Comparison of long-term outcome of schizophrenic, affective and schizoaffective disorders.
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Adult↗
Biomedical subjects
A Deister
Publications and source records attributed to A Deister.
Stability of diagnoses in affective, schizoaffective and schizophrenic disorders. Cross-sectional versus longitudinal diagnosis.
The present study investigated the syndrome shift during the course of disease in 355 patients with functional psychoses. The mean observation time was 25.2 years. Every episode was diagnosed cross-sectionally as schizophrenic, melancholic, manic, manic-depressive mixed, schizodepressive, schizomanic or schizomanic-depressive mixed. With regard to the whole course, 148 patients fulfilled the diagnostic criteria of schizophrenic, 106 of affective and 101 of schizoaffective disorders. Patients with a schizophrenic initial episode showed the greatest stability: 90% had no other type of episode. The majority of patients who suffered a melancholic initial episode remained unipolar melancholics or developed manic symptomatology, and only a few suffered schizoaffective or schizophrenic episodes. Patients with a manic symptomatology at the beginning had a very unstable and changeable course. The stability of patients with initial schizodepressive episodes lay between that of patients with melancholic initial episodes and that of those with manic initial episodes. The findings demonstrate the relevance of longitudinal considerations in making the final diagnosis.
Bipolar Disorder↗
[Phenomenologic constellations of persistent alterations in idiopathic psychoses. An empirical comparative study].
The long-term outcome of 355 patients with affective, schizoaffective and schizophrenic disorders was evaluated after long duration of the illness (mean more than 25 years). All patients were personally interviewed using operational instruments (PSE, WHO/DAS, WHO/PIRS, GAS, Huber's Psychopathological Criteria). By application of descriptive methods, integrating operationally estimated findings with clinically-impressively estimated "interactional atmosphere", we defined eight types of phenomenological constellations of persistent alterations ("residual-types") of functional disorders: "depletion syndrome", "apathetic-paranoid syndrome (resp. apathetic-hallucinatory syndrome)", "adynamic-deficient syndrome", "chronic psychosis", "structural deformation", "asthenic insufficiency syndrome", "chronic subdepressive syndrome", and "chronic hyperthymic syndrome". It was found a different distribution of persistent alterations in affective and schizophrenic disorders while schizoaffective disorders occupied a position in-between. The differences in the phenomenology of persistent alterations are interpreted as the result of differing biological and psychological processes. It was also found that the phenomenology of persistent alterations is related to the degree of disability.
Adult↗
[Affective, schizoaffective and schizophrenic psychoses. A comparative long-term study].
A total of 402 patients were followed up for, on average, 25 years after the onset of their illness. The diagnoses, made longitudinally, were as follows: schizophrenic disorder (n = 148); schizoaffective disorder (n = 101); affective disorder (n = 106). The remaining 47 patients did not fulfil the criteria for any of these diagnoses. A distinction was made between "episode" (cross-sectional diagnosis) and "illness" or "disorder" (longitudinal diagnosis). The "episodes" (cross-sectional diagnosis) were classified according to slightly modified DSM-III criteria into schizophrenic, affective (melancholic, manic, manic-depressive mixed), schizoaffective (schizodepressive, schizomanic, schizomanic-depressive mixed) and non-characteristic episodes. The criteria for the episodes are: Schizophrenic episode: criteria of DSM-III, slightly modified. Melancholic episode: according to "Major Depression, Melancholic Type" of DSM-III-R. Manic episode: according to the criteria of DSM-III, slightly modified. Manic-depressive mixed episode: Presence of manic and depressive symptomatology during one episode. Schizodepressive episode: Presence of schizophrenic and depressive symptomatology during one episode. --Schizomanic episode: presence of schizophrenic and manic symptomatology during one episode. Schizomanic-depressive mixed episode: Presence of schizophrenic, manic and depressive symptomatology during one episode. The diagnosis of an "illness" or "disorder" (longitudinal diagnosis) took account of all the kinds of episodes that occurred during the whole course. The final diagnosis (longitudinal diagnoses) were defined as follows: Schizophrenic disorder: only schizophrenic episodes during the whole course Affective disorder: only affective episodes during the whole course (melancholic, manic, manic-depressive mixed episodes). Schizoaffective disorder: at least one schizoaffective episode during the course (schizodepressive, schizomanic, schizomanic-depressive mixed episode), independently of the type and number of other episodes, or sequential manifestation of schizophrenic and affective episodes. The principal instruments of investigation and evaluation were: Global Assessment Scale (GAS); Disability Assessment Schedule (WHO/DAS); Psychological Impairment Rating Schedule (WHO/PIRS); Present State Examination (PSE); Criteria for social class and social mobility according to Kleining and Moore (also transferred to the criteria of Hollingshead and Redlich) - A pool of items based on WHO instruments for social parameters; Items for pharmacological treatment and prophylaxis.
