Prognosis

What is the prognosis for patients who develop paranoid schizophrenia?

Total Medical Recovery from paranoid schizophrenia: "Over a time scale of decades between 1/3 and ˝ of persons suffering severe schizophrenia recover to the point of not requiring medication".*

This statistic represents a synthesis of the results of several studies, the most important being the 27 year follow-up of people discharged from the Vermont State hospital in the 1950s. The Vermont study was published by Courtney Harding and colleagues in American Journal of Psychiatry (The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. Am J Psychiatry. 144:727-35, 1987. )

Courtney Harding has published a good review article that examine the various different longitudinal studies performed over the past 100 years (Chronicity in schizophrenia: fact, partial fact, or artifact? Hosp Community Psychiatry. 1987, 38(5):477-86.

Two well-known studies, one by the University of Bonn and the one at the University of Vermont, showed a remarkable similarity in outlook for those suffering this debilitating illness. The teams in the studies did along-term follow-up of patients with schizophrenia admitted to psychiatric hospitals in the late 1940s and early 1950s. There were 500 patients in each study. They located the patients or their families and, through interviews with the patients and people who knew them, created detailed portraits of what had happened to them. About a quarter had died, mostly by suicide. Many of them might have survived if the traditional medical model accepted schizophrenia as rooted in experience rather than mere biology. Most of those who committed suicide did so in the first ten years of their illness. Some, a small percentage, were still institutionalised, apparently unresponsive to drugs or to electroshock therapy. Another group was living with their families but still had symptoms, especially the negative ones of lethargy, lack of drive and interest or pleasure in life, these symptoms being those caused by the less modern drugs for schizophrenia then available- as well as some of the newer ones. But a surprisingly large proportion, about a quarter, seemed to be symptom-free, living independently, with a circle of friends and jobs in the professions for which they had been trained or had before they become ill. Most of these had not been under the care of a physician for years. (Taken from "A Beautiful Mind" by Sylvia Nasar).

*Jobe & Harrow (2005) conclude ‘ there is heterogeneity of long-term outcome, with between 21% and 57% showing good outcome, depending on the strictness of the criteria used to diagnose schizophrenia’.


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