The natural course of schizophrenia and psychopathological predictors of outcome. A community-based cohort study

The natural course of schizophrenia is extremely heterogeneous and generally considered unpredictable. This prospective research investigated the natural course of schizophrenia in a community-based population linked to an Italian Mental Health Center, looking for the identification of psychopathological predictors of outcome. Forty schizophrenic patients were assessed at baseline in a stabilized phase of illness with clinical scales of psychopathology and social functioning and afterwards were followed up for 36 months. All of them were treated with antipsychotic drugs. According to their symptoms and function scores patients were empirically classified into three groups with a cluster analysis: a group characterized by low symptoms and good functioning, a group with high symptoms and poor functioning and an intermediate group. A crosstabs analysis revealed that the empirical classification correctly predicted long-term outcome. A survival analysis with comparison of distributions (Wilcoxon Gehan test) also revealed significant differences in terms of hospital admission and occurrence of alcohol-related diagnosis across groups. This study suggests that the long-term outcome in schizophrenic patients followed by a community-based mental health service is generally poor and multifaceted. However, outcome may be predicted on the basis of the psychopathological and social functioning profile assessed in a stabilized phase of illness defined with operational criteria.