Fully recovered schizophrenics compared to chronic patients on premorbid and treatment characteristics

Full recovery from schizophrenia: the prognostic role of premorbid adjustment, symptoms at first admission, precipitating events and gender

A number of long-term studies of course and outcome in schizophrenia report that about a fourth of the cases show good clinical and social recovery. However, very few studies have been carried out examining the main characteristics of schizophrenia patients who have fully recovered according to a strict definition of 'full recovery'. The purpose of the present study was, therefore, to compare a group of 17 fully recovered schizophrenia patients (Group A) with a group of 33 patients (Group B) with current symptoms of schizophrenia on several prognostic factors that have been associated with a good outcome. These clinical groups were matched groupwise with a similar mean on two variables: age range at onset of illness and age at time of interview. Duration of illness (length of time from age of onset of illness to time of assessment) was 22.4 years in group A and 21 years in group B. Mean GAS scores were 72.2 and 46.5, respectively. Positive symptoms (delusions and disorganized behavior) at admission predicted an unfavorable outcome. The results confirmed the prognostic significance of several clinical and demographic factors. However, a good premorbid adjustment did not show significant predictive power, but showed substantial association in the predicted direction. In addition, a clear sex difference was found: women report a significantly better premorbid functioning and demonstrate a more favorable psychosocial functioning than men.

"Full recovery" from schizophrenia in the long term: a ten-year follow-up of eight former schizophrenic patients

The present study reports longitudinal data on individuals who ten years ago were fully recovered from a previously diagnosed schizophrenia. Seven out of ten subjects consented and were reexamined at the present follow-up, and data on an eighth subject was secured elsewhere. A semistructured interview was used to examine psychosocial functioning of the subjects in the follow-up period. Out of the six subjects with a confirmed diagnosis of schizophrenia, only three subjects were still fully recovered; one had a deteriorating course and two had a fluctuating course of illness. The results from the study indicate that recovery from schizophrenia may take the form of time-limited remissions for half of the reexamined subjects when strict criteria for full recovery are used. Protective factors such as willpower, a (partly) intact capacity for object attachment, and a supportive family may be important prerequisites for recovery. Two different courses of schizophrenia are illustrated by cases.

Stability in cognitive dysfunctions in schizophrenic patients

The purpose of the present study was to classify cognitive dysfunctions in schizophrenic subjects according to a trait/state model. A sample of 15 patients was examined on 10 different cognitive measures in two distinctly different phases: an acute psychotic state and partial remission. To determine the degree of dysfunction at the two stages of illness, the schizophrenic patients were also compared to 14 non-psychiatric controls. Six of the 10 measures examined can be classified as cognitive deficits in schizophrenics. Four measures are possibly trait-dependent components: two backward masking scores and two long-term memory measures. A short-term memory measure is the only one that can be classified as an episode-linked factor. The other cognitive deficits found can be characterized as mediating vulnerability factors, i.e. they are more prominent in the acute psychotic state, but do not completely disappear during remission states.

Cognitive dysfunctions and psychosocial treatment of schizophrenics: research of the past and perspectives on the future

First, family research with the focus on the concept of communication deviance is reviewed. Then, the link between family factors and cognitive characteristics in the offspring is elaborated on. Research on cognitive dysfunctions with a basis in a vulnerability model is the theme of the next section. Finally, psychosocial and cognitive treatment programmes are outlined and discussed.

The Psychosis Project: outcome and cost-effectiveness of a psychoeducational treatment programme for schizophrenic adolescents

The outcome of a psychoeducational treatment programme for very early-onset schizophrenics was compared with a standard reference treatment. The study sample consisted of 12 patients in each group. Clinical outcome was assessed by relapses during the 2-year treatment period and changes in psychosocial functioning as measured by the Global Assessment Scale. A cost-effectiveness analysis was also carried out. The results indicated that the most effective programme measured by relapse was also the cheapest: the psychoeducational programme. Patients with poor premorbid psychosocial functioning benefit most from this treatment. Decisive with respect to how effective the programme can be is the cooperativeness of patients' parents and their ability to change their emotional attitudes toward the patient.

Recovered versus nonrecovered schizophrenic patients among those who have had intensive psychotherapy

Eight cases of fully recovered formerly schizophrenic (DSM-III-R) patients who had been treated with intensive psychodynamic psychotherapy were compared with 10 nonrecovered schizophrenic patients who also had been treated with intensive psychotherapy. There were no significant differences in chronicity, medication or type and amount of psychotherapy given. The most striking difference between the groups was the type and quality of auditory hallucinations. In the nonrecovered group the hallucinations were more dominating and often of the running commentary type, sometimes occurring even in calm periods. Visual hallucinations were also found more commonly in the nonrecovered group. The findings are discussed in terms of predominantly genetic vs predominantly lesional vulnerability. The limitations of the study lie in the scarcity of cases and the sometimes low quality of the hospital records.