The Chestnut Lodge Prognostic Scale for Chronic Schizophrenia is a simple test for assessing patients with schizophrenia which is independent of chronicity. It measures prognosis as a dynamic interplay between skill acquisition and the relative virulence of the illness.



(1) adaptive occupational functioning

(2) social functioning (made friends vs loner)

(3) psychotic assaultiveness (erosion of reality testing)

(4) depressed mood (preservation of affect)

(5) family history of schizophrenia (genetic loading)


Acquisition of skills and interests (explanation from table above)

(4) The patient is working at an occupation - or preparing him/herself for an occupation - in which he/she is interested and in which he/she sees a future. In addition, he/she is following some avocational interest or interests. (If he/she occupational interests seem complete, but there is no avocational pursuits, rank at 3).

(3) The patient has worked somewhat steadily at something he/she enjoys, but in which he/she sees no future, or although working at different jobs, has developed a set of interests or hobbies which he/she is pursuing with some vigor and interest (perhaps a sport, music, or collection).

(2) The patient has been able to earn money at jobs that require some low level skill (e.g., fry cook or construction worker). He/she has not seemed to settle on an occupation that interests him/her and seems to have developed few interests or skills beyond these self-sustaining efforts.

(1) The patient may have developed a hobby or talent to the point of being fairly proficient. It does not have the potential for financial reward, and it does not seem to bring the patient much closer to others. The overall impression is that the hobby or interest is a lone exception in a life otherwise lacking in skills.

(0) The patient seems to have developed no skills that would help him/her sustain him/herself, develop friendships, or gratify curiosities and interests. There is no indication of either occupational endeavors or hobbies.


Chestnut Lodge prognostic scale =

= SUM(points for all 5 aspects)



• minimum score: 0

• maximum score: 12

• The lower the score the more likely a poor outcome will occur.

• Poor outcome can be predicted with greater sensitivity than good outcome.

Prognostic Scale

Poor Outcome

Moderate Outcome

Good Outcome

1 - 3




4 - 6




7 - 9




10 - 12






• Advances in chemotherapeutic agents may alter the expected outcome for a given score.


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