The Natural History of the Course and Outcome of Schizophrenia

  • Judith Allardyce
  • Jim van Os


Understanding a disease’s pathological trajectory, by describing its progression and course, from the time an individual is exposed to causal factors until recovery or death, is just as important as aetiological understandings, when considering strategies to deal with disease prevention and control (Bhopal 2002; Wynne 1988). The natural history describes the uninterrupted trajectory in an individual of the biological and symptom development of a disorder from the moment it is initiated by exposure to its risk factors. However, there is very little information regarding the natural history of schizophrenia. Why is this? First, throughout history psychotic symptoms (with associated disability), i.e. the manifest cases, have resulted in institutional care or other medical, religious or cultural interventions, which influence the longitudinal progression, and certainly from the 1950s the vast majority of individuals diagnosed with schizophrenia have received antipsychotic medication; therefore, our contemporary studies examining course are unlikely to reflect the true natural history.


Psychotic Symptom Psychotic Disorder Psychotic Experience Genetic Liability Schizophreniform Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Allardyce Jv, J. Outcome of psychosis at 5-year follow-up. Submitted 2009.Google Scholar
  2. Bhopal R. Natural History, Spectrum, Iceberg, Population Patterns and Screening. Concepts of Epidemiology. Oxford: Oxford University Press; 2002, 132–62.Google Scholar
  3. Bromet EJ, Naz B, Fochtmann LJ, Carlson GA, Tanenberg-Karant M. Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia. Schizophrenia Bulletin 2005 July 1; 31(3):639–49.CrossRefPubMedGoogle Scholar
  4. Cougnard A, Marcelis M, Myin-Germeys I, De Graaf R, Vollebergh W, Krabbendam L, et al. Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 2007 Apr; 37(4):513–27.CrossRefPubMedGoogle Scholar
  5. Driessen G, Gunther N, Bak M, van Sambeek M, van Os J. Characteristics of early- and late-diagnosed schizophrenia: implications for first-episode studies. Schizophrenia Research 1998 Sep 7; 33(1–2):27–34.CrossRefPubMedGoogle Scholar
  6. Eaton WW, Thara R, Federman E, Tien A. Remission and relapse in schizophrenia: the Madras Longitudinal Study. Journal of Nervous & Mental Disease 1998 Jun; 186(6):357–63.CrossRefGoogle Scholar
  7. Ganev K, Onchev G, Ivanov P. A 16-year follow-up study of schizophrenia and related disorders in Sofia, Bulgaria. Acta Psychiatrica Scandinavica 1998; 98(3):200–7.CrossRefPubMedGoogle Scholar
  8. Möller HJ, Bottlender R, Wegner U, Wittmann J, Strauss A. Long-term course of schizophrenic, affective and schizoaffective psychosis: focus on negative symptoms and their impact on global indicators of outcome. Acta Psychiatrica Scandinavica 2000; 102(s407):54–7.CrossRefGoogle Scholar
  9. Hanssen M, Bak M, Bijl R, Vollebergh W, van Os J. The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 2005 Jun; 44(Pt 2):181–91.CrossRefPubMedGoogle Scholar
  10. Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A. The Vermont longitudinal study of persons with severe mental illness, II: long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry 1987a Jun; 144(6): 727–35.Google Scholar
  11. Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A. The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry 1987b Jun; 144(6):718–26.Google Scholar
  12. Harding CM, Strauss JS, Hafez H, Lieberman PB. Work and mental illness. I. Toward an integration of the rehabilitation process. Journal of Nervous & Mental Disease 1987c Jun; 175(6):317–26.Google Scholar
