Die Bedeutung praemorbider und psychopathologischer Parameter für den Verlauf schizophrener Psychosen in der Adoleszenz zu unterschiedlichen Zeitpunkten

The aim of this doctoral thesis in the field of child psychiatry was to identify prognostic factors of the medium and long-term outcome of schizophrenic disorders in the adolescence. The study includes a retrospective, and a prospective exploration as well as a catamnesis of 40 rehabilitants with an overall observation period of 23.4 years. The date of first admission at the average age of 15.6 years corresponds to the first incidence of the disease and coevally defines the beginning of the first psychotic episode. At the time of the catamnesis the average duration of the disease was 8.1 years. 1. The retrospective study allowed a distinction between premorbid abnormal behaviour symptoms of the predromal phase and the episode of the first manifestation of the disease based on the IRAOS (Instrument for the Retrospective Assessment of Onset of Schizophrenia). The social background was described as affected by a low level of education and employment, abuse of alcohol and drugs, broken-home (27.5%), and schizophrenic relatives (17.5%). 77 % of the children suffered from extro- and introversive disorders as well as from a retardation of development. In 13 cases, pathological changes of the brain were diagnosed. 37.5 % showed to be relatively low intelligent (IQ<85). 90 % out of 65% of children with graduation had attended either the secondary school or the school for mentally handicapped children. None of them had tried to get in nearer contact with the opposite sex. 2. The psychopathological findings of the prospective study were collected during 6 semi-structured interviews which were analysed based on BPRS. Additionally the parameters of the cognitive capacity were measured. The collected data was then related to the premorbid items (see retrospective study) and to the degree of psychosocial adaptation (GAF- Score) as shown in the catamnesis. The prediction criteria, and the degree of impairment of the psychosocial functioning was once detected two years after the start of the prospective study, and then explored during the catamnesis. The data of the premorbid period, and the early course as well as the findings of the prospective study were later related to the acquired GAF-Score. The following predictors determine the medium-term course of the disease: 1. The extent of the positive symptoms (according to ANDREASEN) at the end of the first episode. It predicts the extent of the negative symptoms at the beginning – and the global symptoms score of the prospective study. 2. A long-lasting beginning of the disease. 3. A long-lasting duration of the first period. Both have an effect on the positive and global symptoms-score. 4. The age of the onset of schizophrenia predicts the extent of the negative symptoms -the earlier the beginning, the higher the extent of symptoms. 5. The impairment of the cognitive abilities is predicted by the developmental disorders. Following factors are predictors for the long-term-outcome: 1. Premorbid developmental disorders. 2. Duration of the first episode 3. The extent of positive symptoms at the end of the first episode. 4. Gender 5. Cognitive abilities during the prospective study 6. The extent of the global symptoms-score during the prospective study. The dichotomizing principle of ANDREASEN was not useful to distinguish two types of schizophrenia. The patients rated as “systematical” (according to LEONHARD) showed an unfavourable course, while 65% of those with a better outcome were classified as the “unsystematical type.” The course type 7 (according to HARDING) with the signs “beginning”, “several episodes”, and “unfavourable outcome” was the most frequently found type in our population. 3. In time to the catamnesis 12.5% of the patients were rated as well and satisfying socially adapted (according to DAS-M, respectively GAF-Score), 27.5% showed a low degree of social adaptation, 60% a bad or a completely missing adaptation. The level of psychosocial adaptation was improved by rehabilitation procedures in 57.5% of the cases. In comparison to course studies in the field of adults-psychiatry, see e.g. BLEULER (1972), CIOMPI and MÜLLER (1976), and HARDING (1988), the findings of this study proved to be far more unfavourable referring to the psychosocial-functioning level. Responsible for the difference are the given selection criteria. Even at the beginning of the study, the explored group of adolescent patients could be classified as seriously suffering from schizophrenia, and being exposed to unfavourable psychosocial conditions. The adverse starting point reflects on one hand the extent of premorbid risk factors and predicts on the other hand an unfavourable outcome level.