Schizophrenia natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
[[Life expectancy]] is decreased; the average life expectancy of people with the disorder is 10 to 12 years less than those without, owing to increased physical health problems and a high [[suicide]] rate.<ref name="Brown_Barraclough_2000">Brown S, Inskip H, Barraclough B. (2000) Causes of the excess mortality of schizophrenia. ''Br J Psychiatry'', 177, 212-7. PMID 11040880</ref> Numerous international studies have demonstrated favorable long-term outcomes for around half of those diagnosed with schizophrenia, with substantial variation between individuals and regions.<Ref>Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, León CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study. ''Br J Psychiatry.'' Jun;178:506-17. PMID 11388966</ref> One retrospective study found that about a third of people made a full recovery, about a third showed improvement but not a full recovery, and a third remained ill.<ref name="fn_42">Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A (1987). The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. ''American Journal of Psychiatry'', 144(6), 727–35. PMID 3591992</ref> A clinical study using strict recovery criteria (concurrent remission of positive and negative symptoms and adequate social and vocational functioning continuously for two years) found a recovery rate of 14% within the first five years.<ref name="fn_43">Robinson DG, Woerner MG, McMeniman M, Mendelowitz A, Bilder RM (2004). Symptomatic and functional recovery from a first episode of schizophrenia or [[schizoaffective disorder]]. ''American Journal of Psychiatry'', 161, 473–479. PMID 14992973</ref> A 5-year community study found that 62% showed overall improvement on a composite measure of symptomatic, clinical and functional outcomes.<ref>Harvey, C.A., Jeffreys, S.E., McNaught, A.S., Blizard, R.A., King, M.B.(2007) [http://isp.sagepub.com/cgi/content/abstract/53/4/340 The Camden Schizophrenia Surveys III: Five-Year Outcome of a Sample of Individuals From a Prevalence Survey and the Importance of Social Relationships.] ''International Journal of Social Psychiatry,'' Vol. 53, No. 4, 340-356</ref> Rates are not always comparable across studies because an exact definition of what constitutes recovery has not been widely accepted, although standardized criteria have been suggested. | [[Life expectancy]] is decreased; the average life expectancy of people with the disorder is 10 to 12 years less than those without, owing to increased physical health problems and a high [[suicide]] rate.<ref name="Brown_Barraclough_2000">Brown S, Inskip H, Barraclough B. (2000) Causes of the excess mortality of schizophrenia. ''Br J Psychiatry'', 177, 212-7. PMID 11040880</ref> Numerous international studies have demonstrated favorable long-term outcomes for around half of those diagnosed with schizophrenia, with substantial variation between individuals and regions.<Ref>Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, León CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study. ''Br J Psychiatry.'' Jun;178:506-17. PMID 11388966</ref> One retrospective study found that about a third of people made a full recovery, about a third showed improvement but not a full recovery, and a third remained ill.<ref name="fn_42">Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A (1987). The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. ''American Journal of Psychiatry'', 144(6), 727–35. PMID 3591992</ref> A clinical study using strict recovery criteria (concurrent remission of positive and negative symptoms and adequate social and vocational functioning continuously for two years) found a recovery rate of 14% within the first five years.<ref name="fn_43">Robinson DG, Woerner MG, McMeniman M, Mendelowitz A, Bilder RM (2004). Symptomatic and functional recovery from a first episode of schizophrenia or [[schizoaffective disorder]]. ''American Journal of Psychiatry'', 161, 473–479. PMID 14992973</ref> A 5-year community study found that 62% showed overall improvement on a composite measure of symptomatic, clinical and functional outcomes.<ref>Harvey, C.A., Jeffreys, S.E., McNaught, A.S., Blizard, R.A., King, M.B.(2007) [http://isp.sagepub.com/cgi/content/abstract/53/4/340 The Camden Schizophrenia Surveys III: Five-Year Outcome of a Sample of Individuals From a Prevalence Survey and the Importance of Social Relationships.] ''International Journal of Social Psychiatry,'' Vol. 53, No. 4, 340-356</ref> Rates are not always comparable across studies because an exact definition of what constitutes recovery has not been widely accepted, although standardized criteria have been suggested. | ||
The [[World Health Organization]] conducted two long-term follow-up studies involving more than 2,000 people suffering from schizophrenia in different countries. These studies found patients have much better long-term outcomes in developing countries (India, Colombia and Nigeria) than in developed countries (USA, United Kingdom, Ireland, Denmark, Czech Republic, Slovakia, Japan, and Russia),<ref name="fn_44">Hopper K, Wanderling J (2000). Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. ''Schizophrenia Bulletin'', 26 (4), 835–46. PMID 11087016</ref> despite the fact antipsychotic drugs are typically not widely available in poorer countries, raising questions about the effectiveness of such drug-based treatments. | The [[World Health Organization]] conducted two long-term follow-up studies involving more than 2,000 people suffering from schizophrenia in different countries. These studies found patients have much better long-term outcomes in developing countries (India, Colombia and Nigeria) than in developed countries (USA, United Kingdom, Ireland, Denmark, Czech Republic, Slovakia, Japan, and Russia),<ref name="fn_44">Hopper K, Wanderling J (2000). Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. ''Schizophrenia Bulletin'', 26 (4), 835–46. PMID 11087016</ref> despite the fact antipsychotic drugs are typically not widely available in poorer countries, raising questions about the effectiveness of such drug-based treatments. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Complications
The disorder is primarily thought to affect cognition, but it also usually contributes to chronic problems with behavior and emotion. People diagnosed with schizophrenia are likely to be diagnosed with comorbid conditions, including clinical depression and anxiety disorders; the lifetime prevalence of substance abuse is typically around 40%. Social problems, such as long-term unemployment, poverty and homelessness, are common.
