From a sample of 1357 schizophrenic patients hospitalized between 1913 and 1940 at the Phipps Clinic, we particularly studied 484 patients with follow-ups of 5 or more years. Of the sample of 1357 patients, 28 (10%) committed suicide. None of the suicides were included in the sample of 484, which also eliminated all patients with any previous psychiatric admissions or episodes of mental illness, even without hospitalization. On follow-up, only 13% of the 484 were rated recovered, whereas 58% were rated unimproved. Long-term global follow-up was highly correlated with discharge status. Subgroups retrospectively diagnosed by DSM-IV criteria were significantly related to long-term follow-up in the sample of 484 patients, there being a continuum of poor outcome ranging from the diagnoses schizophrenia through schizophreniform to schizoaffective. Poor follow-up was significantly correlated with poor premorbid history, gradual onset, lack of depressive symptoms and heredity, seclusive personality, lack of precipitating events, lack of confusion, single status, onset before age 21, delusions of control, onset 6 months or more before admission, and emotional blunting. These variables were used to construct a validated prognostic scale. More recent treatment results have been contrasted with these findings from an earlier non-drug treatment era.
1 Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287.
2 Centre Hospitalier Spécialisé Esquirol, Paris, France.
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This research was supported by the Allene Rubin Memorial Research Fund.