정신분열증의 예후 예측 변인에 관한 임상적 관찰

Predictable Variables of Prognosis in Schizophrenia

With the review of literatures on prognostic variables in schizophrenia, this study was designed to observe the predictable variables of prognosis and outcome including general, as well as premorbid functional and family factors in terms of the improvement at discharge. The subjects were consisted of 81 schizophrenics who had been hospitalized at least for more than 20 days in the department of neuropsychiatry, Soon Chum Hyang Med. college hospital from March, 1st, 1979 to Dec. 31th, 1981. Among 24 prognostic variables studied, 10 items were found to be valuable in predicting outcome upon discharge. 1) Better the premorbid adaptability, higher the degree of improvement at discharge. 2) Good premorbid personalities were significantly correlated with the higher improvement rate. 3) The group of acute onset (under 6 months). was associated with the highest rate of improvement, whereas the group of chronic course of illness (above 10 years) was with the poorest. 4) The presence of past history of psychiatric hospitalization was highly correlated with the lower rate of improvement (33.696). 5) Improvement rate was significantly higher in the group with the identified precipitating factors (8b%) than the group without ones (16.2%). 6) There was highly significant correlation found between the group with and without physical and functional defects or disabilities in the rate of improvement (10% ： 49. 3% rerpectively). 7) Between the group with and without family history of schizophrenia, there was also significant correlation in the improvement rate. (20% ： 50% respectively). 8) The rate of improvement was higher in the group with disturbance of consiousness (85.6%) around the time of admission than the group with clear one (40.596). 9) As for the state of affect, the group with anxiety and elated mood were associated with the higher improvement rates (66.1% and 78.5), while the group with emotional blunting was associated with the poorer improvement rate (12.4% ). There was no unimproved case in the depressive group. 10) In terms of clinical type, the catatonic, paranoid, affective and atypical groups were associated with the higher improvement rates above 60%, while the hebephrenic and simple groups were associated with the lower rates of improvement. To summarize, a 10-point prognostic score was constructed by using the ten variables enumerated above as a prognostic variables. The group with the total score of 4 or less could be predicted as a favorable prognostic group and a score of 5 or 6 as a undetermined group, while the group with the score of 7 or more could be predictedj as a definitely poor progonstic group.