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Am J Psychiatry 1993; 150:1182-1188
Copyright © 1993 by American Psychiatric Association
An 8-year follow-up of patients with DSM-III-R psychotic depression, schizoaffective disorder, and schizophrenia
D Tsuang and W Coryell
Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City 52242-1057.
OBJECTIVE: The purpose of this study was to investigate the long-term
outcome of patients with functional psychoses. The functional status of
patients with mood-congruent and mood-incongruent psychotic depression,
schizoaffective disorder, and schizophrenia was examined. METHOD:
Ninety-two inpatients with nonmanic and nonorganic functional psychoses who
had been discharged from the hospital were identified through inpatient
records. A blind rater used DSM-III-R criteria to assign research diagnoses
to the patients on the basis of the data gathered at admission. Seventy-one
patients were located 8 years later, and personal interviews were conducted
with them. RESULTS: Baseline diagnosis was a powerful predictor of
long-term outcome, even after controlling for age at onset and duration of
episode at admission. Patients with psychotic depression had much better
outcomes than patients with schizoaffective disorder or schizophrenia.
Fourteen (43.8%) of 32 patients with psychotic depression were free from
psychosis at follow-up, in marked contrast to those who had schizoaffective
disorder or schizophrenia, none of whom had recovered. Patients with
schizoaffective disorder could not be distinguished from patients with
schizophrenia. CONCLUSIONS: The prognosis of patients with major depression
with mood-incongruent features most closely resembles that of depressed
patients with mood-congruent features, while patients with DSM-III-R
schizoaffective disorder have a prognosis resembling that of schizophrenic
patients. Patients with psychotic affective disorders have a much higher
likelihood of recovering from psychosis than do schizophrenic patients.
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