Affective impairment in young acute schizophrenics: its structure, course and prognostic significance

In order to investigate the structure, longitudinal course, and significance of affect impairments in young acute schizophrenics, we prospectively studied a group of 37 consecutively admitted acute inpatients at baseline and 26 months later (n = 19). They were evaluated at both points on a multidimensional affect rating scale, psychopathology rating scales, and tests of attention and motorium. Additionally, they were assessed on historical and subdiagnostic variables at baseline and on level of functioning at follow-up. Factor analysis revealed three reliably measured affect components: emotional unrelatedness, expressive immobility, and inappropriateness of affect. The first two factors were strongly interrelated and associated also with the BPRS depression factor at baseline. All four affective dimensions proved unstable over the course of 2 years and produced different sets of correlates at the two points of time. In the acute phase, only the depression factor carried favorable prognostic import (r = 0.52, P less than 0.05). Emotional unrelatedness and expressive immobility were of unfavorable consequence only when observed in the follow-up stage. Thus, the affect profile seemed to be an evolving rather than a static phenomenon, precluding generalizations across the early course of schizophrenia. Possible interpretations of the baseline overlap between affect deficits and depression were discussed as well as their different prognostic implications.