Activities of Daily Living↗
[Self-sufficiency and impaired self-sufficiency in schizophrenic patients].
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Activities of Daily Living↗
The concept of distinct but voluminous groups of bipolar and unipolar diseases. I. Bipolar diseases.
One hundred and six affective (76 unipolar and 30 bipolar) and 101 schizoaffective patients (45 unipolar and 56 bipolar) were investigated after a long-term course of illness, evaluating sociodemographic and general data, the long-term course of illness, disability and psychosocial alterations according to WHO/DAS, WHO/PIRS and GAS, as well as several social consequences of the illness (living situation at the end of the observation time, downward occupational drift, downward social drift, premature retirement, achievement of the expected social development). Comparing the 30 bipolar affective and 56 bipolar schizoaffective disorders, no differences were found regarding (a) sociodemographic and general data (i.e. sex distribution, age at onset, education and occupation at onset, stable heterosexual relationship, premorbid personality and social interactions, mental illness in the family, broken home, life events, season of birth and social classes) and (b) relevant patterns of the long-term course. Regarding long-term outcome, the only difference found concerned the more favourable outcome of the bipolar affective disorders according to WHO/DAS, while using GAS the difference was not statistically significant. No difference was found either between the two bipolar groups in the social consequences of the illness. The combining of both bipolar groups as "bipolar diseases" is discussed, as well as the use of the terms "bipolar disease, affective subtype" and "bipolar disease, schizoaffective subtype".
Adult↗
The concept of distinct but voluminous groups of bipolar and unipolar diseases. II. Unipolar diseases.
Seventy-six unipolar affective and 45 unipolar schizoaffective patients were compared using the same instruments as mentioned in part I of this study (this issue). In contrast to bipolar diseases significant differences regarding age at onset were found between the unipolar groups: schizoaffective unipolar patients became ill at a significantly lower age than affective unipolar patients (about 8 years). No other sociodemographic differences were found between the two groups. Patterns of course were found to be similar in both unipolar groups. Unipolar affective patients had a more favourable long-term outcome (GAS and WHO/DAS) than unipolar schizoaffective ones. Altogether, unipolar affective and unipolar schizoaffective disorders seems to have more similarities than differences.
Activities of Daily Living↗
The concept of distinct but voluminous groups of bipolar and unipolar diseases. III. Bipolar and unipolar comparison.
Comparing unipolar diseases (n = 121) as one group with bipolar diseases (n = 86) as another group (both groups including affective and schizoaffective disorders) relevant differences were found in sex distribution, age at onset, premorbid personality, long-term course and some aspects of long-term outcome. Although building two voluminous groups of "unipolar diseases" and "bipolar diseases" runs some risk of inhomogeneity, this danger could perhaps be limited by referring to the "affective subtype" and the "schizoaffective subtype".
Activities of Daily Living↗
[Disability and residual symptoms in schizoaffective psychoses--data, methodologic problems and references for future research].
Schizoaffective disorders take a position between schizophrenia and affective disorders regarding outcome in the sense of psychological residuum and social consequences. What prognosis a schizoaffective illness has depends mainly on intrasymptomatological factors: Melancholic episodes during course seem to predict a good long-term outcome, schizophrenia-typical symptoms in the opposite predestinate to the development of residuum and disability. Non-symptomatological factors do not have any direct influence on the development of a residuum and disability. The comparison of course studies is limited by severe difficulties based on methodological and definitional shortcomings. Such shortcomings are (a) broad definition of schizoaffective but also of schizophrenic psychoses, (b) globalization of the term "outcome", (c) partialization of the term "prognosis", (d) equalization of the terms "course" and "outcome", (e) ignoring of inhomogeneity and polymorphism of schizoaffective disorders, (f) global evaluation of "outcome", (g) short follow-up periods. Some suggestions how to limitate the mentioned methodological shortcomings are discussed.
