Schizophrenia: The Prognosis

Three courses:

The 'Rule of Thirds' commonly held by American psychiatrists and found to hold true in Europe:

• one-third of all people diagnosed and hospitalized with schizophrenia will recover completely,
• one-third will be improved, needing only occasional hospitalization, if any,
• one-third will remain unimproved.

Prognosis:

• The predictors of a good outcome, complete recovery or marked improvement, are little or no family history of schizophrenia, normal adjustment before onset, precipitating events, confusion, paranoia, depression, catatonic behavior.
• Early age of onset, family history, marked thinking disorder, withdrawal, apathy point to a poor outcome.
• The prognosis for men is worse than it is for women. Also, the greater number of relapses, the less the chances for complete recovery.

Hospitalization and outcome:

The longer the stay, the greater the chances of the person becoming institutionalized and, therefore, dependent on hospital care.

Social attitudes and outcome:

If the expectation is that you won't get better, then you won't.

Drugs and outcome:

"Medications have certainly influenced the course of schizophrenia, but it is too early to say exactly how much. At a minimum the drugs have decreased the number of relapses and rehospitalizations; whether this prevents some of the brain damage from occuring is not known. It is most likely that the drugs have 'improved' the functioning of the 'improved' middle one-third, allowing more of them to live independently and to hold jobs. This is no small accomplishment. It is less clear whether the drugs have altered the course of the recovered one-third, who would probably have recovered with or without drugs although drugs may well have speeded the process. Nor is it yet certain whether drugs decrease the size of the group who are unimproved on follow-up, although it is likely that they do so, at least modestly. And in addition to probably moving some patients from the unimproved to the improved category, the drugs significantly improve functioning in some remaining unimproved patients. For example, many chronically ill schizophrenic patients, when properly medicated, can be given grounds privileges and weekend passes, and taken on trips outside the hospital; whereas without medication they are too acutely disturbed to do any of these things."

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