Follow-up studies of schizophrenia I: Natural history and non-psychopathological predictors of outcome

Abstract

Treatment-resistant schizophrenia does not exist as a discrete entity, so separating patients who will fail to respond to traditional antipsychotics from those who will respond is impossible with 100% accuracy. However, several predictors of poor clinical outcome have emerged from recent research and knowledge of the processes that lead to poor outcome has become increasingly important with the advent of atypical antipsychotics that may be used in patients with treatment-resistant illness. Much of the variation in outcome can be understood in terms of differences in sample selection, outcome definition and stringency of the diagnostic criteria used. Failure to appreciate these mechanisms may lead to over- or underestimation of the proportion of patients with poor treatment response in clinical and research settings. The importance of factors that predict poor outcome should be judged in terms of their effect size and the degree to which alternative explanations for the association with outcome have been excluded. Although much current research is being focused on specific biological predictors, baseline demographic and illness-related factors, such as ethnic group, sex, social class, type of onset, age of onset and concurrent misuse of alcohol or drugs, have large effects on outcome. Although duration of untreated psychosis before first contact with services may independently predict poor outcome. confounding by variables that are associated with both pathways to care and clinical outcome has not been excluded.

The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis

“…Situational Feature Recognition Test (Corrigan and Green, 1993b) Social cue sensitivity A' (hits/false alarms in determining features that fit certain situations) Number of correct identified situational features Schema Component Sequencing Task (Corrigan and Addis, 1995) Number of correct juxtaposed/ordered cards that describe social situations Social Cue Recognition Task (Corrigan and Green, 1993a) Number of correct identified intentions/goals of people in vignettes Social Cue Recognition Task-revised (Corrigan et al, 1996) Social Stimuli Sequencing Task (Corrigan et al, 1992) Number of errors Number of correct adjoining cards WAIS comprehension (Wechsler, 1987) Number of correct answers on social problem solving/practical reasoning Half profile of Nonverbal Sensitivity (Ambady et al, 1995) % of scenes correctly labeled social cues in 110 videotaped scenes Second, illness chronicity, inpatient status, age, and male gender were taken into the analysis as moderators, as they may influence cognition-outcome associations (Andia et al, 1995;Dickerson et al, 1999;Fiszdon et al, 2008;Schennach-Wolff et al, 2009;Van Os et al, 1997). We used a mixed-effects meta-regression model to examine their influence.…”

The Myth of Schizophrenia as a Progressive Brain Disease

“…Rather it may be a reflection not only of nonadherence and resulting relapses but also of the consequences of other critical determinants of health such as poverty, homelessness, unemployment, and lack of social support, as well as other comorbidities, that all too often complicate the course of schizophrenia. 31 …”

Predictors of Noncompliance in Patients With Schizophrenia

“…10 Many factors affect outcome in schizophrenia treatment, and they have been reviewed comprehensively. [11][12][13] Poor compliance or noncompliance with treatment is considered to be one of the most important factors, 2 being strongly associated with an increased risk of relapse, 6,11,14,15 greater likelihood of hospital admission, 16,17 and a longer duration of hospitalization once admitted. 18 Such negative impact of noncompliance on long-term outcome was demonstrated convincingly by Helgason 19 in a 20-year followup study of patients with schizophrenia in Iceland.…”