Disability Evaluation↗
Lymphocytes of healthy subjects and schizophrenic patients possess no high-affinity binding sites for spiroperidol.
We investigated 3H- and 125I-spiroperidol binding to lymphocytes from healthy subjects and schizophrenic patients and compared it with that to a porcine striatum dopaminergic D2-receptor preparation using identical conditions. Incubation for 60 min at 37 degrees C reduced lymphocyte 3H-spiroperidol binding to 29% of its maximal value. Binding of 3H- and 125I-spiroperidol to striatal membranes was saturable and showed high affinity; the apparent half-maximal saturation constants, KD, were 0.5 nmol/l and 1.0 nmol/l respectively for the two ligands. Lymphocyte membranes did not possess high-affinity binding sites for 3H-spiroperidol; binding to intact lymphocytes was saturable in the micromolar range; the KD values of healthy subjects and schizophrenic patients were similar. Validating all lymphocyte binding studies by parallel experiments with a striatal receptor preparation showed that human lymphocytes do not possess physiologically relevant high-affinity spiroperidol receptors.
Adult↗
Psychopathological and social status of patients with affective, schizophrenic and schizoaffective disorders after long-term course.
A total of 106 affective, 101 schizoaffective and 148 schizophrenic disorders were investigated after a long-term course of illness (mean follow-up period 25.1 years), employing narrow definitions and using reliable international instruments of evaluation. In addition, the social consequences of the illness were evaluated (upward and downward social and occupational drift, premature retirement and achievement of the expected social development). Considering all aspects of outcome, schizophrenic patients (narrow defined, slightly modified DSM-III criteria) had persistent alterations in several aspects of social life, communication and cognitive functions, in some cases to a very high degree. Although the outcome of affective disorders is not always favourable, it is significantly more favourable than that of schizophrenia. Schizoaffective disorders occupy a position between affective and schizophrenic disorders regarding outcome, but with more similarities to that of affective than to that of schizophrenic disorders.
Adolescent↗
Long-term outcome of schizoaffective and schizophrenic disorders: a comparative study. I. Definitions, methods, psychopathological and social outcome.
The long-term outcome of 72 schizoaffective and 97 schizophrenic patients with a mean duration of illness of 25.6 years and 19.6 years respectively was investigated. The outcome was assessed using the WHO Disability Assessment Schedule (WHO/DAS), the Psychological Impairment Rating Schedule (PIRS) (also developed by the WHO), the Global Assessment Scale (GAS), and the Bonn Psychopathological Criteria of Outcome. The outcome of schizoaffective disorders was found to differ from that of schizophrenia in several ways: (a) schizoaffectives achieve a full remission significantly more frequently than schizophrenics (50% vs 10%); (b) the development of so-called characteristic schizophrenic residua is the exception in schizoaffective disorders, but is frequent in schizophrenia; (c) disability, psychological impairment and disturbances of the level of functioning are not only significantly less frequent in schizoaffective disorders but are also less intense than in the schizophrenic group. The factors influencing the outcome of the two disorders are different (see part II), as are the social consequences (part III).
Adult↗
Long-term outcome of schizoaffective and schizophrenic disorders: a comparative study. II. Causal-analytical investigations.
The influence of symptomatological and non-symptomatological factors on the long-term outcome of schizoaffective and schizophrenic disorders was investigated using the Analysis of Linear Structural Relationships (LISREL). The outcome was assessed employing the GAS, WHO/DAS, PIRS and the Bonn Criteria of Outcome. The analysis produced some interesting results in both groups, separately and in comparison with each other. The most striking difference between the two disorders concerns the finding that only symptomatological parameters directly influence the long-term outcome of schizoaffective disorders - melancholic episodes are correlated with favourable outcome, symptoms typical of schizophrenia with a relatively unfavourable outcome. Both symptomatological parameters (such as schizophrenic first-rank symptoms during course) and non-symptomatological parameters (such as life events or acuteness of onset) have a direct impact on the outcome. It was also found that "simple" depressive symptomatology (the presence of depressive symptoms not fulfilling the criteria of melancholic episodes according to DSM-III-R) has no influence on the long-term outcome of schizophrenia.
