Longitudinal Course of Schizophrenia

Background: Understanding the course of schizophrenia is essential to improve prophylaxis, early diagnosis, diagnostic validity, and prognosis. Method: We completed a comprehensive literature search for longitudinal, prospective and retrospective studies of schizophrenia. As studies span over almost a century and use different diagnostic criteria to decrease the effect of studies heterogeneity we reviewed the data organized according to historical periods (institutionalization and deinstitutionalization, pre and post neuroleptic periods) Results: The majority of the longitudinal studies of schizophrenia report that up to 30-50% of patients present with a stable or favorable course. Interestingly, this moderately positive outcome is de-emphasized in the literature, which most times focuses on the bleaker outcome of the rest of the patients (50-70%). A number of putative course predictors at the time of the initial diagnosis have been proposed. However, the current level of evidence about risk and protective factor is putative rather than clear and convincing.