Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-28T11:49:08.569Z Has data issue: false hasContentIssue false
  • English
  • Français

The Northwick Park ‘Functional’ Psychosis Study: diagnosis and outcome

Published online by Cambridge University Press:  09 July 2009

E. C. Johnstone ,
C. D. Frith ,
T. J. Crow ,
D. G. C. Owens ,
D. J. Done ,
E. J. Baldwin  and
A. Charlette
E. C. Johnstone*
Affiliation:
Division of Psychiatry and Section of Medical Statistics, Northwick Park Hospital and Clinical Research Centre, Harrow
C. D. Frith
Affiliation:
Division of Psychiatry and Section of Medical Statistics, Northwick Park Hospital and Clinical Research Centre, Harrow
T. J. Crow
Affiliation:
Division of Psychiatry and Section of Medical Statistics, Northwick Park Hospital and Clinical Research Centre, Harrow
D. G. C. Owens
Affiliation:
Division of Psychiatry and Section of Medical Statistics, Northwick Park Hospital and Clinical Research Centre, Harrow
D. J. Done
Affiliation:
Division of Psychiatry and Section of Medical Statistics, Northwick Park Hospital and Clinical Research Centre, Harrow
E. J. Baldwin
Affiliation:
Division of Psychiatry and Section of Medical Statistics, Northwick Park Hospital and Clinical Research Centre, Harrow
A. Charlette
Affiliation:
Division of Psychiatry and Section of Medical Statistics, Northwick Park Hospital and Clinical Research Centre, Harrow
*
1Address for correspondence: Professor Eve C. Johnstone, University Department of Psychiatry, The Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Three hundred and twenty-six consecutively admitted patients with functional psychotic illnesses to which no diagnostic classification had been applied were followed up after 2·5 years. They were examined in social, clinical and psychological terms and the CATEGO programme and DSM-III criteria were applied to data concerning the index episode to derive diagnostic classifications. The deterioration in occupational functioning and the hospital careers of patients with diagnostic classifications of schizophrenia were worse than those in the other groups and positive and negative features were also more severe in patients with a classification of schizophrenia. By contrast, no differences in psychological test performance were found between the groups based upon diagnostic classification. Impaired psychological test performance was found and it was strongly related to concurrent mental state abnormalities, particularly negative symptoms. It is concluded that the diagnostic classifications used were of limited value in predicting outcome in functional psychosis.

Type
Original Articles
Information
Psychological Medicine , Volume 22 , Issue 2 , May 1992 , pp. 331 - 346
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achté, K. A. (1967). On prognosis and rehabilitation in schizophrenic and paranoid psychoses. A comparative follow-up study of two series of patients admitted to hospital in 1950 and 1960 respectively. Acta Psychiatrica Scandinavica 43, Suppl. 196.Google Scholar
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). APA: Washington DC.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised). (DSM-III-R.) APA: Washington DC.Google Scholar
Annett, M. (1970). A classification of hand preference by association analysis. British Journal of Psychology 61, 303–321.CrossRefGoogle ScholarPubMed
Bech, P., Rafaelsen, O. J., Kramp, P. & Bolwig, T. (1978). The mania rating scale: scale construction and inter rater reliability. Neuropharmacology 17, 430–431.CrossRefGoogle Scholar
Bishop, D. V. M. (1980). Handedness, clumsiness and cognitive ability. Developmental Medicine and Child Neurology 22, 569–579.CrossRefGoogle ScholarPubMed
