell: Oxford.Google Scholar
Kendell, R., Brockington, I. & Leff, J. (1979). Prognostic implications of six alternative definitions of schizophrenia. Archives of General Psychiatry 35, 25–31.CrossRefGoogle Scholar
Leff, J., Sartorius, N., Jablensky, A., Korten, A. & Ernberg, G. (1992). The International Pilot Study of Schizophrenia: five year follow-up findings. Psychological Medicine 22, 131–145.CrossRefGoogle ScholarPubMed
Lenzenweger, M., Dworkin, R. & Wethington, E. (1991). Examining the underlying structure of schizophrenic phenomenology: evidence for a three-process model. Schizophrenia Bulletin 17, 515–524.CrossRefGoogle ScholarPubMed
Liddle, P. (1987 a). The symptoms of schizophrenia. A re-examination of the positive–negative dichotomy. British Journal of Psychiatry 151, 145–151.CrossRefGoogle ScholarPubMed
Liddle, P. (1987 b). Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine 17, 49–57.CrossRefGoogle ScholarPubMed
Liddle, P., Friston, K., Frith, C., Hirsch, S., Jones, T. & Frackowiak, R. (1992). Patterns of cerebral blood flow in schizophrenia. British Journal of Psychiatry 160, 179–186.CrossRefGoogle ScholarPubMed
McEvoy, J., Freter, S., Everett, G., Geller, J., Appelbaum, P., Apperson, J. & Roth, L. (1989). Insight and the clinical outcome of schizophrenic patients. Journal of Nervous and Mental Disease 177, 48–51.CrossRefGoogle ScholarPubMed
McGlashan, T. (1981). Does attitude toward psychosis relate to outcome? American Journal of Psychiatry 138, 797–801.Google ScholarPubMed
McGlashan, T. (1988). A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophrenia Bulletin 14, 515–542.CrossRefGoogle ScholarPubMed
McGuffin, P., Farmer, A. E. & Harvey, I. (1991). A polydiagnostic application of operational criteria in psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764–770.CrossRefGoogle ScholarPubMed
Manley, B. (1986). Multivariate Statistical Methods. Chapman & Hall: London.Google Scholar
May, P., Tuma, H. & Dixon, W. (1981). Schizophrenia, a follow-up study of the results of five forms of treatment. Archives of General Psychiatry 38, 776–784.CrossRefGoogle ScholarPubMed
Maxwell, A. E. (1971). Multivariate statistical methods and classification problems. British Journal of Psychiatry 119, 121–127.CrossRefGoogle ScholarPubMed
Maxwell, A. E. (1972). Difficulties in a dimensional description of symptomatology. British Journal of Psychiatry 121, 19–26.CrossRefGoogle Scholar
Mortimer, A., Lund, C. & McKenna, P. (1990). The positive–negative dichotomy in schizophrenia. British Journal of Psychiatry 157, 41–49.CrossRefGoogle ScholarPubMed
Peralta, V., De Leon, J. & Cuesta, M. (1992). Are there more than two syndromes in schizophrenia? A critique of the positive–negative dichotomy. British Journal of Psychiatry 161, 335–343.CrossRefGoogle ScholarPubMed
Philips, L. (1953). Case history data and prognosis in schizophrenia. Journal of Nervous and Mental Diseases 117, 515–525.CrossRefGoogle Scholar
Pogue-Geile, M. (1989). The prognostic significance of negative symptoms in schizophrenia. British Journal of Psychiatry 155 (suppl. 7), 123–127.CrossRefGoogle Scholar
Pope, H. & Lipinski, J. (1978). Diagnosis in schizophrenia and manic depressive illness. Archives of General Psychiatry 35, 811–828.CrossRefGoogle ScholarPubMed
Prentky, R., Lewine, R., Watt, N. & Fryer, J. (1980). A longitudinal study of psychiatric outcome: developmental variables vs. psychiatric symptoms. Schizophrenia Bulletin 6, 139–148.CrossRefGoogle ScholarPubMed
Shepherd, M., Watt, D., Falloon, I. & Smeeton, N. (1989). The Natural History of Schizophrenia: a Five-year Follow-up Study of Outcome and Prediction in a Representative Sample of Schizophrenics. Psychological Medicine, Medicine, Monograph Suppl. 15. Cambridge University Press: Cambridge.Google Scholar
Soni, S., Hollis, S., Reed, P. & Musa, S. (1992). Syndromes of schizophrenia on factor analysis. British Journal of Psychiatry 161, 860–861.CrossRefGoogle ScholarPubMed
Soskis, D. & Bowers, M. (1969). The schizophrenic experience: a follow-up study of attitude and post-hospital adjustment. Journal of Nervous and Mental Disease 149, 443–449.CrossRefGoogle Scholar
Spitzer, R., Fleiss, J., Endicott, J. & Cohen, J. (1967). Mental status schedule. Archives of General Psychiatry 16, 479–493.CrossRefGoogle ScholarPubMed
Spitzer, R., Gibbon, M. & Endicott, J. (1975). The Global Assessment Scale (GAS). New York State Psychiatric Institute: New York.Google Scholar
Spitzer, R., Endicott, J. & Robins, E. (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
STATA Corporation (1993). STATA Reference Manual: Release 3.1, 6th edn. College Station: TX.Google Scholar
Stephens, J. & Astrup, C. (1963). Prognosis in ‘process’ and ‘nonprocess’ schizophrenia. American Journal of Psychiatry 119, 945–953.CrossRefGoogle Scholar
Strauss, J. S. & Carpenter, W. T. (1978). The prognosis of schizophrenia: rationale for a multidimensional concept. Schizophrenia Bulletin 4, 56–67.CrossRefGoogle ScholarPubMed
Thompson, P. & Meltzer, H. (1993). Positive, negative, and disorganisation factors from the schedule for affective disorders and schizophrenia and the present state examination. British Journal of Psychiatry 163, 344–351.CrossRefGoogle ScholarPubMed
Wechsler, D. (1955). Wechsler Adult Intelligence Scale: Manual. Psychological Corporation: New York.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
World Health Organization (1992). WHO Coordinated Multi-center Study on the Course and Outcome of Schizophrenia. WHO: Geneva.Google Scholar