Predicting outcome of schizophrenia: significance of symptom profiles and outcome dimensions

To clarify the antecedents of poor long-term outcome in schizophrenia, 58 DSM-III diagnosed schizophrenic inpatients, mostly chronic, were prospectively assessed on psychiatric symptoms and background variables. The 46 patients (79.3%) who could be relocated after 1 to 4 years (mean, 2.7 years) were evaluated on a multidimensional outcome scale and days of subsequent hospitalization. We found, contrary to prevailing belief, that a baseline positive, not negative, syndrome predicted poor outcome. Thought disturbance portended the worst prognosis and depressive syndrome the best. Multiple regression analysis showed (a) reliable prediction for 9 of 10 outcome measures (r values from .49 to .61); (b) separate contributions by clinical, genealogical, and historical predictors; and (c) different sets of variables that predicted social v occupational adjustment. The results have implications for prognosis, rehabilitation planning, and understanding of the obstacles to successful transition to community living.