Prognosis

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.

References

Arango, C., Bombín, I., González-Salvador, T. et al. (2006). Randomised clinical trial comparing oral versus depot formulations of zuclopenthixol in patients with schizophrenia and previous violence. Eur Psychiatry 21, 34-40. Ballard, C., Waite, J. and Birks, J. (2006). Atypical antipsychotics for aggression and psychosis in Alzheimer's disease. Cochrane Database Syst Rev Issue 1, Art. No. CD003476. Crow, T. J. (2002). Handedness, language lateralisation and anatomical asymmetry: relevance of protocadherin XY to hominid speciation and the aetiology of psychosis. Br J Psychiatry 181, 295-297.

Koro, C., Fedder, D. O., L'Italien, G. J. et al. (2002). Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study. BMJ 325, 243-246. Nadeem, Z. et al. (2006). Psychoeducational interventions. Clinical Evidence (15th edn), p. 1484. London: BMJ Books. http://www.clinicalevidence.com/ceweb/conditions/meh/ 1007/1007_I32.jsp.

Pilling, S., Bebbington, P., Kuipers, E. et al. (2002). Psychological treatments in schizophrenia. I. Meta-analysis of family interventions and cognitive behaviour therapy. Psychol Med 32, 763-782.

Tsapakis, E. M., Basu, A. and Aitchison, K. J. (2004). Clinical relevance of discoveries in psychopharmacogenetics. Adv Psychiatr Treat 10, 455-465.

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