NARRATIVES OF 20 TO 30 YEAR OUTCOMES IN SCHIZOPHRENIA

THIS descriptive study objectively compares three decades in the life histories of women and men with schizophrenia treated continuously at one institution. On the basis of clinical observation, it was hypothes ized that the first ten years of illness would be stormier for men, bu t that women would suffer more than their male counterparts as they be gan to approach the age of menopause. Eighty active patients with a cu rrent diagnosis of DSM-IV schizophrenia were identified. From this gro up, ten men and ten women, randomly selected, agreed to review and pub lication of their life stories in slightly altered form. These twenty patients and their current case managers were interviewed. Their medic al records were reviewed and the course of selected predictor variable s was charted on the Camberwell Assessment of Need (CAN) entry form. T he entries on the CAN fluctuated markedly for most of the patients ove r the two to three decades of illness. Seven of the ten men were, as p redicted, globally most severely ill during their first decade of illn ess and improved thereafter. By contrast, eight of the ten women appea red to suffer a relatively need-free first decade, followed by increas ing disability over time. In this small group, which, because of the m ethod of recruitment, excluded best and worst outcomes, factors such a s onset age, duration of untreated prodrome, and early course of illne ss (as assessed by chart review) did not predict long-term outcome. On the other hand, substance abuse, social supports, and a family histor y of schizophrenia were more closely correlated with 20- to 30-year ou tcome status. The direct effect of female menopause on illness severit y was not possible to gauge in this study, but alterations in hormones may have played a part in responsivity to family and social loss.