The prognosis of schizophrenia: rationale for a multidimensional concept

Three main ways of viewing schizophrenia exist that have different prognostic, practical, and conceptual implications. The mixed cross-sectional/longitudinal view of Kraepelin and others states essentially that there is a disease, schizophrenia, that can be identified by considering both characteristic symptoms and course. Prognosis in the disorder so defined is guarded, but because of the composite diagnostic criteria used, the characteristics most important for relating to outcome remain unknown. The second view defines schizophrenia primarily in terms of the cross-sectional symptom picture alone. It has been shown empirically that defining a disorder in this way has relatively limited prognostic implications. The third approach identifies schizophrenia in terms of several "axes," such as type of schizophrenic symptoms, their duration, the person's social relations, and his work function. These axes are viewed as relatively independent processes with somewhat different determinants, implying the need for different specific treatments. The authors believe this last view is the one most supported by currently available data.