Schizophrenia prognosis

The goals of treatment during the acute phase of illness are to reduce the positive symptoms of schizophrenia and to plan for extended treatment during the maintenance phase. Reducing the positive symptoms quickly is important for at least two reasons. First, the erratic behavior of an acutely psychotic patient can take a tremendous toll, risking arrest, loss of job, suicide, and the alienation of friends and family. Second, there is some evidence that psychosis itself is harmful to the brain. In other words, it may be that the longer the patient is actively psychotic, the worse the prognosis becomes. 

Another hypothesis (Crow, 1982) involves a division of schizophrenias into two types Type I corresponds to acute schizophrenia or schizophreniform disorder in which one observes more positive symptoms of hallucinations and delusions with a good prognosis and excellent response to neuroleptics... Type II represents chronic schizophrenia with affective flattening, poverty of speech and loss of drive, the so-called negative symptoms of schizophrenia. Type II patients respond less well to neuroleptics... (Snyder, 1982). Type I patients would fit into the dopamine hypothesis whereas a pathophysiological basis other than dopaminergic hyperactivity must be assumed for type II patients. However, as pointed out by Snyder (1982). "one should be cautious about drawing such a distinction. ... 

In contrast, patients with good premorbid personalities and more typical functioning during childhood who later developed schizophrenic symptoms, especially in the face of massive precipitating events, had better outcomes. They also tended to have family histories of mood disorders as well as affective features as part of their own illness, which led to the concept of process versus reactive schizophrenia (i.e., poor prognosis versus good prognosis) ( 34, 35). 

Stephens JH. Long-term course and prognosis of schizophrenia. Semin Psychiatry 1970 2 464-485. 

Stephens JH, Astrup C. Prognosis in process and non-process schizophrenia. Am J Psychiatry 1963 119 945-953. 

Little work has been done on the drug treatment of schizophreniform or brief reactive psychosis. Flirschowitz et al. ( 374) further explored the range of lithium s efficacy by systematically treating patients with schizophrenic or schizophreniform disorders. They found that poor-prognosis schizophrenia rarely responded to lithium. 

Hirschowitz J, Casper R, Garver DL, et al. Lithium response in good prognosis schizophrenia. Am J Psychiatry 1980 137 916-920. 

Please expand on the prognosis and comorbidity issues relevant to the condition of schizophrenia. 

Herken H, Erdal ME. 2001. Catechol-O-methyltransferase gene polymorphism in schizophrenia Evidence for association between symptomatology and prognosis. Psychiatr Genet 11 105-109. 

Bleuler, M. 1968. Prognosis of schizophrenic psychoses A summary of personal research. In The schizophrenias, F. Flach, ed. New York Norton. 

Cohen, A., Prognosis for Schizophrenia in the Third World A Re-evaluation of Cross-Cultural Research, in Culture, Medicine and Psychiatry, 1992, 16, pp. 53-75, Kluwer Press. 

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