Prognostic scale for chronic schizophrenia.

Although prognostic scales are available for schizophrenia, these focus on acute or subacute populations where premorbid functioning and established chronicity are the best predictors of outcome. Their usefulness in chronic schizophrenia is limited. The authors describe a simple and reliable 5-item, 12-point prognostic scale for chronic schizophrenia independent of chronicity. It measures prognosis as the product of a dynamic interplay between the highest level of adaptive occupational and social functioning ever achieved by the individual and the "invasiveness" of the Axis I disorder as manifest by genetic loading (family history of schizophrenia), erosion of reality testing (psychotic assaultiveness), and preservation of affect in psychopathology (depressed mood). Among chronic schizophrenic patients in the Chestnut Lodge Followup Study (n = 163), the prognostic score (based on history and admission clinical picture) allowed strong probabilistic statements to be made about long-term outcome. Tables present the conditional probability or risk of specific outcomes in the domains of institutionalization, work functioning, social relations, and global outcome for patients at varying levels along the prognostic spectrum. Close examination of these predictor-outcome relationships suggests that prognosis in chronic schizophrenia may be thought of as the variability (as opposed to fixedness) remaining in the individual's future life course, and poor outcome can be predicted with greater sensitivity than good outcome.