Blackwood, D. H. R., Muir, W. J., St Clair, D. M. & Evans, H. J. (1989). Schizophrenia and chromosomes. Lancet ii, 1459.CrossRefGoogle Scholar
Bleuler, E. (1911). Dementia Praecox or the Group of Schizophrenias (translated by Zinkin, Joseph, 1950). International Universities Press: New York.Google Scholar
BMDP (1988). Statistical Software Manual. University of California Press: London, UK.Google Scholar
Brockington, I. F. & Leff, J. P. (1979). Schizo-affective psychosis: definitions and incidence. Psychological Medicine 9, 91–99.CrossRefGoogle ScholarPubMed
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement 20, 37–46.CrossRefGoogle Scholar
Cox, D. R. (1970). The Analysis of Binary Data. Methuen: London.Google Scholar
Crow, T. J. & Stevens, M. (1978). Age disorientation in chronic schizophrenia: the nature of the cognitive defect. British Journal of Psychiatry 133, 137–142.CrossRefGoogle Scholar
Drake, R. E. & Cotton, P. G. (1986). Depression, hopelessness and suicide in chronic schizophrenia. British Journal of Psychiatry 148, 554–559.CrossRefGoogle ScholarPubMed
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, A., Winokaur, G. & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 57–63.CrossRefGoogle ScholarPubMed
Gruzelier, J. H. (1981). Cerebral laterality and psychopathology: fact and fiction. Psychological Medicine 11, 219–227.Google Scholar
Guy, W. (1976). ECDEU Assessment for Psychopharmacology. National Institute for Mental Health, Psychopharmacology Research Branch: Rockville, Maryland.Google Scholar
Häfner, H., Riecher, A., Maurer, K., Löffler, W., Munk-Jørgensen, P. & Strömgren, E. (1989). How does gender influence age at first hospitalization for schizophrenia? Psychological Medicine 19, 903–918.CrossRefGoogle ScholarPubMed
HMSO (1980). Classification of Occupations of the Registrar General. Her Majesty's Stationery Office: London.Google Scholar
Huber, G., Gross, G. & Schlutter, R. (1975). A long term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatrica Scandinavica 52, 49–57.CrossRefGoogle ScholarPubMed
Ingvar, D. H. (1987). Evidence for frontal/prefrontal cortical dysfunction in chronic schizophrenia: the phenomenon of hypofrontality reconsidered. In Biological Perspectives of Schizophrenia (ed. Helmchem, H. and Henn, F. A.), pp. 201–211. John Wiley/S. Bernhard Dahlem Konferenzen 1987: Chichester.Google Scholar
Johnstone, E. C., Owens, D. G. C., Gold, A., Crow, T. J. & Macmillan, J. F. (1984). Schizophrenic patients discharged from hospital – a follow up study. British Journal of Psychiatry 145, 586–590.CrossRefGoogle ScholarPubMed
Johnstone, E. C., Owens, D. G. C., Frith, C. D. & Calvert, L. (1985). Institutionalisation and the outcome of functional psychoses. British Journal of Psychiatry 146, 36–44.CrossRefGoogle ScholarPubMed
Johnstone, E. C., Crow, T. J., Frith, C. D. & Owens, D. G. C. (1988). The Northwick Park ‘Functional’ Psychosis Study: diagnosis and treatment response. Lancet ii, 119–126.CrossRefGoogle Scholar
Kasanin, J. (1933). The acute schizoaffective psychoses. American Journal of Psychiatry 90, 97–126.CrossRefGoogle Scholar
Keller, M. B., Lavori, P., Rice, J., Coryell, W. & Hirschfield, R. M. A. (1986). The persistent risk of chronicity in recurrent episodes of non-bipolar major depressive disorder: a prospective follow up. American Journal of Psychiatry 143, 24–28.Google Scholar
Kety, S. S. (1980). The syndrome of schizophrenia: unresolved questions and opportunities for research. British Journal of Psychiatry 136, 421–436.CrossRefGoogle ScholarPubMed
Kiloh, L. G., Andrews, G. & Neilson, M. (1988). The long-term outcome of depressive illness. British Journal of Psychiatry 153, 752–757.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1899). Psychiatrie, ein Lehrbuch für Stuierende und Arzte 6th edn.Barth: Leipzig.Google Scholar
