Predicting outcome in schizoaffective psychosis

To better evaluate the prognosis for psychiatric patients with the diagnosis of schizoaffective (SA) psychosis, a condition that includes both schizophrenia and an affective (emotional) disorder, investigators conducted a retrospective study of 68 patients discharged from one psychiatric facility during a 25-year period. Interviews were carried out primarily by telephone with former patients (62 percent) or their significant others. The follow-up study was carried out an average of 15 years after discharge. The variable that measured outcome was ''sum'' global functioning since the time of discharge, formed by rating subsequent hospitalizations, social and work functioning, and the prevalence of symptoms since discharge. This information constituted the basis for rediagnosis based on the criteria of DSM-III (Diagnostic and Statistical Manual, third edition): using these standards, 19 patients were schizoaffective manic, 33 were schizoaffective depressed, and 16 were schizoaffective bipolar. Results showed that, while no variable was a strong predictor of the outcome of SA, people with more skills prior to their first hospitalization were functioning better than those with fewer skills. Factors that predicted poorer outcome were the presence of bizarre delusions, concreteness (impaired ability to think abstractly), and inappropriate affect. The results imply that SA may be a composite of psychiatric disorders that lies somewhere between schizophrenia and the mood disorders. Patients with more of the schizophrenic component have a more chronic disorder. (Consumer Summary produced by Reliance Medical Information, Inc.)