About 25 per cent of patients make a good recovery from a first episode of schizophrenia. About 10 per cent require long-term care, as in supported accommodation or a long-stay ward. The rest, while able to live relatively independently, continue to suffer chronic symptoms and may experience intermittent acute relapses.

Poor prognostic factors include a premorbid personality of schizoid type, with poor social adjustment; onset of illness early in life; gradual onset of illness without precipitating life stress; predominance of negative symptoms such as affective flattening; and delay between onset of symptoms and starting drug therapy.

Suicide, often committed by a violent method and without warning, accounts for death in about 15 per cent of patients. There is an association between schizophrenia and violence to others, although homicide is fortunately rare. There is some evidence (Arango et al., 2006) that adherence to medication is associated with a reduction of violence to others.


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