Mediumrange predictors

In first-episode cases, male sex, single marital status, premorbid social withdrawal, and insidious onset have been shown by a number of studies to be relatively robust predictors of a poor outcome in the short to medium term (2-5 years), while female sex, being married, having social contacts outside the home, and acute onset predict a relatively good outcome. No consistent findings have been reported for age at onset as a predictor, and the long-term follow-up studies do not lend support to the view that an early onset is associated with a poor prognosis. Similarly, a history of psychotic illness (including schizophrenia) in a first-degree relative does not predict a worse prognosis. On the contrary, in some studies(6!.) patients with a high familial load were found on follow-up to have a better outcome than patients with no psychotic illness among their close relatives.

A consistent finding of many studies is that the clinical symptoms in either the early or the advanced stages of schizophrenia have a very limited capacity to predict future course and outcome. An exception is the modest predictive power of any clear-cut negative symptoms appearing early in the course of the disorder, or when assessed under the conditions referred to above.

The sociocultural setting, i.e. a developing country or a developed country, was the best predictor of 2-year and 5-year outcome in the WHO studies. (3,38) Exactly what factors may be underlying these marked cultural differences in the prognosis of schizophrenia remains an unresolved issue.

The predictive status of psychophysiological or neurophysiological variables (such as the electrodermal orienting response or rapid eye movement sleep latency), or neurocognitive measurements (sustained attention, event-related potentials or the pre-pulse inhibition of the startle reflex) has not been sufficiently investigated. At least one study(59) found that brain imaging (computed tomography) evidence of cortical atrophy on first admission was a predictor of poor 2-year clinical and social outcome.

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