CLINICAL HANDBOOK OF SCHIZOPHRENIA

11. Course and Outcome 109quency of relapses varied from zero to several per year, with an average of three and amaximum of 22 in 11.3 years.SOCIAL COURSESchizophrenia is on average not a progressive illness characterized by deterioration andsocial decline after the first illness episode. Many patients already have considerableimpairment and social disadvantage at the prodromal stage. Because of impaired socialdevelopment in early-onset illness or social decline from a relatively high status in lateonsetillness, this disadvantage often makes schizophrenia a permanently disabling disorder.In the ABC Schizophrenia Study (an der Heiden et al., 2005) 31% of the first-episodesample had full-time jobs at first admission, and 32% at 11.3-year follow-up, comparedwith 70% for individually matched controls. Similar differences were found in the meanrates for patients living independently and for those divorced. Considerably more femalethan male patients had remarried. These results further corroborate the stable trend inthe main domains of illness course in schizophrenia despite some changes that occur bothfor the better and for the worse (high divorce and remarriage rates, job loss, andreemployment).The quality of life of patients with a long, chronic course of illness, when measuredby objective criteria, is significantly reduced in several domains. But after a history of illnessof several years, their subjective life satisfaction often does not differ significantlyfrom that of healthy controls, because most patients manage to cope emotionally with thedisorder and reduce their expectations. Factors detrimental to the subjective quality ofFIGURE 11.3. The prevalence of purely depressive and manic symptoms (no overlap with negative orpositive symptoms) in the long-term course of schizophrenia. Depressive and manic symptoms (n =107) were assessed retrospectively per month over 136 months with the IRAOS. Depressive symptomswere validated prospectively with the Present State Examination (PSE) at seven cross sectionsover that same period (n = 13).