Long-term course of schizoaffective disorders. Part III: Onset, type of episodes and syndrome shift, precipitating factors, suicidality, seasonality, inactivity of illness, and outcome.

In addition to the findings presented previously, one-half of the 72 investigated schizoaffective patients had an acute onset. Onset of manic symptomatology was found to be usually acute. Although precipitating factors were found in 76% of the patients, this was found for only one-third of the 397 episodes. In spite of the fact that the majority of patients (61%) had a polymorphous course (with more than one type of episode), the pure schizophrenic or pure affective syndromes only seldomly dominated the course, as schizoaffectivity score and syndrome-presence index showed. Some 81% of the patients had delusions or hallucinations but only 37% of the individual episodes; 65% of the patients had suicidal symptomatology (24% of the episodes, mainly the schizodepressive ones). No seasonality was found, and 50% of the patients had a favorable outcome, only 6% ended in severe residuum. In old age the illness usually became inactive.