Clinical course and outcome of schizoaffective disorders. A three-year follow-up study

Four samples of patients (fulfilling at the index episode, respectively, Research Diagnostic Criteria for schizoaffective disorder manic type, schizoaffective disorder depressed type, manic disorder and major depressive disorder) were followed up for 3 years. At the end of the follow-up period, no significant difference with respect to the mean scores on the Disability Assessment Schedule (DAS) and on the Strauss-Carpenter Outcome Scale was observed between schizomanics and manics (although the global outcome was slightly poorer in the former group). In contrast, significant differences between schizodepressives and depressives were found both on some DAS subscales (the schizodepressives were more socially withdrawn, had less social contacts and poorer work performance) and on the Strauss-Carpenter Outcome Scale (the mean total score and the mean scores on the items "social contacts" and "employment" were significantly lower in schizodepressives). The most frequent pattern of course in patients diagnosed cross-sectionally as schizomanic was a bipolar one. Some patients had only recurrent schizomanic episodes and others more an alternance of schizomanic and schizophrenic episodes. In patients diagnosed cross-sectionally as schizodepressives, the most frequent pattern of course was that characterized by recurrent schizodepressive episodes. In some patients an alternance of schizodepressive and depressive or schizodepressive and schizophrenic episodes was observed. These data confirm that patients diagnosed cross-sectionally as schizoaffective represent a very heterogeneous group when they are studied longitudinally, and support the usefulness of a "multiaxial" approach to the classification of schizoaffective disorders, taking into account both cross-sectional symptomatology and clinical course.