Depressed patients with schizophrenic or paranoid symptoms

Family history, response to treatment and outcome are reported in a series of 76 patients presenting with both depression and schizophrenic or paranoid symptoms. About 10% of psychotic admissions to the Maudsley and Bethlem Royal Hospitals met a study definition of "schizodepressive" illness. The patients were highly heterogeneous in history, clinical picture and outcome. Many followed a typical schizophrenic course, and others a typical course for effective disorders, but only 4 were given a final diagnosis of manic depressive disease. The best predictors of poor outcome were a mode of onset as an exacerbation of previous psychotic symptoms and the presence of schizophrenic symptoms at some time without depression. The best predictors of good outcome were Stephens' criteria of good prognosis schizophrenia and Kasanin's concept of "acute schizo-affective psychosis". These findings are not easily reconciled with Kraepelin's two entities principle but suggest a continuum of outcome between schizophrenia and unipolar depressive psychosis.