NATURAL COURSE OF SCHIZOPHRENIC DISORDERS - A 15-YEAR FOLLOW-UP OF A DUTCH INCIDENCE COHORT

Data are presented on the 15-year natural course of schizophrenia and other nonaffective functional psychoses in a cohort of 82 first-contac t cases from a circumscribed area in the Netherlands, The subjects wer e suffering from functional psychosis with International Classificatio n of Diseases-Ninth Revision (ICD-9) diagnoses 295, 297, or 298.3-9 (b road definition of schizophrenia) on entry, Standardized assessments o f psychopathology, psychological impairments, negative symptomatology, social disability, and use of mental healthcare were used, The study reveals a pattern of chronicity and relapses with a high risk of suici de: Two-thirds of the subjects had at least one relapse and after each relapse 1 of 6 subjects did not remit from the episode; 1 of 10 commi tted suicide; and 1 of 7 had at least one episode with affective psych otic symptoms that started on average 6 years after the onset of the s chizophrenic disorder, Diagnoses were reclassified in five patients, a ccording to DSM-III-R criteria for a bipolar disorder, The predictive power-in terms of time in psychosis and in partial or full remission-o f demographic, illness, and treatment variables at onset of the illnes s was very limited, Insidious onset and delays in mental health treatm ent are risk factors that predict a longer duration of first or subseq uent episodes, The importance of mental health treatment in regard to outcome is probably subject to change because an early warning and int ervention strategy could prevent further damage and deterioration, Our data support the need for an adequate relapse prevention program as a priority for our mental health services.