'Rule of Thirds' commonly held by American psychiatrists and found
to hold true in Europe:
of all people diagnosed and hospitalized with schizophrenia will
will be improved, needing only occasional hospitalization, if
will remain unimproved.
- The predictors of
a good outcome, complete recovery or marked improvement,
are little or no family history of schizophrenia, normal adjustment
before onset, precipitating events, confusion, paranoia, depression,
- Early age of onset,
family history, marked thinking disorder, withdrawal, apathy point
to a poor outcome.
- The prognosis for
men is worse than it is for women. Also, the greater number of
relapses, the less the chances for complete recovery.
The longer the stay,
the greater the chances of the person becoming institutionalized
and, therefore, dependent on hospital care.
If the expectation is
that you won't get better, then you won't.
Drugs and outcome:
certainly influenced the course of schizophrenia, but it is too
early to say exactly how much. At a minimum the drugs have decreased
the number of relapses and rehospitalizations; whether this prevents
some of the brain damage from occuring is not known. It is most
likely that the drugs have 'improved' the functioning of the 'improved'
middle one-third, allowing more of them to live independently and
to hold jobs. This is no small accomplishment. It is less clear
whether the drugs have altered the course of the recovered one-third,
who would probably have recovered with or without drugs although
drugs may well have speeded the process. Nor is it yet certain whether
drugs decrease the size of the group who are unimproved on follow-up,
although it is likely that they do so, at least modestly. And in
addition to probably moving some patients from the unimproved to
the improved category, the drugs significantly improve functioning
in some remaining unimproved patients. For example, many chronically
ill schizophrenic patients, when properly medicated, can be given
grounds privileges and weekend passes, and taken on trips outside
the hospital; whereas without medication they are too acutely disturbed
to do any of these things."