Search

Objective: This research addresses the relationship of formal thought disorder in the early stages of psychotic illness to the long-term outcome of mental health many years later. The specific topic of concern was to evaluate the prognostic significance of thought disorder on the severity of psychosis over time., Methods: Subjects with new-onset psychosis were evaluated on a variety of measures including education, physical health, Brief Psychiatric Rating Scale scores. They were also given the Thought, Language, and Communication Scale to evaluate thought disorder. Subjects were interviewed again at 10 and 20 years to evaluate variations in outcome. Appropriate statistical methods were used to evaluate changes in the level of functioning over time., Results: Thought disorder was not unique to schizophrenia. Bipolar patients presented with significant positive thought disorder at the onset of psychosis. Overtime positive thought disorder gradually improved in most patients. Negative thought disorder was more persistent, especially in subjects with schizophrenia. Initial psychosis with thought disorder characterized by poverty of content seemed to be associated with poor long-term outcome., Conclusion: Formal thought disorder can predict outcome in some cases of psychosis. Not all types of thought disorder have the same prognostic implication. Positive forms of thought disorder (pressured speech, tangentiality) had no significant predictive value. Negative thought disorder (particularly poverty of speech and poverty of content) tend to predict a chronic, more unrelenting course of illness., (Published by Elsevier Inc.)

The purpose of this study was to determine whether the preponderance of data support a continuum hypothesis of the psychoses or a concept of separate, autonomous illnesses. Patients (N = 70) were hospitalized for nonmanic psychoses, given structured interviews and a dexamethasone suppression test (DST), and diagnosed according to the Research Diagnostic Criteria (RDC). Patients were then evaluated at 1 year and 6 years with a structured interview. Diagnoses were made at three points of time: intake, 1 year, and 6 years. The patients were divided into groups that had a consistent (over the three points) set of affective disorder diagnoses (affective disorder or schizoaffective disorder, mainly affective [AD group]) and those that had a consistent set of schizophrenic diagnoses (schizophrenic or schizoaffective disorder, mainly schizophrenic [S group]). A third group (inconsistently diagnosed) consisted of subjects who at one point were diagnosed in the AD group and at another in the S group. A series of discriminant function analyses suggested that the AD group differs widely from the S group; and the inconsistently diagnosed group most closely resembled the AD group. The family background of the inconsistent group was similar to that of the AD group. The DST and outcome showed that the inconsistent group was more like the AD group than the S group. Using the characteristics of the medical model-clinical picture, outcome, laboratory tests, and family history-the group that was inconsistent with regard to diagnosis over time appeared similar to the AD group. Taking the follow-up evaluation into account, the data favor the possibility that patients who have a variable clinical diagnosis over time do not suffer from schizophrenia.

Classification of individuals with alcoholism is currently limited. The purpose of this analysis was to determine whether antisocial personality disorder and other primary psychiatric syndromes identified subgroups of alcoholics with differing characteristics. Alcoholic probands (n = 224) with alcoholism were divided into those with primary alcoholism (n = 128), antisocial alcoholism (n = 50), and secondary alcoholism (n = 46). These groups were evaluated with regard to alcohol-related symptoms and upon a variety of psychiatric signs and symptoms. The secondary alcoholism. The antisocial alcoholic and primary alcoholic groups demonstrated many similarities, but overall, the antisocial alcoholic group appeared most severe. The antisocial alcoholic group additionally exhibited a dissociation between the subjectively reported and the observed behavior. These findings support the concept of heterogeneity within the alcoholism spectrum. Longitudinal data are needed to determine whether the observed cross-sectional differences predict outcome differences.

Using archival data, we conducted a systematic study of consecutive admissions of bipolar patients and found that an early age of onset, a subacute onset, a family history of bipolarity, and the administration of electroconvulsive therapy (ECT) during an index episode were individually associated with a polyepisodic course of illness (three to nine or more episodes) during a period of observation which included onset of illness, index admission, and a period of follow-up. The family history of biopolarity which seems to predispose to multiple episodes suggests that what may be transmitted may not necessarily be a bipolar illness but possibly an illness with many episodes, thus increasing the likelihood of occurrence of a manic episode.