Long-term Prognosis and Followup in Schizophrenia

Abstract

The long-term course or natural history of schizophrenia is correlated with differing diagnostic criteria and commonly agreed upon prognostic variables. A review of 38 long-term followup studies of hospitalized schizophrenics reveals that unspecified or Kraepelinian-type schizophrenia has a much worse prognosis than atypical schizophrenia, schizoaffective psychosis, reactive psychosis, or other good premorbid types. Diagnoses based on longitudinal as well as cross-reactional data are more predictive of outcome than cross-sectionally based diagnoses. Drug and psychosocial treatment results must be evaluated in terms of prognostic variables, many of which are incorporated in some currently employed diagnostic criteria. There is no firm evidence that maintenance medication is indicated in some good prognosis patients. The paucity of long-range followups, the inadequacies of outcome assessments, and diagnostic disagreements limit our understanding of the effects of drug treatment, a treatment which is not without dangerous neurological side effects in many patients.

The International Pilot Study of Schizophrenia: five-year follow-up findings

“…There has been a large number of relevant studies in developed countries, incurring the usual disadvantage of a great variety of methods of selection of patients, assessment and categorization of course and outcome. Stephens (1978) reviewed 38 studies involving a long-term followup of schizophrenic patients. Of these 13 are of most immediate relevance to our design, since the follow-up was at least five years but averaged less than ten.…”

The effects of early and sustained intervention on the long-term morbidity of schizophrenia

“…Caution is needed to interpret these findings because numerous studies have demonstrated that patients with an acute onset have a better prognosis than patients whose onset of illness is more gradual (Stephens, 1970). Therefore, it is possible that individuals treated early in the course of their illness have a different form of schizophrenia than those for whom treatment is delayed.…”

A comprehensive assessment of gray and white matter volumes and their relationship to outcome and severity in schizophrenia

“…In comparison to schizophrenia patients with more favorable outcomes, the course of the pooroutcome schizophrenia is characterized by severe dysfunctions in self-care (Keefe et al, 1996), limitations in premorbid sociosexual functioning (Keefe et al, 1989(Keefe et al, , 1990), more severe negative symptoms and formal thought disorder (Stephens, 1978;Keefe et al, 1989), poorer response to antipsychotic treatment , lower association with affective symptomatology (Kilzieh et al, 2003;Rieckmann et al, 2005), excessive summertime clustering of birthdates (Bralet et al, 2002), and more extensive family history of schizophrenia spectrum disorders (Keefe et al, 1992). Some of these poor-outcome characteristics are in turn interrelated, e.g.…”