Schizophrenia Phases and Characteristics

Natural History of Schizophrenia

• Schizophrenia usually appears in late adolescence to early adulthood.

Stages of Illness

• The natural history of schizophrenia is classified into premorbid, prodromal, first-episode, early-course, and chronic phases.
• The duration, course, and severity of symptoms differ greatly in each phase.

Premorbid Phase

• This phase occurs before psychotic symptoms appear.
• Childhood features include delayed motor milestones, cognitive function deficits, and a lower IQ (about 8 points less).
• During adolescence, cognitive functions like information processing speed, attention, and verbal memory decline, while social understanding and function are impaired.
• Cognitive and functional deficits overlap with the general population, making it difficult to distinguish individuals who will develop schizophrenia.

Prodromal Phase

• 75%-80% of individuals developing schizophrenia experience it, it involves attenuated, subsyndromal, psychotic-like symptoms before full psychosis onset.
• Symptoms involve disturbances in thought content, process, perception, and behaviors, occurring frequently (several times a month).
• Retention of insight is a key feature, as the individual understands these experiences are not real.
• Schizophrenia's negative symptoms often emerge, alongside cognitive impairments at the level seen in first-episode schizophrenia.
• Dysphoric moods like depression, anxiety, and irritability are common, with about 75% meeting criteria for a mood or anxiety disorder.
• Attenuated psychotic, negative, cognitive, and mood symptoms impair functioning at school, work, or in social situations.
• Social and occupational function decline significantly during the prodromal phase.
• Attenuated psychotic symptoms indicate elevated risk but not a certainty of developing schizophrenia, with a 25% risk of developing a psychotic disorder within 2 years and 30%-35% within 5 years.
• Among non-converters, roughly half continue to experience attenuated symptoms, while the other half experiences complete remission.
• Interventions like psychotherapy can reduce the risk of conversion to psychosis by about half; antipsychotics are not first-line treatments due to the majority not actually being prodromal and the effectiveness of psychotherapy.
• Pharmacological interventions targeting glutamate receptors are promising.
• Conflicting results exist regarding omega-3 fatty acids preventing conversion to psychosis.

Onset of Schizophrenia

• Schizophrenia spectrum disorders, including schizophrenia, schizoaffective disorder, and schizophreniform disorder, typically emerge in late adolescence or early adulthood, with the highest risk period between ages 20 and 30.
• The risk of schizophrenia is higher in men than in women before age 30, but higher in women after age 30, with an overall slightly higher (about 15%) risk for men.
• Symptom emergence varies from abrupt (days to weeks) to insidious (months to years).
• For about half the individuals, psychosis emerges relatively acutely (within a month or less).

Course and End State After the First Episode

• The course of illness is variable after the first episode.
• Psychotic symptoms, along with negative, mood, and cognitive impairments, may remit, persist, recur, or worsen.
• Social and vocational functioning can range from premorbid levels to severe impairments.
• The severity often stabilizes after 5-10 years, ranging from chronic symptoms to full recovery.
• Elevated mortality rates are seen in persons with schizophrenia, mainly due to suicide, accidents, lung diseases, and cardiovascular diseases.
• Treatment with antipsychotics potentially improves the natural course, increasing symptom remission, reducing relapse, and possibly improving the final outcome.
• Research before the antipsychotic era sheds light on the natural history regardless of antipsychotic medication use.

Course and End State Prior to Availability of Antipsychotic Medication

• Clinical criteria used to diagnose schizophrenia are still evolving.
• Emil Kraepelin and Eugen Bleuler shaped diagnostic criteria early in the 20th century, before antipsychotics.
• Kraepelin's "dementia praecox" included psychosis, negative symptoms, and cognitive impairments, with the course characterized as either episodic or chronic, typically progressing towards severe disability.
• Kraepelin noted heterogeneity, with a minority not having a progressive course and complete spontaneous recoveries occurring, albeit rarely.
• Kraepelin differentiated "dementia praecox" from manic-depressive insanity based on prominent mood symptoms and a more benign course in the latter.
• Eugen Bleuler coined "schizophrenia" to differentiate it from dementia praecox.
• Bleuler emphasized cross-sectional presentation rather than the clinical course, involving disturbances of thought process (delusions, disorganized ideas, poverty of thought) and disorganized speech.
• Severity of accessory features varied, including disturbances of perception (hallucinations, illusions), affect (mania, depression, anxiety), cognition (attention, ambivalence, "dementia"), and negative symptoms (decreased motivation, blunting of emotions).
• Bleuler's formulation resulted in schizophrenia diagnoses in persons diagnosed based on current criteria.
• Bipolar disorder or depression have psychosis, that is, he included people with disorders that have a better prognosis than does more narrowly defined schizophrenia

Course

• Kraepelin and Bleuler both noted schizophrenia is a variable course.

