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Psycology » Psychiatry and psychotherapy » Schizophrenia and schizoaffective disorder » Course and prognosis

Although it has become a generally accepted opinion that the outcome of schizophrenia worse than most other mental disorders, conducted surprisingly little long-term follow-up studies of patients with schizophrenia. Even fewer were studies that used diagnostic criteria satisfactory, adequate largest sample of patients and outcome evaluation methods that allow to distinguish between symptoms and social adaptation. It is known that the result can vary widely. These differences can be explained in three ways: 1) schizophrenia may be a single disease state, during which modified extraneous factors, 2) schizophrenia may include several subtypes with different expectations, and 3) cases with a good prognosis may not relate to schizophrenia, and how to something other diseases.
The second and third explanations have already been discussed; later in this section will be considered the first option. Necessary to distinguish between research data, taking into account only the primary hospitalization, and research data covering a second or subsequent hospitalization, or data that does not contain any information about this (see: Harding et al. 1987 review of the outcomes). In the study of a consecutive series of work gives the impression that the outlook could improve from the beginning of this century. Kraepelin (Kraepelin 1919) concluded that even after many years, only 17% of the patients in Heidelberg well adapted socially. In 1932, the same clinic Mayer-Gross (Mayer-Gross) reported social rehabilitation after 16 years, about 30% of patients. By 1966, Brown et al. published data on social recovery after five years 56% of patients. In contrast, the Ciompi (1980), conducted a study of patients who in the same center was diagnosed with schizophrenia since the beginning of the century and up to 1962, found no significant changes in terms of increase in the total proportion of cases of patients with good or satisfactory social outcome. Mortality among schizophrenics is significantly higher than in the general population. Increased mortality due to several natural causes and suicide (Allebeck, Wisledt 1986). Data from all studies with long catamnesis indicate that up to 10% of schizophrenics die by suicide (see: Roy 1982).
Important long-term study was carried out by Manfred Bleuler (Bleuler 1972, 1974), who personally conducted follow-up 208 patients hospitalized in Switzerland between 1942 and 1943. 20 years after hospital admission in 20% of patients had a complete remission and 24% had severe mental disorders. M. Bleuler believed that such a relationship has changed little since the introduction of modern methods of treatment, although thanks to the success of drug and social therapy received effective assistance to patients with fluctuating course of the disease. In the study of social adaptation was found that cases with a good outcome constitute approximately 30% of the total study group, and among the first 40% of hospitalized patients. In cases where the disease came to an end in complete recovery, it usually occurred during the first two years and rarely after five consecutive years of the disease.
Bleuler used narrow (strict) diagnostic criteria for schizophrenia, and his findings indicate that the traditional view of schizophrenia as a disease that in most cases and leads to progressive disability, should be revised. But still 10% of the patients suffered from a disease such severity that they needed a long stay and proper care in a psychiatric boarding. In the case of the recurrent form of the disease usually each subsequent episode of the clinical signs resembled the very first. Conclusions M. Bleuler mainly supported the results of a larger, but less detailed study of long-term outcome, held in Lausanne (Ciompi 1980). The study was based on the well-preserved records histories of 1642 patients diagnosed with schizophrenia, delivered in the period from the beginning of the century until 1962. The average duration of follow-equal 37 years. One third of patients have found a good or satisfactory social outcome. At older ages symptoms often mitigated. Similar data were obtained by Huber et al. (1975) as a result of a 22-year follow-up 502 patients in Bonn. (See: Harding et al. 1987 review of the outcomes).
Attempts were made to identify reliable predictors of outcome in schizophrenia (see: Stephens 1978). Langfeldt (1961) set and said set of criteria, they apparently are satisfactory. However, in the framework of the International preliminary study of schizophrenia (World Health Organization 1979) evaluated the prognostic value of several sets of criteria based on symptoms, including criteria Langfeldt, Feighner diagnostic criteria and some others, and they all gave very poor results in predicting the outcome of a two-year period (Strauss, Carpenter 1977). The most reliable predictors of poor outcome, apparently, are the criteria used for diagnosis in the DSM-III, but not completely, and partly because they stipulate that the diagnosis of schizophrenia can be delivered only if the presence of the syndrome for at least six months (Helzer et al. 1983). During the above-mentioned international study continued testing and other clinical and social criteria. When combined the 47 prospective predictors, they explained less than 38% of options two-year outcome, here included 11% of cases attributed by sociodemographic variables, 14% due to the history of the disease and 13% due to clinical signs of the disease for the most recent episode.
Therefore, clinicians should use caution when asked about the prognosis of the disease outcome in each case. In this case, admittedly useful guided the factors listed in Table. 9.8. Still discussed factors acting until disease or schizophrenia in the initial period. Below we consider factors acting after the established disease.


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