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UBC Theses and Dissertations

The prediction of short term adjustment in psychotic patients Smith, Geoffrey Norman


Progress in schizophrenia research has been hindered by the limitations of contemporary diagnostic criteria. All widely used diagnostic systems allow considerable variability in symptoms between schizophrenics and much similarity across psychotic disorders. Furthermore, schizophrenics show large differences in response to treatment strategies and in prognosis. These facts have led to a growing consensus that schizophrenia is not a homogeneous disorder but represents a heterogeneous collection of disorders. In the face of this heterogeneity, most schizophrenia research is conducted by comparing a group of diagnosed schizophrenics with a control group. This approach carries with it the implicit assumption that the disorder is homogeneous. The variability between schizophrenics and similarities across various psychotic disorders in association with this research strategy probably contributes to the slow progress in schizophrenia research. An alternative, three-point research strategy was proposed: 1) All psychotic patients, without diagnosed organic disorders, should be included in research studies to compensate for the imprecision in contemporary diagnostic procedures, 2) multiple measures should be used to identify variables that cluster within subgroups of patients, and 3) any identified subcategory of schizophrenia should be evaluated with regard to how well it predicts response to treatment and prognosis. In the present study, premorbid adjustment, negative symptoms (e.g., flat affect), and smooth pursuit eye movement anomalies were used to predict rehospitalization, general level of adjustment at follow-up, and employment-heterosexual period was nine to 18 months. Thirty-seven patients who had recently experienced their first psychotic episode served as subjects. Twenty were diagnosed schizophreniform, nine unipolar depressed, six bipolar, and two paranoid. The results of this study were successful in identifying two subgroups of psychotic patients. Disrupted eye-tracking, poor premorbid adjustment and a preponderance of negative symptoms tended to cluster in individuals with poor general and employment-heterosexual adjustment while good eye-tracking, normal premorbid adjustment, and a relative absence of negative symptoms were common in individuals with good adjustment at follow-up. Rehospitalization was not predicted successfully. The results are discussed in terms of their implications for a neuropathological subtype of schizophrenia. Suggestions for further research to extend the present findings are offered.

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