• Kraepelin described the illness course in a cohort of 488 patients, finding that 74% had a chronic deteriorating course reaching terminal state within two to three years.

• Kraepelin reported real improvement in 26% of cases, with residual symptom severity varying in the patients with improvements; 3% were "completely well". Kraepelin found that most improved patients eventually relapsed.

• Bleuler gave a description of the course of schizophrenia; in every course, exacerbations may appear at any time, but after 2 to 3 decades they are rare, and complete arrests are not frequent in asylum patients.

• Other investigators following Kraepelin gave similar descriptions.

• In a 4.5- to 10-year follow-up of 571 hospitalized first-episode patients, chronic symptomatic severely disabled, 18% psychotic symptoms remitted, improved. Half relapsed during the follow-up period, and the majority, chronically psychotic.

• The "natural" course is variable, with two-thirds to three-quarters experiencing this course. The rest experienced range from partial to complete symptom remission improvement in function.

• After a period, patients who were chronically psychotic have experienced a remission of psychosis.

End State

• The typical outcome prior to antipsychotics involved a progressive deterioration that severely impaired capacity with others function independently.
• The terminal states with varying severity are psychotic symptoms.
• Bleuler depicted the range of pathology in his outcome rating scale.
• Patients who maintain sensible conversations are not frequent patients in general.
• Patients live outside the institution. A patient should not reveal any evidence of schizophrenia.

Course and End State in the Antipsychotic Era

• The era for schizophrenia began in the early 1950s because of chlorpromazine.
• It induces disinterest promotes its use to psychiatric colleagues.
• Pierre and Jean tried a series of patients, deniker and investigated the use of chlorpromazing thus avoiding affects.
• In the 1950s, the " era" began.

Course

• In the twentieth century, people developed systems in the course of these.
• These systems are episodic (recovery between these), and as the level is (end, 1988).
• Studies Reported that of patients have had a symptomatic course with most of an episodic course.
• Studies also reported that patients received the medication effects for a short course, but there is lower proportion patients with availability medication and a higher availability of their medications.

End State

• Since the were shifted to modern assessments.
• Studies have a definition of of less or on the a with symptoms consistent those in the studies.
• Diagnosed before mid-, ratings, those used in the scales that are comparable to used in (1978).
• Recovered ratings required the and.
• Not the the or to have outcomes rated state.

Natural History

• The rate of schizophrenia can be traced to genetics through environmental influences. People that don't seem to be too common. One for people with a single .
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Potential Factors Affecting the "Natural" History of Schizophrenia

Treatment

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Additional Symptoms Associated With Schizophrenia

• Symptoms affect% of cognitive impairment comes in.

Morbidity and Mortality

• People suffer more from schizophrenia by developing the first episode. Death is the most common thing, accidents, cancer .

Functional Outcomes

• Among persons with schizophrenia functions are more effective in social and community functioning that the Hopkin's verbal learning test. Functional and memory related to social functioning.

Mood and Anxiety Symptoms

• The symptoms related to anxiety have no difference among individuals with schizophrenia and those without such illness. Schizophrenia and have always remained as separate.
• In DSM, some of the disorders meet psychotic , but only during episodes.

Complications of Schizophrenia

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Suicide

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Potential Factors Affecting the "Natural" History of Schizophrenia

Treatment

• The second half of the twentieth century marked a turning point for people.
• Antipsychotics effectively reduce or eliminate psychotic symptoms in the majority of.

Conclusion

• Researchers investigate, but we must continue or improve our studies.

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General Notes

• General populations: -18 -65
• What are all the specific criteria? What is each component measuring?
• The best approach would be a mix of long hand data collection, followed by cross referencing and triangulation
• There are still ongoing studies on the subject. Be sure to follow these up.