Identify and discuss the typical course of schizophrenia and its prognosis

What will be an ideal response?

The typical course of schizophrenia consists of three phases: prodromal, active, and residual. The prodromal phase includes the onset and buildup of schizophrenic symptoms. During this phase, social withdrawal and isolation, peculiar behaviors, inappropriate affect, poor communication patterns, and neglect of personal grooming may become evident. Often, psychosocial stressors or excessive demands on an individual with schizophrenia in the prodromal phase result in the onset of prominent psychotic symptoms, and the person transitions into the active phase of schizophrenia. In this phase, the person shows full-blown symptoms of schizophrenia, including severe disturbances in thinking, deterioration in social relationships, and flat or markedly inappropriate affect. At some later time, the person may enter the residual phase, in which the symptoms are no longer prominent. In the residual phase, the symptom severity declines, and the individual may show milder impairment similar to that seen in the prodromal phase.

Most people with schizophrenia recover gradually rather than suddenly. Long-term studies have shown that many people with schizophrenia can lead productive lives; however, full recovery is rare. Specifically, research conducted by Harrow et al. (2005) indicated over 40 percent of individuals diagnosed with schizophrenia showed one or more periods of recovery, and a sizable minority was not on any medication. Another study conducted by Wiersma and colleagues (1998) identified 25 percent of individuals diagnosed with schizophrenia in complete remission of symptoms, another 50 percent showed partial remission of symptoms accompanied by either anxiety and depression or negative symptoms, and 11 percent showed no recovery after the initial psychotic episode. Relapses however, also occurred in two-thirds of this sample, after which about one in six showed no remission of symptoms.

Regarding prognosis, there are factors associated with a positive outcome. Being female, married, having a higher premorbid level of functioning, and having a better educational background are associated with better outcomes. Research indicates that baseline predictors associated with recovery from schizophrenia include fewer negative symptoms; a prior history of good work performance and ability to live independently; and lower levels of depression and aggression (Shrivastava, Shah, Johnston, Stitt & Thakar, 2010). Social factors such as peer support/friends, work opportunities, being single or married as opposed to be separated, and reducing the stigma of schizophrenia also play an important role in the recovery process.

Early intervention and reduction of positive symptoms have shown to yield a more favorable course of the illness (Mihalopoulos, Harris, Henry, Harrigan & McGorry, 2009). Interventions to decrease stress from issues such as self-stigmatization, negative beliefs, and social skills deficits can significantly enhance recovery (Tsang et al., 2010).