P. Mason et al., THE COURSE OF SCHIZOPHRENIA OVER 13 YEARS - A REPORT FROM THE INTERNATIONAL STUDY ON SCHIZOPHRENIA (ISOS) COORDINATED BY THE WORLD-HEALTH-ORGANIZATION, British Journal of Psychiatry, 169(5), 1996, pp. 580-586
Background. This paper describes the 13 year course of illness in an e
pidemiologically defined and representative cohort of patients selecte
d when they were experiencing their first episode of schizophrenia. Me
thod. In a 13-year follow-up study of 67 patients with ICD-9 schizophr
enia, identified in Nottingham in 1978-80, the course of illness (symp
toms, disability and hospitalisation) was assessed using standardised
instruments, applied at onset, 1, 2, and 13 years. Time to first relap
se and first readmission were calculated and plotted as survival curve
s and patients were assigned to the course types described by Ciompi.
Results. The survival curves show that first relapses and first readmi
ssions occur during the first five years. The amount of time spent in
psychotic episodes and in hospital is greatest in the first year of fo
llow-up, but stable thereafter. Social adjustment improves from entry
to the study to the first follow-up year, but there is a small deterio
ration in social adjustment between 2 and 13 years. Conclusions. The f
indings reported suggest that after the initial episode the course of
schizophrenia is relatively stable. The data support neither concepts
of progressive deterioration nor progressive amelioration. There was n
o evidence of a 'late recovery'.