On early and mid-adolescent schizophrenia.--Part II: prognosis, course and defect

Twenty-three adolescent schizophrenics were studied in regard to the problems of the course of illness, prognosis and defect. Illustrations of cases (follow-up for three to 15 years) were presented. 1) The course was considered chiefly from the viewpoint of positive symptoms, namely paranoid-hallucinatory experiences. It was divided into the following four categories; remittent, persistent, scanty and fading types. At the same time, general characteristics of each type were discussed. 2) As to the changes in clinical forms, hebephrenia was gradually manifested in more than half of the cases. There were some cases in which the expansion of paranoid activities were observed. These two prominent tendencies might be explained in terms of personality disintegration and maturation. We were impressed, in this regard, that autistic tendencies and behavior disturbances were more manifest in the initial stages in patients who later turned more hebephrenic. 3) A mild defect was observed in fourteen cases, while a medium or severe defect was recognized in eight cases. Generally, the degree of defect seemed to be more manifest in female patients than in males. Moreover, the defect was generally more severe in early adolescent cases and in patients with insidious onsets as well as in those with a longer duration of illness than in mid-adolescent patients and those with acute onsets and a shorter duration of illness. 4) As the result of this investigation, it was substantiated that the prognosis in adolescent schizophrenia, especially in early adolescence, was unfavorable. 5) Finally, we were impressed by the fact that there were many patients who were treated mainly in ambulatory clinics or who stayed at home in spite of the above-mentioned unfavorable prognosis.