Psychoses: Results of a Followup Study

The course of illness was investigated retrospectively and prospectively in a sample of 150 hospitalized schizoaf-fective patients and 95 hospitalized bipolar manic-depressive patients. The two disorders showed more simi-larities than differences in their course; this was true for the age of onset (31.8 versus 34.7 years) and the length of illness until the end of the observation period (22.5 versus 23.8 years). Schizoaffective disorders took a more benign course than bipolar disorders, as measured by the fre-quency of the episodes (median 7 ver-sus 9 episodes). Accordingly, periods of remission between episodes were longer in schizoaffective patients. The length of the episodes themselves was about the same in both disorders (me-dian 3 months). Although subjects had reached an average age of 60 years, 63 percent of schizoaffective and 82 percent of bipolar patients had experienced new episodes during the last 5 years of the observation period. Patients with schizoaffective psychoses were less likely to achieve a full remission than patients with bipolar disorders. A residual state was observed in 57 percent of schizoaffective and 24 percent of bipolar patients during the intervals between episodes. Because both schizoaffective and bipolar disorders showed a highly recurrent course, many patients received long-term treatment with neuroleptic drugs, an-tidepressants, or lithium. Schizoaffective psychoses are defined as mental disorders in which manic or depressive syndromes are mixed with schizophrenic syndromes simul-taneously or successively during the course of illness (World Health Organization 1977). Therefore, neither a pure schizophrenia nor a pure affective disorder can be diag-nosed. It is well-known that patients with schizoaffective psychoses have a relatively high risk of relapse, but show a good tendency to achieve full remission between episodes. As part of a larger study of the course of af-fective disorders in general, we have compared the course of schizoaffec-tive psychoses with that of bipolar manic-depressive disorders. The com-parison seems justified because the disorders have a similar age of onset, both disorders show a high relapse risk^and both are characterized by manic-depressive syndromes