Predictors and characteristics of mental health among men at midlife: a 32-year longitudinal study.

In a prospective, 32-year longitudinal study of 87 young men originally selected for general health, it was found that good physical and mental health were maintained by most. Successful predictors of midlife mental health included satisfactory peer social adjustment, little or no angry behavior, and a mentor relationship in young adulthood. Overall findings suggest that mental health is closely associated with developing social relationships.

Early longitudinal course of acute-chronic and paranoid--undifferentiated schizophrenia subtypes and schizophreniform disorder.

This prospective longitudinal study examined symptoms and adjustment at 2 and 4 years posthospital discharge in Research Diagnostic Criteria (RDC) and Diagnostic and Statistical Manual (DSM-III) schizophrenia subtypes and in DSM-III schizophreniform disorder. Delusions, hallucinations, thought disorder, anxiety, depression, and specific areas of community adjustment were assessed at each follow-up. RDC acute and subacute schizophrenia and DSM-III schizophreniform disorder were associated with more satisfactory overall adjustment and lower frequencies of psychotic symptoms over time. No significant differences in the course of symptoms or adjustment were found between paranoid and undifferentiated schizophrenia subtypes. Schizophrenia subtyping schemes based on length of illness features appear more prognostically viable than do symptom-based approaches.

Risk for suicide in schizophrenia and other psychotic and nonpsychotic disorders.

To determine the rate of suicide in young, early phase schizophrenics and other psychotic disorders, and to analyze risk factors for suicide, a large sample of patients was prospectively assessed at index hospitalization and then followed up systematically after discharge. Thirty-six patients committed suicide and these patients were compared with those who did not commit suicide for major diagnostic and prognostic factors. Results indicated the following: a) During early years, schizophrenics and other types of psychotic patients were more likely to commit suicide than nonpsychotic patients. b) Similarly, among depressives, psychotic depressed patients were more likely to commit suicide than nonpsychotic depressed patients. c) Schizophrenics and other psychotic patients were especially vulnerable to suicide within the first 6 years of their first hospitalization. d) Among the combined sample of psychotic patients (schizophrenic and other psychotic patients), those at greater risk for suicide were unmarried, white, high IQ, male patients with a more gradual onset of disorder and were of "chronic" Research Diagnostic Criteria subtypes.

Posthospital course and outcome in schizophrenia.

To study the early course of schizophrenia, we assessed 79 early phase, young, DSM-III schizophrenic patients at two successive posthospital follow-ups, 2.5 and 5.0 years after index hospitalization. More than 50% of the sample had poor overall outcome, with either severe impairment in functioning and symptoms, or suicide, in the follow-up period. Rehospitalization rates decreased significantly during the course of the two posthospital assessments, despite the sample showing persisting psychosis. Only a small group of schizophrenic patients showed complete remission: 10% at the first follow-up and 17% at the second follow-up, when patients who suicided are excluded from consideration. While progressive deterioration is not common in schizophrenia, our relatively negative findings challenge the conclusions of some other longitudinal studies. Implications of our data on schizophrenic course are discussed.

Process-reactive dimension and outcome for narrow concepts of schizophrenia.

The data presented by the authors suggest a more successful prediction of outcome by the process-reactive dimension when it is applied to schizophrenic patients defined according to broad concepts of schizophrenia (e.g., DSM-II) than to narrow concepts of schizophrenia (e.g., DSM-III). Research indicates that the DSM-III is more likely than the DSM-II diagnosis to be composed of "poor prognosis" schizophrenia, as defined by the classical prognostic indicators. In general, the overall results could support the views of Herron and others that the process-reactive dimension is more valuable as a predictor for a schizophrenia spectrum than for modern, narrow concepts of schizophrenia. However, while recent data of the authors indicate that DSM-III schizophrenic patients show poorer outcome than DSM-II schizophrenic patients, they also indicate that (1) DSM-III schizophrenic patients still show heterogeneity in prehospital functioning and outcome, and (2) other prognostic indexes, such as the Zigler-Phillips Scale and the Vaillant-Stephens Scale, have some efficacy in predicting course and outcome among DSM-III schizophrenic patients. Data on prehospital functioning and outcome are discussed in terms of two contrasting models--a developmental model and a natural history model of the course of schizophrenia.

Predictors of outcome in schizophrenia: the process-reactive dimension.

Premorbid social-sexual competence and the process-reactive dimension, as assessed by the Phillips Scale, were investigated as predictors of posthospital adjustment in a prospective study of two samples of 141 young, early phase schizophrenics (a private hospital sample and a state hospital sample). The Phillips Scale predicted subsequent outcome at significant levels for one of the two samples of DSM-II schizophrenics (a "broad" construct of schizophrenia). It did not predict outcome as well for DSM-III schizophrenics (a "narrow" construct of schizophrenia). Mixed results emerged from separate analyses of first-admission schizophrenics only and for male schizophrenics only. The data indicated that marital status accounts for some of the positive relationship between the Phillips Scale and later outcome. A more focused measure of prehospital social adjustment successfully predicted social functioning at followup for both DSM-II and DSM-III schizophrenics (p less than .05). There were some significant and near-significant relationships, but overall results suggest that when the influence of chronicity and marital status is reduced, the relationship between the Phillips Scale and subsequent outcome is less robust than was once thought.

The course of psychosis in early phases of schizophrenia.

To study the course of psychosis in early schizophrenia, the authors assessed 111 patients at hospitalization and at one or two follow-ups. The course of psychosis was analyzed separately for broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia. The patients diagnosed with DSM-II improved in psychosis between the first and second follow-ups. Those also diagnosed with DSM-III showed more persistent psychosis; 40% were psychotic at both follow-ups. A subgroup of patients showed improvement in psychosis even after several years of sustained symptoms. The authors discuss the implications of the data for views about the persistence of psychotic symptoms.

Prognosis and outcome using broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia.

The classical prognostic indicators of Vaillant and Stephens, the acute onset of psychotic symptoms, and key demographic factors were investigated as predictors of outcome in a prospective study of 153 schizophrenic patients defined using broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia. Findings indicate: Several established prognostic items did not show strong predictive utility in DSM-II or DSM-III schizophrenia when young, nonchronic patients were studied. For both DSM-II and DSM-III schizophrenic patients, longitudinal assessments of psychotic symptoms, work history, and social functioning predicted their respective assessments at followup. However, the predictive utility of some key prognostic indicators shifted for narrow vs. broad concepts of schizophrenia. Most importantly, sex, which was the most powerful predictor of overall outcome among patients with DSM-II schizophrenia, failed to predict outcome among patients with DSM-III schizophrenia, primarily because many women with favorable outcome did not meet the DSM-III criteria for schizophrenia. DSM-III schizophrenia comprises a more homogeneous group of poor prognosis patients in comparison to DSM-II schizophrenia. Educational level, age at first hospitalization, and work history were successful predictors of outcome (p less than .01) when a new, narrow concept of schizophrenia was used.