Schizophrenia natural history, complications and prognosis

• 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.

• 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), despite the fact antipsychotic drugs are typically not widely available in poorer countries, raising questions about the effectiveness of such drug-based treatments.^[6]

• Several factors are associated with a better prognosis: Being female, acute (vs. insidious) onset of symptoms, older age of the first episode, predominantly positive (rather than negative) symptoms, the presence of mood symptoms and good premorbid functioning.^[7][8]
• Most studies were done on this subject, however, are correlational in nature, and a clear cause-and-effect relationship is difficult to establish.
• The 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]

• 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]

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