Lecture 3: Course and outcome Flashcards
Why do we care about the time-course of a disorder?
- May allow us to predict who will develop the disorder and treat them early
- Helps us to plan treatment; inform patients and families
- Assess the effects of medication, other interventions
- Perhaps identify sub-types that have different causes, treatments
What are the stages of illness?
- Premorbid phase (before onset of psychotic symptoms)
- Prodromal phase (sub-clinical psychotic symptoms)
- Onset (first episode)
- Long-term course or outcome
Define the Premorbid stage.
Some people show signs of poor function or disturbed development in childhood and adolescence
What do we know from Retrospective studies?
1) Delayed motor development (walking, balance, coordination)
2) Lower IQ
3) Poor performance on tests of processing speed, attention, memory
4) Poor social understanding (theory of mind) and impaired social skills (family and peer interactions)
- But, these deficits overlap with other developmental disorders and adjustment problems
Define the prodromal stage
Most people with SZ show signs of disturbance from 1-3 years before diagnosis
What are the psychotic-like symptoms in the prodromal stage?
Hallucinations, delusions and thought disorder
Less persistent – come and go for brief periods
The person retains insight – they can tell they are not “real”
What are the negative symptoms in the prodromal stage?
- Cognitive changes (confusion, lack of concentration)
- Poor social functioning and social withdrawal
These symptoms in the prodromal stage indicate ___________________
a risk that the person will develop SZ
In the prodromal stage, medication is __________
not typically used
Psychological interventions at the prodromal stage can ____________
reduce this risk
What is the percentage of risk that when these symptoms first appear the person will develop SZ?
(prodromal stage, positive and negative symptoms)
25% within 2 yrs; 35% within 5 yrs
What makes it difficult to diagnose SZ in the prodromal stage?
The most common prodromal symptoms are signs of depression and negative symptoms such as confusion and social withdrawal
In the prodromal stage, only ____ show positive symptoms?
6.5%
In the prodromal stage, ___ show both negative and positive symptoms
20%
The most predictive factor for later diagnosis is _______
poor social skills and few friends
What are the characteristics of onset in SZ
- Variable rate of onset of symptoms
- Half experience a rapid onset of acute symptoms, in others the onset may take months or years
What is the Outcome of SZ?
Outcome is variable and has changed with the development of more effective medications
When Kraepelin first defined SZ, he called it ________________
“dementia praecox” or “early dementia”
Kraepelin wanted to differentiate it from ________
the type of dementia defined by Alois Alzheimer
Kraeplin thought that there were two different sub-types of SZ, what were they?
Group I: mostly psychotic symptoms and a variable course
Group 2: mostly negative symptoms with a declining course
Why did Kraepelin divide SZ into two sub-types?
He hoped that by defining sub-groups, more specific treatment could be given
Name one of the goals of studying the time course of SZ
Specify treatment
Current research focuses on __________
positive vs negative symptoms
Follow-up studies of time-course of SZ, before antipsychotic medications (1-10 yrs) showed on average that _______________
- The symptoms got more severe as time progressed without medication
[67% still severely ill; 21% were moderately ill; 12% recovered
Studies with longer follow-up showed more severe outcome]
Follow-up studies after antipsychotic medications (5-15 yrs) showed on average:
- 21% recovered.
- Symptoms did not get worse over time with medication.
[25% severe; 54% moderate; 21% recovered
No pattern of worse outcome with longer follow-up
Despite the fact that modern criteria are stricter]
What is recovery?
Full recovery from SZ – with no psychotic symptoms and no impairment – is rare
Many people considered recovered will experience __________
relapse or have residual negative (especially cognitive) symptoms
What is the effect of antipsychotics on SZ?
Antipsychotics control symptoms, but do not cure
_________ of people considered recovered in a WHO study were taking medication
Less than half
Why were less than half of people considered recovered in a WHO study were taking medication?
- Taking medications has a negative effect
- Those who have recovered more likely to stop taking medications
- Other social factors may be important
How do Antipsychotics improve outcome? (hint: 3)
1) Decrease positive symptoms
2) Increase time between relapse – more frequent relapse is related to poorer long-term outcome
3) Reduce mortality
Does Cognitive function change?
- Cognitive deficits appear to be stable
- No differences between new and chronic cases
- No differences over time
- These may be linked to pre-existing differences in brain structure or function
In regard to the prediction from the period before diagnosis, Hafner predicted that the ____________________________
the longer a person had symptoms before being diagnosed and treated for SZ, the worse would be their outcome
What were the two measures of Hafner’s study and what did they predict?
Two measures:
Duration of untreated psychosis (DUP)
Duration of untreated illness (DUI; not psychotic)
DUP predicts level of positive symptoms
DUI predicts level of negative symptoms
Does Social functioning change?
People at high risk of developing SZ already show social impairments compared to controls and do not differ from those already diagnosed.
