Course and outcome
Schizophrenia can take a variety of courses. The onset may be gradual and hardly noticeable at first. A person’s relatives may express concern that their personality has changed. The person may loose their job and friends and start to neglect personal hygiene. Negative symptoms become predominant with withdrawal, social isolation and odd behaviour. The condition may be particularly resistant to treatment and the prognosis is poor.
Some people may experience an acute onset of mainly positive symptoms such as hallucinations and delusions. This can be precipitated by substance abuse e.g. cannabis, amphetamines. Such drugs are thought to exacerbate the underlying mental health condition, not to cause it. People may frequently be admitted to hospital with the acute presentation of the condition, when there may be a good response to treatment. Some people recover completely from such an episode and do not experience the illness again. Others suffer a pattern of relapse and remission over the years, with the negative symptoms of the condition becoming more predominant as the years go by.
A number of well publicised episodes of violent behaviour by individuals in a paranoid and deluded states may have lead to the general perception that people with schizophrenia are often a danger to others. In fact people with schizophrenia do not produce more violent episodes than the rest of the public at large.
30-40% of people with severe schizophrenia attempt suicide. 1 in 10 of people with schizophrenia eventually commit suicide. Suicide and suicide attempts are often impulsive and unpredictable. Suicide however is more likely to occur early in the illness, during hospitalisation for an acute exacerbation or soon after discharge. Other risk factors include male gender, co-existing depression, frequent relapses, social isolation, substance misuse, unemployment and history of a previous suicide attempt. High educational achievement prior to the illness is also a risk factor. The risk tends to lessen over the years as the individual adjusts to accepting the illness.
As an overall generalisation a third of people with schizophrenia have a satisfactory outcome with some of these experiencing only one or very few episodes with complete recovery. Another third respond to treatment moderately well and manage to live in the community with varying degrees of independence. A third respond poorly, and up to 20% has significant long-term disabilities requiring a high degree of care in a supervised group home.
