Definitions and assessment of course and outcome variables

There is no single measure of course and outcome of a complex disorder such as schizophrenia, and blanket terms such as 'recovery', 'improvement', or 'deterioration' tend to conflate substantially different aspects of the evolution of the disorder over time. Most investigators today agree that course (comprising the pathways or trajectories of the disorder) and outcome (the net balance of the clinical and functional descriptors at the endpoint of observation) are multivariate composites. As a minimum, three domains that need not covary over time should be independently assessed: symptom severity, functional impairments including cognitive deficits, and disablement in social and occupational role performance. Each one of these can be further articulated into a number of areas or dimensions. In addition, one must consider extrinsic variables such as measures of environmental and treatment-related influences on course and outcome, as well as subjective experiences commonly described as 'quality of life'. Standardized reliable instruments (interviews, inventories, rating scales) are required for the assessment of most variables. It should not be forgotten, however, that some of the richest sources of information are the perceptive, in-depth case studies based on personal patient contact over many years. Collectively, such single case observations can generate hypotheses for testing in epidemiologically designed studies.

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