Six-month clinical status as a predictor of 24-month clinical outcome in first-admission patients with schizophrenia.

The aim of this study was to determine whether clinical status at 6-month follow-up is a predictor of 2-year clinical status in first-admission schizophrenic patients. If short-term status is indeed a strong predictor of subsequent functioning, the relationship would support earlier initiation of aggressive interventions. An epidemiologically based sample of 162 first-admission schizophrenic patients was examined at index hospitalization and at 6- and 24-month follow-up, using a variety of diagnostic and clinical assessment instruments. Respondents were divided into three groups based on their 6-month clinical status: delusions or hallucinations present at 6-month follow-up with or without negative symptoms (n = 63); moderate to high levels of negative symptoms (but not positive symptoms) present (n = 42); neither positive nor negative symptoms present (n = 57). Differences in 24-month clinical functioning were evaluated (GAF scores, BPRS factors, role functioning, number of rehospitalizations, and illness course). No significant differences were found among the three groups on demographic characteristics, substance abuse history, or extent of treatment during the follow-up. At 24-month follow-up, respondents with positive psychotic symptoms at 6-month follow-up had the worst, and those with no positive or negative symptoms the best functioning, with the negative-symptom group intermediate on most indices. Thus, among schizophrenic patients, poor 6-month clinical status identified a patient subgroup at high risk for continued poor clinical status at 24 months, suggesting the need for earlier intensive intervention in an attempt to prevent this progression.