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Natural History of Schizophrenia

  • Oliver Freudenreich
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

Having a good understanding of the natural history of schizophrenia, admittedly an abstraction, allows clinicians to make a correct diagnosis based on the longitudinal history. In this chapter, I describe the clinical phases of schizophrenia that need to be recognized, particularly the prodromal phase of schizophrenia that often begins with non-specific symptoms several years before schizophrenia declares itself with the onset of frank psychosis. A corresponding phase exists in chronic patients, where an impending relapse is heralded by non-specific early warning sign. This chapter also discussing the problem of prognostication as schizophrenia has many possible outcomes, ranging from a restitutio ad integrum in about 20–30% of cases to severe, unremitting illness in 10% of cases. For most patients treated schizophrenia is a manageable illness, particularly if help is provided when needed.

Keywords

Natural history Course Onset Childhood-onset schizophrenia (COS) Late-onset schizophrenia (LOS) Very late-onset schizophrenia-like psychosis Postpartum psychosis Premorbid phase Prodrome First episode of psychosis Conrad stages of beginning psychosis Chronic schizophrenia Psychotic relapse Long-term outcome Prognosis Culture 

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Additional Resources

    Book

    1. Watters E. The shifting mask of schizophrenia in Zanzibar. Crazy like us: the globalization of the American psyche. New York: Free Press; 2011. – Read this book! It makes you question the wisdom of imposing our Western ideas about psychiatric illnesses (what counts as disease, how to you best treat it) on other, non-Western societies. Some societies may offer a more hopeful conceptual framework that allows for inclusion and healing and prevents psychological damage to patients. The book contains a chapter on schizophrenia.Google Scholar

    Articles

    1. Farmer PE, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical medicine. PLoS Med. 2006;3:e449. – A manuscript worth reading if you are interested in a critique of the idea of a “natural history” of any disease. Paul Farmer is an ID doctor from Boston who has brought first-rate health care to Haiti, proving that the outcome of disease is fundamentally a function of the society you live in – that social interventions are at least as important as any molecular advance.PubMedPubMedCentralCrossRefGoogle Scholar
    2. Mishara AL. Klaus Conrad (1905–1961): delusional mood, psychosis, and beginning schizophrenia. Schizophr Bull. 2010;36:9–13. – An excellent summary in English if you are interested in learning more about Conrad’s descriptions of beginning psychosis.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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