Prospective Follow-up of Patients with Schizophrenia – Results for Outcome Predictors

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Schizophrenia is a heterogeneous disease with wide variation in the therapeutic response of patients – from good to treatment refraction and severe disability. This study has naturalistic, non-interventional design, and includes one-year prospective follow-up. Schizophrenia patients are evaluated in three time points: at admission (T1), at discharge (T2), and one year after the hospitalization (T3). Psychopathology is assessed by the Positive and Negative Syndrome Scale (PANSS), negative symptoms – by the Scale for Assessment of Negative Symptoms (SANS), aggression – by the Modified Overt Aggression Scale (MOAS), and functioning – by the Global Assessment of Functioning (GAF) scale. Statistical analyses are performed using descriptive methods, Student's t-test, Wilcoxon Signed Ranks Test, and multiple regression. Ethical approval for the study has been obtained. The sample consists of 108 patients with mean age of 39 (SD ± 12.7), and 89.8% (N = 97) of them were prospectively assessed after one year. All symptom dimensions in the 5-factor model – positive, negative, disorganized, manic, and depressive, measured by PANSS, as well as the negative symptoms (objectified by SANS) and aggression (objectified by MOAS) rates, are significantly lower after inpatient treatment. There is an improvement in functioning one year after admission (z = –8.01, p < .001), although both negative symptoms (z = –2.45, p = 0.015) and aggressive behaviour (z = –4.260, p < .001) are significantly higher as compared to discharge. From the multiple regression, at T1, involuntary admission is a significant predictor for higher aggression and lower functioning (p < .001$). The duration of hospitalization is longer with lower compliance (p = .022$), and the treatment with atypical antipsychotics decreases the hospital stay (p = .021$). One year after admission, employment serves as a positive predictive factor as it is significantly associated with drop of psychopathology (p = .001) and negative symptoms (p < .001), and with improvement of functioning (p < .001). Good compliance is a predictor for lower psychopathology (p = .015), less aggression and higher functioning (p < .001). The inpatient treatment is efficacious in terms of psychopathology and aggression, and is linked to better functioning. The naturalistic design shows depletion of the positive effects of treatment in terms of negative symptoms and aggression probably due to incomplete medication compliance, which is a poor prognostic factor for functioning. This demonstrates the imperative need of continuity in mental health care and better psychoeducation after discharge.