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Psychopathological syndromes in the functional psychoses: associations with course and outcome

Published online by Cambridge University Press:  09 July 2009

J. Van Os ,
T. A. Fahy ,
P. Jones ,
I. Harvey ,
P. Sham ,
S. Lewis ,
P. Bebbington ,
B. Toone ,
M. Williams  and
R. Murray
J. Van Os*
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
T. A. Fahy
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
P. Jones
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
I. Harvey
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
P. Sham
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
S. Lewis
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
P. Bebbington
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
B. Toone
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
M. Williams
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
R. Murray
Affiliation:
Department of Psychological Medicine and MRC Social and Community Psychiatry Unit, Institute of Psychiatry; Department of Psychological Medicine, King's College and Maudsley Hospitals, London; Coventry Mental Health Unit, Walsgrave, Coventry
*
1Address for correspondence: Dr Jim van Os, Department of Psychiatry, Section of Social Psychiatry and Psychiatric Epidemiology, University of Limburg, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Synopsis

The aim of this study was to identify underlying dimensions of psychopathology in a cohort of patients with functional psychosis of recent onset, and to examine their prognostic value. Factor analysis of the psychopathological features of 166 consecutively admitted patients with functional psychosis of recent onset revealed seven psychopathological dimensions, which explained 63% of the variance. Five of these seven syndromes bore differential associations with subsequent treatment and illness course, independent of: (i) associations with DSM-III-R diagnosis; (ii) associations with other prognostic factors; and (iii) associations with the baseline values of outcome variables. The most striking associations were shown for an early and insidious onset syndrome with affective flattening, which predicted a more disabled course of illness on three of four outcome dimensions, and which was more common in males and unmarried individuals. A second syndrome, characterized by bizarre behaviour, inappropriate affect, catatonia, and poor rapport showed similar, slightly less striking, associations with illness course, as well as with poor pre-morbid social functioning. A third syndrome, characterized by positive psychotic symptoms was to a lesser degree associated with poorer outcome, whereas a fourth syndrome distinguished by manic symptomatology predicted a more benign illness course. A fifth syndrome identified by lack of insight predicted more time in hospital and admission under a section of the Mental Health Act during the follow-up period.

A further finding was that dimensional representations of psychopathological features were considerably more useful than categorical representations (DSM-III-R and ICD-10) as predictors of illness course and treatment decisions.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 1 , January 1996 , pp. 161 - 176
Copyright
Copyright © Cambridge University Press 1996

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