Clinical Signs, Diagnosis and Prognosis in the Functional Psychoses

Abstract

In a previous enquiry the prognostic significance of diverse aspects of the functional psychoses was examined (Harris and Lubin, 1952; Harris and Norris, in press). Prognosis was evaluated in terms of total length of stay in a mental hospital over a follow-up period of 18 years. Each patient was assigned to one of three major diagnostic groups (schizophrenia, affective psychosis or atypical psychosis), the diagnosis being based on Kraepelinian and Bleulerian criteria. The diagnosis was made by one of the authors (A.H.) on the evidence of 20-year-old case notes written by a large number of different psychiatrists. In this investigation the same author himself examined all the patients included in the series. We felt it would be interesting to compare the predictive value of diagnoses made by the rough and ready method of the earlier survey with that of those made by a detailed examination of the patients concerned, as in the present survey. For reasons previously stated (Harris and Norris, 1954) we feel that only certified patients admitted in the second period are comparable with the types of cases admitted in 1930. If a diagnosis of schizophrenia is held to connote an unfavourable and the remaining categories a favourable outcome then in the first series 60 per cent. of the patients were correctly classified while in the second series 58 per cent. of the certified patients were assigned to their correct diagnostic group. This difference is not significant. Thus it would appear that a more sophisticated application of Bleulerian methods of diagnosis does not necessarily give rise to more reliable evaluation of prognosis. Accordingly we have attempted to dissect these three diagnostic categories to determine whether any of the components show prognostic significance. For this purpose we took the second series because for these patients there were available detailed clinical descriptions made by one of the authors (A.H.) in the observation ward of a general hospital, prior to the patient's transfer to a mental hospital. Unfortunately 13 of the case notes containing these detailed clinical descriptions had been lost, so that we could only use 187 patients out of the total of 200. They were first admitted to hospital in the period May, 1940 to May, 1942 and were followed-up for the next 10 years. The result of the analysis is set out in the table.