Kraepelin, E. (1919). Dementia Praecox and Paraphrenia (translated by Barclay, R. M. and printed in 1971). R. E. Kreger: New York.Google Scholar
Krawiecka, M., Goldberg, D. & Vaughan, M. (1977). A standardised psychiatric assessment for rating chronic psychotic patients. Acta Psychiatrica Scandinavica 55, 299–308.CrossRefGoogle ScholarPubMed
Landis, J. R. & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics 33, 159–174.CrossRefGoogle ScholarPubMed
Lee, A. S. & Murray, R. M. (1988). The long-term outcome of Maudsley depressives. British Journal of Psychiatry 153, 741–751.CrossRefGoogle ScholarPubMed
Lewine, R. J. (1981). Sex differences in schizophrenia: timing or subtypes. Psychological Bulletin 90, 432–444.CrossRefGoogle ScholarPubMed
McCabe, M. (1975). Demographic differences in functional psychoses. British Journal of Psychiatry 127, 320–323.CrossRefGoogle ScholarPubMed
Macmillan, J. F., Crow, T. J., Johnson, A. L. & Johnstone, E. C. (1986). Northwick Park Study of first episodes of schizophrenia. II. Short-term outcome in trial entrants and trial eligible patients. British Journal of Psychiatry 148, 128–133.CrossRefGoogle Scholar
Miles, C. P. (1977). Conditions predisposing to suicide: a review. Journal of Nervous & Mental Disease 164, 231–246.CrossRefGoogle ScholarPubMed
Montgomery, S. A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Murray, R. M. (1989). Why Kraepelin was wrong. Abstracts of VIII World Congress of Psychiatry. Excerpta Medica, International Congress Series 899, 169.Google Scholar
Nelson, H. E. & O'Connell, A. (1978). Dementia: the estimation of premorbid intelligence levels using the New Adult Reading Test. Cortex 14, 234–244.CrossRefGoogle ScholarPubMed
Pope, H. G. & Lipinski, J. F. (1978). Diagnosis of schizophrenia and manic depressive illness: a reassessment of the specificity of ‘schizophrenic’ symptoms in the light of current research. Archives of General Psychiatry 35, 811–828.CrossRefGoogle ScholarPubMed
Procci, W. R. (1976). Schizo-affective psychosis: fact or fiction. Archives of General Psychiatry 33, 1167–1178.CrossRefGoogle ScholarPubMed
Robertson, G. & Taylor, P. J. (1987). Laterality and psychosis: neuropsychological evidence. British Medical Bulletin 43, 634–650.CrossRefGoogle ScholarPubMed
Schneider, K. (1959). Clinical Psychopathology. Grune & Stratton: New York.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1975). Research Diagnostic Criteria for a Selected Group of Functional Psychoses 2nd edn.Biometrics Research Division: New York.Google Scholar
Stephens, J. H. (1978). Long-term prognosis and follow-up in schizophrenia. Schizophrenia Bulletin 4, 25–47.CrossRefGoogle ScholarPubMed
Tsuang, M. T. & Simpson, J. C. (1984). Schizoaffective disorder: concept and reality. Schizophrenia Bulletin 10, 14–25.CrossRefGoogle Scholar
Weissman, M. & Klerman, G. (1977). Sex difference and the epidemiology of depression. Archives of General Psychiatry 34, 98–111.CrossRefGoogle Scholar
Welner, A., Croughan, J. L. & Robins, E. (1974). A group of schizoaffective and related psychoses – critique, record, follow-up and family studies. Archives of General Psychiatry 31, 628–631.Google ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Description and Classification of Psychiatric Symptoms: an Instruction Manual for the PSE and CATEGO Systems. Cambridge University Press: Cambridge.Google Scholar
Wing, J. K. (1989). The concept of negative symptoms. British Journal of Psychiatry 155, suppl. 7, 10–14.CrossRefGoogle Scholar
Wojcik, J. D., Gelenberg, A. J., Labrie, R. A. & Meske, M. (1980). Prevalence of tardive dyskinesia in an outpatient population. Comparative Psychiatry 21, 370–380.CrossRefGoogle Scholar