Schizophrenia Course, Long-Term Outcome, Recovery, and Prognosis

Abstract

Our 26-year longitudinal study and other longitudinal studies confirm older views that outcome for schizophrenia, while showing some variation for different schizophrenia patients, is still significantly poorer than that for other psychiatric disorders, with the exception of the dementias. Our research leads us to propose that risk factors, either stress related or those related to vulnerability to psychosis, account for the episodic course of periods of recovery followed by periods of recurrence that is experienced by most schizophrenia patients. These risk factors interact with personality, temperament, and cognitive traits that, while not causing psychosis, influence its course. It is these interactions that account for the heterogeneous outcome trajectories of different subgroups of people with this condition. Our research and that of others has focused on the contributions of these risk factors, such as vulnerability to trait anxiety, poor developmental achievements before the illness, personality traits such as locus of control, cognitive styles, neurocognitive impairments, length of untreated psychosis, and several others. Despite the proven efficacy of antipsychotic medications over the short term, there is a subgroup of schizophrenia patients who, a few years after the acute phase, function adequately or experience periods of recovery for a number of years, without treatment.