However, the dogma about the illness is one of chronicity, that is, schizophrenia is an illness of unremitting symptoms even with the best of treatments.
Is this depiction accurate?
Not entirely, according to Harrow et. al, who set out to answer this question (and many more) in the Schizophrenia Bulletin article "Do Patients with Schizophrenia Ever Show Periods of Recovery? A 15-year Multifollow-Up Study."
The authors wanted to answer 4 questions:
1. Do some or even a large percentage of patients with schizophrenia show periods of recovery? If so, what percentage?
2. Do patients with schizophreniform disorders show more favorable courses and outcomes than patients with schizophrenia? (Yes)
3. Is schizophrenia associated with slower recovery than other psychotic disorders? (Yes)
4. Is psychosis in nonschizophrenia patients a risk factor for subsequent poor outcome? (Maybe)Since the focus of this post is on the answer to that first question, I've provided the answers to the other questions for brevity (the article is available for free).
Methodology and Study Outcomes:
The study consisted of 274 DSM-III diagnosed patients (64 of whom had schizophrenia) who were studied at 5 different intervals over 15 years. The total diagnostic breakdown and numbers of patients within each diagnosis assessed during each follow-up period are listed below:
Patients were assessed at 2 years, 4.5 years, 7.5 years, 10 years, and 15 years post-initial hospitalization.
Other schizophrenia patient demographics are listed below:
1. the absence of major symptoms throughout the follow-up year (i.e., absence of psychotic activity and absence of negative symptoms).
2. adequate psychosocial functioning, including instrumental (or paid) work half-time or more during the follow-up year.
3. the absence of a very poor social activity level.
4. no psychiatric rehospitalizations during the follow-up year.The data provided include, "(a) percentage of patients with schizophrenia in recovery at any follow-up year and (b) the cumulative percentage of schizophrenia patients who, over 15 years, ever show the potential for an interval or period of recovery." In other words,the number of patients with schizophrenia who had at least one interval of recovery during the 15 year period.
Here are the percentages of patients that were in recovery during each follow-up interval for each diagnostic group:
Here are the cumulative percentages of the patients that had at least one interval of recovery during the entire study period:
Here is where it gets interesting:
very poor outcome patients with schizophrenia are more likely to be on antipsychotic medications."
One can generate many different hypotheses based on this result. For example, you could argue that psychotropic medications in general, and antipsychotic medications specifically, are dangerous drugs that cause more harm than good.
That's just how two individuals chose to spin this result:
Indeed, these findings indicate that not receiving treatment works better than pharmaceutical intervention. Similarly, University of Illinois researchers recently found that only 5 percent of medicated schizophrenia patients recover, but 40 percent of non-medicated patients recover (Harrow, Grossman, Jobe, and Herbener 2005; also see Harrow and Jobe 2007). In other words, schizophrenia patients are eight times more likely to recover if they are not on medications!(1)Quick! Somebody notify the APA! We need to start revising all those treatment algorithms, STAT!.
Unfortunately, the authors of that piece, which appeared in the September/October 2008 edition of Skeptical Inquirer, are full of shit (excuse my French, but to call them liars would be considered libel).
Harrow and Thomas, with the same patient cohort, did another study: Factors Involved in Outcome and Recovery in Schizophrenia Patients Not on Antipsychotic Medications - A 15-Year Multifollow-Up Study.
One goal of this study was to examine the "clues on whether the better functioning of the subgroup of unmedicated patients with schizophrenia versus those on antipsychotics at the 15-year follow-up was a function of their current medication status" or "other long-term characteristics marked them off as different types of patients."
They answered this question by comparing the two groups on various premorbid and prognostic factors that were assessed near the beginning of the study.
In the figure above, we see that unmedicated patients scored better on indices of "favorable prognosis." In the figure below, we also see that unmedicated patients had better scores on "premorbid achievement" measures as well. Keep in mind that these two factors (i.e., favorable prognosis and premorbid achievement) were assessed near the beginning of the study, and not afterward. This means that being on antipsychotics was not a major factor in patient outcomes, suggesting that the better overall recovery of the unmedicated patients was mainly due to long-term patient characteristics.
"Looking at from a different viewpoint, the data suggests that schizophrenia patients with good prognostic features, with better premorbid developmental achievements and with more favorable personality characteristics are the subgroup more likely to stay off antipsychotics for a prolonged period."What was identified is a small subset of patients who are able to experience episodes of recovery in the absence of antipsychotics. According to the authors, those patients "who go off antipsychotics are a different type of patient."
There are many things to keep in mind regarding these two research papers. First, the sample is rather small (64 cases of schizophrenia). Of those diagnosed, the majority never did achieved remission. At the end of the study, only 12/64 (19%) patients had been in remission the previous study year. Of those who did achieve remission, many eventually relapsed. And, overall, the schizophrenia patients had significantly poorer outcomes when compared to all other clinical groups...Oh screw it, who wants pie?
Harrow M, Grossman LS, Jobe TH, & Herbener ES (2005). Do patients with schizophrenia ever show periods of recovery? A 15-year multi-follow-up study. Schizophrenia bulletin, 31 (3), 723-34 PMID: 16020553
Harrow M, & Jobe TH (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. The Journal of nervous and mental disease, 195 (5), 406-14 PMID: 17502806