CLINICAL HANDBOOK OF SCHIZOPHRENIA

11. Course and Outcome 103TABLE 11.1. Comparison of the Period Prevalences of the 10 Most Frequent Symptoms in the EarlyCourse of Schizophrenia and Depression and Among Normal ControlsSymptom Schizophrenia Depression Normal Controls Sz vs. Sz vs. Dep vs.% Rank % Rank % Rank Dep NC NCWorrying 74.6 9 94.6 4 26.9 6.5 *** *** ***Headaches, other 49.2 — 66.9 — 30.8 4 ** ** ***aches and painsNervousness, restlessness 88.3 3 81.5 10.5 27.7 5 n.s. *** ***Anxiety 88.1 4 81.5 10.5 26.9 6.5 n.s. *** ***Difficulties of thinking, 93.8 1.5 96.9 3 20.8 — n.s. *** ***concentrationDepressed mood 84.9 5 100.0 1 46.9 1 *** *** ***Loss of self-confidence 68.3 10.5 89.2 7 35.7 3 *** *** ***Social withdrawal, 79.8 8 90.8 6 13.8 — * *** ***suspiciousnessDisturbed appetite 93.8 1.5 98.5 2 43.4 2 n.s. *** ***and/or sleepLoss of energy/82.5 6 93.8 5 15.4 — ** *** ***slownessIrritability 65.4 — 68.5 — 26.2 8 n.s. *** ***Delusional mood 68.3 10.5 4.6 — 0.0 — *** *** *Delusionalmisinterpretations,delusions of reference80.3 7 6.2 — 0.0 — *** *** **Oversensitivity 22.3 — 52.3 — 25.4 9 *** n.s. ***Dissocial behavior 15.3 — 14.6 — 22.3 10 n.s. n.s. n.s.Reduced spare-time 63.5 — 89.1 8 15.5 — *** *** ***activitiesReduced interests/citizen role33.9 — 87.7 9 3.8 — *** *** ***The symptoms—17 in total—were assessed, retrospectively, at age of first admission; symptoms with rank 1 to 10 inany of the three groups. Sz, schizophrenia; Dep, depression; NC, normal controls. McNemar test: n.s., not significant.Data from Häfner et al. (2005).* p < .05; ** p < .01; *** p < .001.A heuristic explanation of this finding is that processes of brain dysfunction mayfirst result in the neuropathological pattern of depression, accompanied by some negativesymptoms and functional impairment. These dysfunctional brain processes may or maynot progress into more negative symptoms and psychosis (Häfner et al., 2005).DUI AND DUP AS INDICATORSOF AN UNFAVORABLE ILLNESS COURSEDUP and DUI have been found to predict an unfavorable course of the first episode ofschizophrenia, including delayed or incomplete remission, reduced level of global functioning,longer duration of hospitalization, and higher treatment costs. In addition, overthe long-term DUP and DUI tend to be associated with a higher risk and a greater severityof relapses, more days in the hospital, poorer global functioning, poorer quality of life,and a greater burden on the family. There is some evidence that DUP and DUI predict the