  13. Harding CM, Zubin J, Strauss JS. Chronicity in schizophrenia: fact, partial fact, or artifact? Hospital & Community Psychiatry 1987d May; 38(5):477–86.Google Scholar
  14. Harrison G, Mason P. Schizophrenia – falling incidence and better outcome? The British Journal of Psychiatry 1993 Oct 1; 163(4):535–41.CrossRefPubMedGoogle Scholar
  15. Harrow M, Grossman LS, Herbener ES, Davies EW. Ten-year outcome: patients with schizoaffective disorders, schizophrenia, affective disorders and mood-incongruent psychotic symptoms. The British Journal of Psychiatry 2000 Nov 1; 177(5):421–6.CrossRefPubMedGoogle Scholar
  16. Hegarty JD, Baldessarini RJ, Tohen M, Waternaux C, Oepen G. One hundred years of schizophrenia: a meta-analysis of the outcome literature [see comment]. American Journal of Psychiatry 1994 Oct; 151(10):1409–16.PubMedGoogle Scholar
  17. Herbener ES, Harrow M, Hill SK. Change in the relationship between anhedonia and functional deficits over a 20-year period in individuals with schizophrenia. Schizophrenia Research 2005; 75(1):97–105.CrossRefPubMedGoogle Scholar
  18. Herbener ES, Harrow M. Longitudinal assessment of negative symptoms in schizophrenia/schizoaffective patients, other psychotic patients, and depressed patients. Schizophrenia Bulletin 2001 Jan 1; 27(3):527–37.PubMedGoogle Scholar
  19. Huber G, Gross G, Schuttler R, Linz M. Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin 1980; 6(4):592–605.PubMedGoogle Scholar
  20. Jäger M, Bottlender R, Strauses A, Möller HJ. Fifteen-year follow-up of ICD-10 schizoaffective disorders compared with schizophrenia and affective disorders. Acta Psychiatrica Scandinavica 2004; 109(1):30–7.CrossRefGoogle Scholar
  21. Kraepelin E. Dementia Praecox and Paraphrenia, 1919 (translated by Barkley RM). New York: Robert E. Kreiger; 1971.Google Scholar
  22. Kua J, Wong KE, Kua EH, Tsoi WF. A 20-year follow-up study on schizophrenia in Singapore. Acta Psychiatrica Scandinavica 2003; 108(2):118–25.CrossRefGoogle Scholar
  23. Last J. The challenge of epidemiology: issues and selected readings. In: Buck C (ed) The Challenge of Epidemiology: Issues and Selected Readings Pan American Health Organization, PAHO, 2004, 917–22.Google Scholar
  24. Last J. The iceberg “completing the clinical picture” in general practice. The Lancet 1963; ii:28–31.CrossRefGoogle Scholar
  25. Mason P, Harrison G, Croudace T, Glazebrook C, Medley I. The predictive validity of a diagnosis of schizophrenia. A report from the International Study of Schizophrenia (ISoS) coordinated by the World Health Organization and the Department of Psychiatry, University of Nottingham. The British Journal of Psychiatry 1997 April 1; 170(4):321–7.CrossRefPubMedGoogle Scholar
  26. Mason P, Harrison G, Glazebrook C, Medley I, Croudace T. The course of schizophrenia over 13 years. A report from the International Study on Schizophrenia (ISoS) coordinated by the World Health Organization. The British Journal of Psychiatry 1996 November 1; 169(5):580–6.CrossRefPubMedGoogle Scholar
  27. Mason P, Harrison G, Glazebrook C, Medley I, Dalkin T, Croudace T. Characteristics of outcome in schizophrenia at 13 years. The British Journal of Psychiatry 1995 Nov 1; 167(5):596–603.CrossRefPubMedGoogle Scholar
  28. McGlashan TH. A selective review of recent North American long-term followup studies of schizophrenia. Schizophrenia Bulletin 1988; 14(4):515–42.PubMedGoogle Scholar
  29. Menezes NM, Arenovich T, Zipursky RB. A systematic review of longitudinal outcome studies of first-episode psychosis. Psychological Medicine 2006 Oct; 36(10):1349–62.CrossRefPubMedGoogle Scholar
  30. Olfson M, Lewis-Fernandez R, Weissman MM, Feder A, Gameroff MJ, Pilowsky D, et al. Psychotic Symptoms in an Urban General Medicine Practice. American Journal of Psychiatry 2002 Aug 1; 159(8):1412–9.CrossRefPubMedGoogle Scholar
