A follow-up study of 129 cases of schizophrenia

A historical review is made of the general prognostic views of schizophrenia, with special reference to the opinions of Meyer.A historical review is made of the results of follow-up studies of schizophrenia which have been published since the War. By adding the reported figures together, the following table was made: -Total number of cases traced: 3624.Results: / No.of cases: / Percentage of cases traced:Complete remission 414 / 11.5Social remission .... 360 / 10At home improved 186 / 5Remitted and Relapsed 61 / 2Unimproved 2406 / 66Died 197 / 5.5The present investigation is a follow-up study of all first a admissions for schizophrenia to the Royal Edinburgh Hospital for Mental and Nervous Disorders during the five-year period from 1st August 1932 to 31st July 1937. None of these cases received any special treatment, such as convulsion therapy. The follow-up study was begun in September 1938.The general results are: Total number of cases: 133 Cases traced: 129.Condition when traced.Condition: / No.of cases: / Percentage:Complete remission 15 / 12Social remission 11 / 8At home improved 12 / 9Remitted and relapsed 27 / 21Unimproved 64 / 50Total: 129All the usual features, both in the patient's previous life and in his illness, which are regarded as having prognostic significance ham been estimated in each case and correlated with the results of the follow-up.It was found that the following features were of favourable prognostic import:1. Healthy habits of reaction in the patient's previous life.2. A preponderance of environmental and psychogenic causes for the illness over the constitutional factors.3. An acute onset of the illness, not more than six months before admìssion.4. Well retained affective response in the illness, with absence of disharmony between the affect and the thought content.5. An acute type of schizophrenic illness, which cannot be fitted into any of the four standard sub-groups.6. The presence of insight.The following features seemed to be just significantly favourable:1. Race. A high recovery rate was seen in a group of eleven Celts.2. Six out of fifteen cases with complete remission showed clouding of consciousness during the illness.It was found that the following features had no prognostic import:1. A family history of mental disorder. 2. The patient' s sex. 3. The patient's educational attainment. 4. Age at the onset of the illness. 5. Tuberculosis, whether in the patient or in his family. 6. The presence of focal sepsis. 7. The presence of regressive symptoms. 8. The presence of hallucinations. 9. The symptomatology reflecting the aetiology.A number of other features were investigated, but no conclusions could be drawn, as the number of positive instances was too loud to be considered a fair sample.The case records of the fifteen patients with complete remissions were analysed from the point view of the general reaction and were classified as follows:GROUP I. A case of psychopathic state with an inter-current paranoid-schizophrenic episode.GROUP II. Schizophrenic episodes in schizoid personalities.All these patients had markedly schizoid personalities, particularly as estimated subjectively, but objectively they were all well adjusted.SUBGROUP A. These patients all passed through a long phase of subjective conflict and maladjustment with much speculation upon sexual, or upon religious, philosophical and other abstract topics. These pre-psychotic personalities all correspond closely to those which Kasanin found in his series of Acute Schizo -- affective Psychoses. The illness supervened fairly suddenly either as a continuation of, or as a solution of, these conflicts. After a short illness the patients recovered, and several became better adjusted than they had ever been before.SUBGROUP B. These are cases of schizoid personality, well- adapted in a sheltered environment, who broke down following minor stresses and than made a quick recovery to their usual level.GROUP III. Two cases in which anxiety symptoms at the onset.GROUP IV: A case in which the records were insufficient for full analysis of the reaction. .Although these pictures are atypical, there were cases in the unrecovered group whose condition was similar to that of these remitted cases