Deister A, Marneros A
Psychiatric Department, University of Bonn, Germany.
Schizophr Res. 1994 May;12(2):145-57. doi: 10.1016/0920-9964(94)90072-8.
The prognostic value of the subtype diagnosis at the initial episode was investigated in 148 narrowly defined schizophrenic patients. Every initial episode was classified according to multiple criteria: DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first rank symptoms. Patients were followed up on average 23 years later (range 10-50 years). Different aspects of long-term outcome were evaluated (global functioning, social adjustment, negative social consequences). In 93% of the patients persisting alterations were found at the end of the observation time. The influence of the predominant clinical features at the initial episode on various aspects of long-term outcome was found to differ depending on which of the four diagnostic systems was used. The highest power for discrimination was found for the subtypes of DSM-III-R, while the presence of first rank symptoms had no prognostic value. It was found that patients with an initial paranoid or positive episode had a significantly better long-term outcome than patients initially having a disorganised/hebephrenic or catatonic episode. The frequency of negative social consequences was not influenced by the initial subtype, with the exception of permanent hospitalisation.
在148例狭义精神分裂症患者中研究了首次发病时亚型诊断的预后价值。每次首次发病均根据多种标准进行分类：《精神疾病诊断与统计手册第三版修订本》（DSM-III-R）、《国际疾病分类第十版》（ICD-10）、阳性/阴性二分法以及施奈德一级症状。患者平均在23年后（范围为10至50年）接受随访。评估了长期预后的不同方面（整体功能、社会适应、负面社会后果）。在93%的患者中，观察期末发现有持续改变。发现首次发病时的主要临床特征对长期预后各方面的影响因所使用的四种诊断系统中的哪一种而异。发现DSM-III-R亚型的区分能力最强，而一级症状的存在没有预后价值。发现首次发病为偏执型或阳性发作的患者长期预后明显好于首次发病为紊乱型/青春型或紧张型发作的患者。除了长期住院外，负面社会后果的发生率不受首次发病亚型的影响。
