Prädiktoren des Schizophrenieverlaufs - eine Literaturübersicht

Abstract

As the course of schizophrenia shows a large variability, a prognosis of outcome is extremely difficult. The search for valid predictors shows that there exist numerous predictors with variable predictive significance for distinct outcome criteria and also for different phases of the illness. The indications in the literature are accordingly variable or even inconsistent. The following statements seem us to be proved: A good premorbid social adjustment, a harmonious premorbid personality, and an acute onset of the illness predict a better course, whereas an insidious onset and a development of marked negative symptoms correspond to a poorer outcome. A combination of several factors improves the predictive significance. The importance of the following indicators remains questionable: Genetic loading, neuropathological findings, positive symptoms, and age at onset of the illness. Equally open are these questions: How are the various indicators interrelated and for what span of time have they a predictive power? Psychosocial indicators have more predictive significance than the so far known biological variables. Probably the difficulties in finding valid predictors are not only related to unsolved methodological problems, but above all to intrinsic characteristics of the illness itself.

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“…It seems that the characteristics of social disintegration are even more important than the characteristics referring to the disease. These results are consistent with those of other studies [ 7 ], according to which a good premorbid adjustment at work and good social relationships usually predict a positive course of the disease.…”

“…He also stressed that the modification of the outcome by long-term treatment has not yet been examined sufficiently. In a review of the literature, Hubschmid and Ciompi [ 7 ] mentioned the significance of the following predictors as sufficiently verified: A generally good premorbid adjustment, a harmonious premorbid personality and an acute beginning of the disease indicate a positive course of the disease. In contrast, a lingering onset, distinct negativism and a poor response to medical treatment usually predict a rather negative course.…”

A 45-year follow-up study of adolescent schizophrenia. Part I: Premorbid values of psychological and relational indicators in the context of illness course and long-term social functioning of patients

“…An opposite significance for the prognosis can be attributed to having numerous and deep extra-family relations in the premorbid period. The importance of this factor is also significantly supported in the literature [e.g., 15,18]. The positive correlation of this parameter with the quality of the respondents' distant social functioning, especially their professional life, was particularly striking.…”

Integrating Genomics into Psychiatric Practice: Ethical and Legal Challenges for Clinicians

“…For example, it has long been known that schizophrenic patients with healthy premorbid social functioning and acute onset of illness fare better than those with more pronounced negative symptoms and gradual onset of illness. 90 With advancements in genomics, researchers may soon be able to identify genetic biomarkers that predict worse outcomes or more severe phenotypes, just as oncologists now use biomarkers to predict disease outcome and guide treatment choices.…”