Positive symptoms and chronicity of illness in schizophrenia

I have proposed recently that the positive symptoms of schizophrenia such as hallucinations and delusions reflect a compensatory mechanism to overcome the dopaminergic deficiency which underlies the core pathology of the disease, namely the negative syndrome. In such case it is possible, in analogy with Parkinson's disease, that these compensatory mechanisms will diminish with progression of the disease. Thus, one would expect the severity of positive symptoms in schizophrenia to decline with progression of the disease. To test this hypothesis, I studied in 20 chronic schizophrenic patients the association between positive symptoms (hallucinations and delusions) with chronicity of illness. I found a significant inverse correlation between chronicity of illness and severity of delusions (r = -.51, p < .05) and hallucinations (r = -.47, p < 0.05). In contrast, chronicity of illness was unrelated to negative symptoms (blunted affect and emotional withdrawal). These data support the prediction that the compensatory ability of the brain to increase dopamine functions may diminish with progression of the disease and are in accord with the clinical impression that with time schizophrenic patients tend to display a more negative syndrome profile and become "burnt out schizophrenics."