[Psychopathology and outcome in first-admission schizophrenia: a 13-year follow-up study at a medical school hospital].

BACKGROUND

The course and outcome of 'dementia praecox' have attracted considerable attention since it was first described. However, studies in which schizophrenic patients have been followed for more than ten years are rare. In this study, the course and outcome of first-admission schizophrenic patients in Jichi Medical School Hospital was investigated.

METHOD

The subjects were 62 schizophrenic patients, 29 females and 33 males (the mean age at first hospitalization was 25.2 +/- 7.4 years), who were consecutively discharged from the Department of Psychiatry, Jichi Medical School Hospital, between June 1983 and May 1988. The mean interval between first-admission and follow-up was thirteen years. The social outcome was measured using Eguma's Social Adjustment Scale. The subjects were divided into two groups according to Eguma's Scale: a favorable outcome group and an unfavorable outcome group. The following data were obtained from clinical records and analyzed: sex, family history of mental disorders, educational background, job experience, marital status, age at first contact to a psychiatrist, age at first hospitalization, type of onset, subtype of schizophrenia (paranoid, catatonic, hebephrenic types) and symptoms at the time of first hospitalization. Symptoms at the time of first hospitalization included delusions, hallucinations, disorders of ego consciousness, thought disorders, emotional disturbances, lack of spontaneity, catatonic symptoms, hypochondriac-cenestopathic symptoms, disorganized behavior, and suicide attempts.

RESULT

Fifty-six of the 62 patients were followed-up. Six patients could not be contacted. Nine of the 56 patients follow-up were dead; two had died suddenly and seven had committed suicide. Forty-seven patients were alive, eight of which were not under psychiatric treatment, while 39 patients were receiving treatment (33 as outpatients, 6 as inpatients). The 47 patients who were still living were divided into two groups: 22 were included in the favorable outcome group, and 25 in the unfavorable outcome group. No significant differences in premorbid status were found. The unfavorable outcome group had an earlier age at first contact and age at first admission than the favorable outcome group. In the favorable outcome group, acute onset was more common than chronic onset. A comparison of psychopathological symptoms at the time of first hospitalization between the favorable and unfavorable outcome groups revealed significant differences in lack of spontaneity and hypochondriac-cenestopathic symptoms. No significant differences were found for any other symptoms. In the favorable outcome group, paranoid type was more common than hebephrenic type.

DISCUSSION

Lack of spontaneity may reflect negative symptomatology, which has been suggested to be a predictor of an unfavorable outcome. While hypochondriac-cenestopathic symptoms may reflect an insufficient psychic container for the body, which has been hypothesized to work as an enabler of body image or imaginary body and an enabler of ego function as well.

CONCLUSION

First-admission schizophrenic patients followed up after a mean period of thirteen years, and of this group data could be obtained on 90% of them. Two symptoms (a lack of spontaneity and hypochondriac-cenestopathic symptoms) present at the time of first hospitalization were observed more frequently in the unfavorable outcome group than in the favorable outcome group.