Long-Term Outcome of Patients with Schizophrenia: A Review

Objective: To review empirical studies that assess outcome of patients with schizophrenia and evaluate the degree to which reported outcome is affected by research methodology, treatment variables, prognostic factors, epidemiologic factors, and patient resilience. Method: We reviewed studies that used control subjects and lasted for a decade or more, comparing them with respect to research methodology and choice of outcome variables. Results: Like other mental illnesses and medical illness in general, the natural course of schizophrenia showed itself to have a threefold division of mild, moderate, and severe. Although a great deal of variance in outcome occurred across the studies reviewed, schizophrenia is nevertheless a disorder with relatively poor outcome. Patients with schizophrenia consistently showed poorer courses and outcomes than patients with other psychotic and nonpsychotic psychiatric disorders. On the positive side, subgroups of schizophrenia patients had extended periods of recovery—some without the benefit of extensive mental health aftercare treatment—and patients with schizophrenia did not show a progressive downhill course. Conclusion: While documenting the heterogeneity in outcome and the generally poorer outcomes of patients with schizophrenia, the studies reviewed also alert us to the danger of suicide and early death in schizophrenia. In addition, they expose problems in clinical management and treatment and also help us anticipate the possibility of intervals or periods of recovery, some of which appear spontaneously and may be tied to individual patient factors such as resilience. Clinical Implications 1. While schizophrenia is generally a poor-outcome disorder, a moderate-to-large subgroup of patients potentially experience periods of recovery (including both the absence of major symptoms and adequate psychosocial functioning) lasting several years or longer. 2. Mental health professionals should be alerted to the high risk of completed suicide among schizophrenia patients, especially in the first 10 to 12 years of this disorder. 3. Long-term outcome is influenced by current treatments, but the personal strengths, the developmental achievements, and the resiliency of individual patients are equal or more important influences. Limitations 1. This review focuses primarily on long-term North American studies of schizophrenia and also on the WHO study. There is less focus on European studies. 2.This review only focuses somewhat on prognostic factors that may be involved in outcome and recovery. 3.The lack of uniform methods among long-term outcome studies limits generalizations regarding the difference between current outcomes in schizophrenia and outcomes prior to the advent of current treatments.