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Study shows 'alarming' long-term declines in schizophrenia functioning

Functioning scores decreased among individuals who received inpatient treatment for psychosis 20 years after discharge, particularly among those with schizophrenia or schizoaffective disorder.

“Emil Kraepelin considered declining course a distinguishing feature of schizophrenia (dementia praecox) in contrast to the nondeclining, episodic course of mood disorders with psychosis. Others have challenged this view, suggesting that a downward trajectory is not typical of schizophrenia and that outcomes tend to improve over time,” Roman Kotov, PhD, of Stony Brook University, New York, and colleagues wrote.

To test Kraepelin’s theory, researchers assessed first-admission patients with psychosis from all inpatient units of Suffolk County, New York. Study participants were evaluated six times over 20 years (n = 373). Month 6, when the majority of the cohort was discharged, was used as a reference.

Overall, 175 participants had schizophrenia or schizoaffective disorder.

Mean Global Assessment of Functioning (GAF) scores decreased from 49 at month 6 to 36 at year 20 among participants with schizophrenia.

GAF scores were initially higher among participants without schizophrenia, but decreased by 9 points during follow-up.

Worsening began between year 5 and 8, according to researchers.

Declines were not accounted for by aging or changes in antipsychotic treatment.

Among all disorders, depression improved and mania symptoms remained low during the 20-year follow-up.

“Our results suggest an alarming public health problem, namely, a high symptom burden in psychotic disorders that increases with time and ultimately may undo initial treatment gains. Previous studies have suggested that better care may preempt this decline,” the researchers wrote. “In the United States, psychotic disorders are associated with a large unmet need for care, and the present study highlights this shortcoming as an urgent priority. Reasons for the decline are unclear, and numerous explanations are possible. Greater research attention to the middle and late course of psychotic disorders is needed to identify factors that drive this decline, as it unfolds, and to inform the field on how to preempt it.” – by Amanda Oldt

Disclosure: Kotov reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.