Adult↗
Long-term outcome of schizoaffective and schizophrenic disorders: a comparative study. III. Social consequences.
A significantly higher proportion of schizophrenic than schizoaffective patients were found to experience negative social consequences of their illness. Schizophrenic males are more likely to have an unfavourable social prognosis than are schizophrenic females or schizoaffective patients of either gender. Schizophrenic males are, however, equally disadvantaged in regard to social consequences independently of other premorbid and sociodemographic factors. Unfavourable social consequences in male schizophrenics and favourable ones in female schizoaffectives can be predicted with high probability. Some social consequences can be predicted with relatively high probability for male schizoaffectives, while no prognosis can be made for female schizophrenics.
Achievement↗
Unipolar and bipolar schizoaffective disorders: a comparative study. I. Premorbid and sociodemographic features.
Seventy-two schizoaffective patients were investigated longitudinally (mean follow-up period 25.6 years). Unipolar (n = 37) and bipolar (n = 35) schizoaffectives were compared. Relevant differences in sociodemographic variables were found between the two groups, especially in: (a) sex distribution (more females among unipolar schizoaffectives), (b) social class, (c) occupational and educational level (higher in bipolars), and (d) premorbid personality (obsessoid and low-self-confidence personality types were more frequent in unipolars). Surprisingly there was no difference in age of onset, but some factors were identified that elevated the age of onset in bipolar and reduced it in unipolar schizoaffectives, which may explain this finding. Among bipolars there were more frequent relapses, but there was more suicidal symptomatology in unipolars. No differences were found with regard to long-term outcome, i.e. disability (Disability Assessment Schedule), level of functioning (Global Assessment Scale) or psychopathology at follow up.
Adult↗
Unipolar and bipolar schizoaffective disorders: a comparative study. II. Long-term course.
Seventy-two schizoaffective patients were investigated longitudinally (mean follow-up period 25.6 years). Of these, 37 were classified as unipolar and 35 as bipolar schizoaffectives. Their long-term courses were compared. Bipolar schizoaffectives were found to have shorter cycles, i.e. more frequent relapses and more episodes. Bipolars displayed much more variation in symptomatology. Unipolar schizo-affectives had longer periods of remission (that is the last relapse-free period if longer than 3 years) and more frequently showed suicidal symptomatology than did bipolar schizoaffectives. Altogether bipolar schizoaffective disorders had a more unfavourable course than unipolar disorders.
Adaptation, Psychological↗
Unipolar and bipolar schizoaffective disorders: a comparative study. III. Long-term outcome.
Seventy-two schizoaffective patients were investigated longitudinally (mean follow-up period 25.6 years). Long-term outcome of unipolar (N = 37) and bipolar (N = 35) schizoaffectives was compared. Different aspects of outcome were investigated separately using standardized instruments of evaluation. No differences were found between unipolar and bipolar schizoaffective patients with regard to global functioning (GAS), disability (WHO/DAS) or psychopathological symptomatology at follow-up. There were also no differences in social consequences of the illness, i.e. downward occupational and downward social drift, premature retirement and achievement of the expected social development.
Adult↗
[Premorbid and social markers of patients with schizoaffective psychoses].
The present study reports on findings in international literature regarding premorbid and social factors of schizoaffective patients and also own findings of the Cologne study (72 schizoaffective patients with a mean follow-up period of 25.6 years). Altogether it can be said that more women suffer from schizoaffective disorders than men. The mean age at first manifestation is higher than that of schizophrenic patients and lower than that of affective disorders, although schizoaffective disorders can occur at any age. Premorbid social adjustment and ability to form a stable heterosexual partnership before onset are good in schizoaffective patients. There seems to be no special premorbid personality of schizoaffective patients. Education and level of vocational training are generally good. Only a few schizoaffective patients belong to the lower social classes. Most schizoaffective patients do not come from a "broken home". Although "life events" are frequent in a schizoaffective population, the relevance of this finding has to be limited: If we evaluate "life events" in regard to single episodes, we find that most episodes, especially episodes occurring during the later course, do not have precipitating factors. In conclusion, it can be said that - besides the already known better prognosis of schizoaffective disorders - several differences exist regarding premorbid and social factors, between schizoaffective disorders and schizophrenia.
Adolescent↗