A. Okasha : CURRENT TREATMENT IN PSYCHOSES :

This lecture will discuss whether there have been any actual changes in the outcome of psychotic illnesses after the introduction of secondgeneration antipsychotics. There is some confusion in the literature concerning the terms prognosis, course and outcome. Prognosis actually includes course and outcome, while outcome is only one aspect of the course, « the end point of the course in a defined period of time ». We shall focus on schizophrenia, bipolar disorder and psychotic depression. An evaluation of outcome from the beginning of the 20th century (i.e. before the introduction of neuroleptics up to now will be attempted, taking into consideration both symptomatic and functional outcome. Psychotic disorders are long lasting and usually life long disorders. Affective disorders have a better long-term outcome than schizophrenic and schizoaffective disorders. It is still uncertain whether modern treatment has substantially changed the course and outcome of psychotic disorders. Manifest changes in the outcome, if any, will be reflected not on a symptomatic or syndromal level but probably on functional, occupational and interpersonal levels, where psychotic patients are not so dislocated from society as before. Reviewing the literature, outcome studies scarcely differentiate between symptomatic (syndromal) and functional outcome, which may lead to biased results. It is unfortunate that recent outcome studies deal only with intermediate and short-term outcome, influenced by research of the industry, to assess the value of novel antipsychotics. The lecture will review the state of the art in the current literature, in developed and developing countries, regarding the short, intermediate and long-term outcome of psychotic disorders.