Learning from outcome studies. Toward a comprehensive biological-psychosocial understanding of schizophrenia

According to results from three major European long-term outcome studies on schizophrenia, from other comparable studies, and from additional investigations on rehabilitation and on the influence of psychosocial factors, long-term evolution of schizophrenia is much more variable and considerably better than hitherto admitted. On this basis, the author presents a comprehensive biological-psychosocial evolutionary model of schizophrenia in three phases, centered around the vulnerability- and information-processing hypotheses. Long-term evolution of schizophrenia cannot be sufficiently represented by a linear organic process mainly determined by genetic factors. Environmental and, in particular, psychosocial factors, also seem to play an important role. Vicious biological-psychosocial circles with multiple feedback effects can lead to non-linear escalating processes. Chronic states appear to be the result of complex interactions between preexisting vulnerability and autoprotective counterregulations on a biological, psychological and social level. Some therapeutic consequences and possible future developments of these concepts are presented.