The 12-year clinical course of schizophrenia

Summary A sample of 46 schizophrenic night-clinic patients (N patients), was matched with a sample of 46 hospital patients (H patients) for diagnosis, age, and sex. They were followed up from 1971/73 until 1983 on the basis of a personal interview and by review of all the case histories and other documents. Their average age at the time of the follow-up examination was 40 years. The average duration of the illness was 18 years in the night-clinic patients and 15 years in the hospital patients. Seven of the 46 N patients (1.4% per year) and two of the 46 H patients (0.4% per year) died during the 12 years. Of the surviving patients one-third had inconspicuous psychopathology. In one-fifth, psychopathology was only conspicuous to a psychiatrist. Only in one-quarter was it very conspicuous even to the layman. The N patients had already shown clearer signs of a chronic, insidious clinical course during the first four years of their illness than the H patients. Although substantially fewer were hospitalised at the time of the follow-up examination (17.6% cf 28.6% respectively), far more of them were receiving either outpatient or semiinpatient care. Unsatisfactory social integration was revealed, their strong tendency to self-isolation and their inadequate work rehabilitation: 71.8% of the N patients and 62% of the H patients were dependent on a disability pension, and only 15.4% of the N patients and 20% of the H patients were employed at work in keeping with their training and experience. Just under half of the patients were living alone. Some 30–40% of them had no contacts with friends or acquaintances. Predictors of a somewhat favourable clinical course included an acutely phasic course during the first few years of the illness, a low level of parental education, and a greater age at the time of the manifestation of the illness. In particular, patients whose illness ran an acute phasic course during the four years after onset had less lengthy hospitalisations in the second stage of the clinical course than patients exhibiting signs of chronicity in the early stage.