Narratives of twenty to thirty year outcomes in schizophrenia

This descriptive study objectively compares three decades in the life histories of women and men with schizophrenia treated continuously at one institution. On the basis of clinical observation, it was hypothesized that the first ten years of illness would be stormier for men, but that women would suffer more than their male counterparts as they began to approach the age of menopause. Eighty active patients with a current diagnosis of DSM-IV schizophrenia were identified. From this group, ten men and ten women, randomly selected, agreed to review and publication of their life stories in slightly altered form. These twenty patients and their current case managers were interviewed. Their medical records were reviewed and the course of selected predictor variables was charted on the Camberwell Assessment of Need (CAN) entry form. The entries on the CAN fluctuated markedly for most of the patients over the two to three decades of illness. Seven of the ten men were, as predicted, globally most severely ill during their first decade of illness and improved thereafter. By contrast, eight of the ten women appeared to suffer a relatively need-free first decade, followed by increasing disability over time. In this small group, which, because of the method of recruitment, excluded best and worst outcomes, factors such as onset age, duration of untreated prodrome, and early course of illness (as assessed by chart review) did not predict long-term outcome. On the other hand, substance abuse, social supports, and a family history of schizophrenia were more closely correlated with 20- to 30-year outcome status. The direct effect of female menopause on illness severity was not possible to gauge in this study, but alterations in hormones may have played a part in responsivity to family and social loss.