Prognosis
Life expectancy is decreased; the average life expectancy of people with the disorder is 10 to 12 years less than those without, owing to increased physical health problems and a high suicide rate.[1] Numerous international studies have demonstrated favorable long-term outcomes for around half of those diagnosed with schizophrenia, with substantial variation between individuals and regions.[2] One retrospective study found that about a third of people made a full recovery, about a third showed improvement but not a full recovery, and a third remained ill.[3] A clinical study using strict recovery criteria (concurrent remission of positive and negative symptoms and adequate social and vocational functioning continuously for two years) found a recovery rate of 14% within the first five years.[4] A 5-year community study found that 62% showed overall improvement on a composite measure of symptomatic, clinical and functional outcomes.[5] Rates are not always comparable across studies because an exact definition of what constitutes recovery has not been widely accepted, although standardized criteria have been suggested.
The World Health Organization conducted two long-term follow-up studies involving more than 2,000 people suffering from schizophrenia in different countries. These studies found patients have much better long-term outcomes in developing countries (India, Colombia and Nigeria) than in developed countries (USA, United Kingdom, Ireland, Denmark, Czech Republic, Slovakia, Japan, and Russia),[6] despite the fact antipsychotic drugs are typically not widely available in poorer countries, raising questions about the effectiveness of such drug-based treatments.
Several factors are associated with a better prognosis: Being female, acute (vs. insidious) onset of symptoms, older age of first episode, predominantly positive (rather than negative) symptoms, presence of mood symptoms and good premorbid functioning.[7][8] Most studies done on this subject, however, are correlational in nature, and a clear cause-and-effect relationship is difficult to establish. Evidence is also consistent that negative attitudes towards individuals with schizophrenia can have a significant adverse impact. In particular, critical comments, hostility, authoritarian and intrusive or controlling attitudes (termed high 'Expressed Emotion' or 'EE' by researchers) from family members have been found to correlate with a higher risk of relapse in schizophrenia across cultures.[9]
Mortality
In a study of over 168,000 Swedish citizens undergoing psychiatric treatment, schizophrenia was associated with an average life expectancy of approximately 80–85% of that of the general population. Women with a diagnosis of schizophrenia were found to have a slightly better life expectancy than that of men, and as a whole, a diagnosis of schizophrenia was associated with a better life expectancy than substance abuse, personality disorder, heart attack and stroke.[10] There is a high suicide rate associated with schizophrenia; a recent study showed that 30% of patients diagnosed with this condition had attempted suicide at least once during their lifetime.[11] [12]Another study suggested that 10% of persons with schizophrenia die by suicide.[13] Other identified factors include smoking, poor diet, little exercise and the negative health effects of psychiatric drugs.[1]
References
- ↑ 1.0 1.1 Brown S, Inskip H, Barraclough B. (2000) Causes of the excess mortality of schizophrenia. Br J Psychiatry, 177, 212-7. PMID 11040880
- ↑ Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, León CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D. (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry. Jun;178:506-17. PMID 11388966
- ↑ Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A (1987). The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144(6), 727–35. PMID 3591992
- ↑ Robinson DG, Woerner MG, McMeniman M, Mendelowitz A, Bilder RM (2004). Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry, 161, 473–479. PMID 14992973
- ↑ Harvey, C.A., Jeffreys, S.E., McNaught, A.S., Blizard, R.A., King, M.B.(2007) The Camden Schizophrenia Surveys III: Five-Year Outcome of a Sample of Individuals From a Prevalence Survey and the Importance of Social Relationships. International Journal of Social Psychiatry, Vol. 53, No. 4, 340-356
- ↑ Hopper K, Wanderling J (2000). Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. Schizophrenia Bulletin, 26 (4), 835–46. PMID 11087016
- ↑ Davidson L, McGlashan TH. (1997) The varied outcomes of schizophrenia. Canadian Journal of Psychiatry, 42 (1), 34–43. PMID 9040921
- ↑ Lieberman JA, Koreen AR, Chakos M, Sheitman B, Woerner M, Alvir JM, Bilder R. (1996) Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia. Journal of Clinical Psychiatry, 57 Suppl 9, 5–9. PMID 8823344
- ↑ Bebbington PE, Kuipers E (1994). The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychological Medicine, 24, 707–718. PMID 7991753
- ↑ Hannerz H, Borga P, Borritz M (2001). Life expectancies for individuals with psychiatric diagnoses. Public Health, 115 (5), 328–37. PMID 11593442
- ↑ Radomsky ED, Haas GL, Mann JJ, Sweeney JA (1999). Suicidal behavior in patients with schizophrenia and other psychotic disorders. American Journal of Psychiatry, 156(10), 1590–5. PMID 10518171
- ↑ Williams R, Dalby JT. Eds. (1989). Depression in Schizophrenics. New York: Plenum Publishing.
- ↑ Caldwell CB, Gottesman II. (1990). Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin, 16(4), 571–89. PMID 2077636