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Harrow M, Sands JR, Silverstein ML, and Goldberg JF (1997).

Schizophrenia Bulletin 23:287-303.

When looking at three groups of patients—those with schizophrenia, patients with other psychotic disorders, and patients with nonpsychotic disorders—the authors found that patients with schizophrenia show worse outcomes than other psychotic patients. In recent years, there has been speculation over whether patients with schizophrenia who respond to antipsychotic medications show relatively favorable or unfavorable outcomes over time. This study showed that, for individual patients with schizophrenia, the pattern of psychopathology and the level of functioning over time are related to previous psychopathology. It therefore suggests that preventing poor functioning at any given time for an individual with schizophrenia could be integral to preventing poor functioning in the future.

The authors studied 276 young, early-phase patients longitudinally, beginning at the acute phase and continuing through followups at roughly two years, four and a half years, and seven and a half years. Seventy-four of the patients were schizophrenic, 74 had other psychotic disorders, and 128 suffered from nonpsychotic mental illnesses. Patients were evaluated initially and at each successive followup for overall functioning; psychotic, anxiety, and affective symptoms; work and social functioning; potential rehospitalization; and medications.

The authors found that patients with schizophrenia functioned significantly more poorly than patients with other psychotic disorders at each of the three followups. The combined group of nonpsychotic and "other psychotic" patients tended to show improvement in overall outcome following the index hospitalization; in contrast, patients with schizophrenia showed more consistent psychopathology and evidence of psychotic symptoms, and had been rehospitalized significantly more frequently at each of the followups than the other patient groups. Although 32% of the schizophrenic sample showed a complete remission at one of the followups, less than 5% had a complete remission at all three of the followups. In contrast, at each followup after the first, more of the other psychotic patients had evidence of a complete remission than those who had uniformly poor outcomes.

Furthermore, schizophrenia patients deemed to be doing poorly at the initial evaluation showed significantly slower recovery at each followup than the other psychotic patients who had been doing poorly early on. There was a similar tendency for both schizophrenic and other psychotic patients with good functioning at one followup to show good functioning at the next followup. Schizophrenics also had the poorest outcome in terms of work functioning, although their social functioning was comparable to both the other patient groups. These results suggest that, during the early course of the illness, patients with schizophrenia still show relatively poor outcomes when compared with other mentally ill patients. Although a small number of them enter into complete remission, they tend to recover more slowly than other psychotic patients.

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