Social Psychiatry and Psychiatric Epidemiology

, Volume 26, Issue 5, pp 202–211 | Cite as

The 12-year clinical course of schizophrenia

  • M. Gmür
Article

Summary

A sample of 46 schizophrenic night-clinic patients (N patients), was matched with a sample of 46 hospital patients (H patients) for diagnosis, age, and sex. They were followed up from 1971/73 until 1983 on the basis of a personal interview and by review of all the case histories and other documents. Their average age at the time of the follow-up examination was 40 years. The average duration of the illness was 18 years in the night-clinic patients and 15 years in the hospital patients. Seven of the 46 N patients (1.4% per year) and two of the 46 H patients (0.4% per year) died during the 12 years. Of the surviving patients one-third had inconspicuous psychopathology. In one-fifth, psychopathology was only conspicuous to a psychiatrist. Only in one-quarter was it very conspicuous even to the layman. The N patients had already shown clearer signs of a chronic, insidious clinical course during the first four years of their illness than the H patients. Although substantially fewer were hospitalised at the time of the follow-up examination (17.6% cf 28.6% respectively), far more of them were receiving either outpatient or semiinpatient care. Unsatisfactory social integration was revealed, their strong tendency to self-isolation and their inadequate work rehabilitation: 71.8% of the N patients and 62% of the H patients were dependent on a disability pension, and only 15.4% of the N patients and 20% of the H patients were employed at work in keeping with their training and experience. Just under half of the patients were living alone. Some 30–40% of them had no contacts with friends or acquaintances. Predictors of a somewhat favourable clinical course included an acutely phasic course during the first few years of the illness, a low level of parental education, and a greater age at the time of the manifestation of the illness. In particular, patients whose illness ran an acute phasic course during the four years after onset had less lengthy hospitalisations in the second stage of the clinical course than patients exhibiting signs of chronicity in the early stage.

Keywords

Public Health Schizophrenia Average Duration Parental Education Case History 

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References

  1. 1.
    Bleuler E (1949) Lehrbuch der Psychiatrie, 11. Aufl. Springer, Berlin Heidelberg New YorkGoogle Scholar
  2. 2.
    Bleuler M (1972) Die schizophrenen Geistesstörungen im Lichte langjähriger Kranken- und Familiengeschichten. Thieme, StuttgartGoogle Scholar
  3. 3.
    Brenner HD, Rey ER, Stramke WG (1983) Experimentalpsychologische Ergebnisse und Beispiele ihrer Anwendung in Behandlung und Rehabilitation. Huber, Bern Stuttgart WienGoogle Scholar
  4. 4.
    Ciompi L, Müller C (1976) Lebensweg und Alter der Schizophrenen. Eine katmnestische Langzeituntersuchung bis ins Senium. Springer, Berlin Heidelberg New YorkGoogle Scholar
  5. 5.
    Ernst K (1979) Die Zunahme der Suizide in den psychiatrischen Kliniken: Tatsachen, Ursachen, Prävention. Sozial Präventivmed 24:34–37Google Scholar
  6. 6.
    Gmür M (1987) Die Prognose der Schizophrenie unter sozialpsychiatrischer Behandlung. Enke, StuttgartGoogle Scholar
  7. 7.
    Gmür M (1986) Schizophrenieverlauf und Entinstitutionalisierung. Enke, StuttgartGoogle Scholar
  8. 8.
    Gmür M (1987) Die Kongruenz zwischen dem Frankfurter Beschwerdefragebogen (FBF2) und klinischem Rating bei schizophrenen Patienten. Nervenarzt 58:365–368Google Scholar
  9. 9.
    Gmür M, Tschopp A (1986) Die Mortalität schizophrener Patienten — eine Untersuchung an 170 Fällen. Sozial Präventivmed 31:294–296Google Scholar
  10. 10.
    Huber G (1973) Verlauf und Ausgang schizophrener Erkrankungen. Schattauer, StuttgartGoogle Scholar
  11. 11.
    Huber G, Gross G, Schüttler R (1975) A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatr Scand 52 (1):49–57Google Scholar
  12. 12.
    Hubschmid T, Aebi E (1986) Berufliche Wiedereingliederung von psychiatrischen Langzeitpatienten. Soc Psychiatry 21: 152–157Google Scholar
  13. 13.
    Hubschmid T, Pfister F Spalinger J (1988) Wiedereingliederung auf der Wohnachse: Eine katamnestische Untersuchung. Psychiatr Prax 15:78–83Google Scholar
  14. 14.
    Jonsson H, Nyman AK (1984) Prediction of outcome in schizophrenia. Acta Psychiatr Scand 69:274–291Google Scholar
  15. 15.
    Möller HJ, Werner K, Wüschner M, v.Zerssen D (1982) Relevante Merkmale für die 5-Jahres-Prognose von Patienten mit schizophrenen und verwandten paranoiden Psychosen. Arch Psychiatr Nervenkr 231:305–322Google Scholar
  16. 16.
    Möller HJ, v.Zerssen D, Werner K, Wüschner M (1982) Outcome in schizophrenic and similar paranoid psychoses. Schizophr Bull 8 (1):99–108Google Scholar
  17. 17.
    Rog DJ, Raush HL (1975) The psychiatric halfway house: How is it measuring up? Community Ment Health J 11 (2):155–162Google Scholar
  18. 18.
    Scharfetter C (1971) AMP-System. Manual zur Dokumentation psychiatrischer Befunde. Springer, Berlin Heidelberg New YorkGoogle Scholar
  19. 19.
    Slipp S (1974) The hospital without walls: an aftercare program for chronic schizophrenic patients. Am J Group Dynamics Psychother 6 (1):21–26Google Scholar
  20. 20.
    Süllwold L (1977) Symptome schizophrener Erkrankungen. Uncharakteristische Basisstörungen. Springer, Berlin Heidelberg New YorkGoogle Scholar
  21. 21.
    Wing JK, Cooper JE, Sartorius N (1982) Die Erfassung und Klassifikation psychiatrischer Symptome Beltz, Weinheim BaselGoogle Scholar
  22. 22.
    Zubin J, Spring B (1977) Vulnerability — A new view of schizophrenia. J Abnorm Psychol 86:102–126Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • M. Gmür
    • 1
  1. 1.Social-Psychiatic Service of the UniversityPsychiatric Hospital in ZürichZürichSwitzerland

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