  31. Poulton R, Caspi A, Moffitt TE, Cannon M, Murray R, Harrington H. Children’s self-reported psychotic symptoms and adult schizophreniform disorder:A 15-year longitudinal study. Archives of General Psychiatry 2000 Nov 1; 57(11):1053–8.CrossRefPubMedGoogle Scholar
  32. Racenstein JM, Harrow M, Reed R, Martin E, Herbener E, Penn DL. The relationship between positive symptoms and instrumental work functioning in schizophrenia: A 10 year follow-up study. Schizophrenia Research 2002; 56(1–2):95–103.CrossRefPubMedGoogle Scholar
  33. Sartorius N, Gulbinat W, Harrison G, Laska E, Siegel C. Long-term follow-up of schizophrenia in 16 countries. A description of the International Study of Schizophrenia conducted by the World Health Organization. Social Psychiatry & Psychiatric Epidemiology 1996 Sep; 31(5):249–58.Google Scholar
  34. Shepherd M, Watt D, Falloon I, Smeeton N. The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychological Medicine – Monograph Supplement 1989; 15:1–46.CrossRefPubMedGoogle Scholar
  35. Stirling J, White C, Lewis S, Hopkins R, Tantam D, Huddy A, et al. Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort. Schizophrenia Research 2003; 65(2–3):75–86.CrossRefPubMedGoogle Scholar
  36. Strauss JS, Carpenter WT, Jr. The prediction of outcome in schizophrenia. II. Relationships between predictor and outcome variables: a report from the WHO international pilot study of schizophrenia. Archives of General Psychiatry 1974 Jul; 31(1):37–42.PubMedGoogle Scholar
  37. Thara R, Henrietta M, Joseph A, Rajkumar S, Eaton WW. Ten-year course of schizophrenia – the Madras longitudinal study. Acta Psychiatrica Scandinavica 1994 Nov; 90(5):329–36.CrossRefPubMedGoogle Scholar
  38. Van Os J. The clinical epidemiology of schizophrenia. In: B. Kaplan, V. Sadock and P. Ruiz (eds) Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 9th edition. London: Lippincott Williams & Wilkins; 2008.Google Scholar
  39. Van Os J, Hanssen M, Bijl RV, Ravelli A. Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 2000; 45(1–2):11–20.PubMedGoogle Scholar
  40. Verdoux H, Maurice-Tison S, Gay B, Van Os J, Salamon R, Bourgeois ML. A survey of delusional ideation in primary-care patients. Psychological Medicine 1998; 28(01):127–34.CrossRefPubMedGoogle Scholar
  41. Westermeyer JF, Harrow M. Prognosis and outcome using broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia. Schizophrenia Bulletin 1984; 10(4):624–37.PubMedGoogle Scholar
  42. WHO. Who Coordinated Multi-Centred Study on the Course and Outcome of Schizophrenia. Geneva: WHO; 1992.Google Scholar
  43. Wiersma D, Nienhuis FJ, Slooff CJ, Giel R. Natural course of schizophrenic disorders: A 15-Year Followup of a Dutch Incidence Cohort. Schizophrenia Bulletin 1998 January 1; 24(1): 75–85.PubMedGoogle Scholar
  44. Wiles NJ, Zammit S, Bebbington P, Singleton N, Meltzer H, Lewis G. Self-reported psychotic symptoms in the general population: Results from the longitudinal study of the British National Psychiatric Morbidity Survey. The British Journal of Psychiatry 2006 June 1; 188(6):519–26.CrossRefPubMedGoogle Scholar
  45. Wynne LC. The Natural Histories of Schizophrenic Processes. Schizophrenia Bulletin 1988; 14(4):653–9.PubMedGoogle Scholar
  46. Zubin J, Magaziner J, Steinhauer SR. The metamorphosis of schizophrenia: from chronicity to vulnerability. Psychological Medicine 1983 Aug; 13(3):551–71.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching NetworkEURON, Maastricht UniversityMaastrichtThe Netherlands
  2. 2.Department of Psychiatry and Neuropsychology, School of Mental Health and NeuroscienceMaastricht University Medical Centre, EURON, SEARCHMaastrichtThe Netherlands
  3. 3.Division of Psychological MedicineInstitute of PsychiatryLondonUK

Personalised recommendations