Progression of Schizophrenia

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We now know that around a third of patients experience just a single psychotic episode during their entire lifetime, from which they make a full recovery or suffer practically no permanent consequences after a period of treatment. All other patients with schizophrenia are capable of following a reasonably adapted life with appropriate and continuous antipsychotic treatment. Between 25% and 35% of people with schizophrenia have a type that is resistant to treatment and they therefore require more complex therapeutic interventions, which generally combine various drug-based, psychosocial and biologic treatments (including electroconvulsive therapy). Around 10% of people with schizophrenia commit suicide, making it one of the most significant aspects to consider during the evaluation and follow-up of these patients.

The three thirds rule

Traditionally, the prognosis for patients with schizophrenia has followed the rule of the thirds. According to this rule, one third of patients will have just a single psychotic episode during their lifetime; another third will experience different psychotic episodes that will recede without causing much deterioration and they will preserve psychosocial functioning; and the final third will present psychotic symptoms continually, as well as suffering notable deterioration and functional incapacity.

Although each patient is unique, a series of factors associated with a good or bad prognosis has been identified and can provide a general idea about the long-term evolution. The intensity and, above all, the duration of psychotic episodes with or without treatment have a negative impact on disease progression since they predispose the appearance of residual symptoms.

Generally speaking, it is evident that we cannot intervene in certain factors (sex, family history of schizophrenia or initial personality type), whilst others are the primary point of contention from the beginning.

In this regard, it is vitally important that patients receive a rapid diagnosis with early drug-based and psychological treatment.

Factors for a good prognosis:

  • Female.
  • Late onset.
  • No family background or history of affective disorders (e.g., depression, bipolar disorder).
  • Good previous adaptation, acute onset that coincided with stressful life events.
  • Clinical picture in which positive symptoms predominate over other types of symptom.
  • Absence of neurostructural alterations in neuroimaging studies and good results in neuropsychological tests.
  • Good response to medication.
  • A pace of life with relative stability in terms of working hours and sleep patterns, no substance abuse, etc.
  • Strict compliance with drug regime and check-ups.

What are the associated medical complications?

Different long-term studies demonstrate that patients with schizophrenia have a lower life expectancy compared to the general population. Apart from deaths due to suicides (5–10%) or accidents, schizophrenics also present a higher incidence of other medical conditions. Notable among these are diabetes, cardiovascular problems and certain carcinogenic processes. Schizophrenia is also associated with a higher rate of smoking and poorer general health habits (nutrition, sedentary lifestyle, etc.).

Substantiated information by:

Eduard Parellada Rodon
Miguel Bernardo Arroyo
Miquel Bioque Alcázar

Published: 20 February 2018
Updated: 30 November 2022

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