Course/Prognosis

Schizophrenia usually begins by the consumer having a "psychotic episode" (serious onset of symptoms) when they are in their 20's. Schizophrenia often begins in men a few years earlier than in women. Some people will have one psychotic episode, receive treatment (often in a hospital) and fully recover. Other people may have an episode, recover (this is called remission) and then have another episode a few months or years later (this is called exacerbation). Many consumers receiving rehabilitation services have frequent exacerbations with few remissions.

There are a number of factors that indicate that the consumer may have a poor outcome (or prognosis). If these factors are present the consumer will probably need more services, and have more impairment to many aspects of their lives (such as their ability to live independently, finding/maintaining a job, having friends). The factors related to negative prognosis are:

• Slow (called insidious) onset of symptoms (rather than symptoms occurring all at once)
• Earlier onset of symptoms (in late teens)
• Lower educational achievement
• Prior failure in treatment, or a lack of response to medications
• Men tend to have worse outcomes than women
• Never having worked or having friends or romantic relationships
• Having negative symptoms
  

People with a close relative with schizophrenia are much more likely to develop this disability. This disorder occurs in about 1% of people across all cultures and countries. The symptoms tend to be similar everywhere in the world.

Common Symptoms

Schizophrenic symptoms are currently divided into two types: Positive and Negative.

Positive symptoms are NOT positive in the sense of "good", but rather indicate an excess or distortion of normal functions. These symptoms are florid or "out there." Positive symptoms include Hallucinations, Delusions, or a Formal Thought Disorder. A Formal Thought Disorder refers to the disorganized thinking often displayed by people with schizophrenia. The person may "slip off the track" from one topic to another in a way that makes no sense (this is called derailment). They may make up strange words, or use words in ways that make no sense (often called word salad). They may move from one topic to another in a way that makes no sense (this is called loosening of associations). The person may also demonstrate Bizarre or Disorganized Behavior. Examples include difficulty performing simple activities of daily living, wearing multi-raincoats on clear hot days, or having trouble with hygiene.

Negative symptoms reflect a reduction in normal funtioning. Negative symptoms include Alogia, Affective Flattening, Anhedonia (lack of pleasure), Apathy (not interested in anything) and difficulty paying attention to anything. They may also demonstrate catatonic-like behaviors.

How others tend to view a person with Schizophrenia

Others tend to view people with schizophrenia as very "odd" or "crazy." These consumers are viewed as being different, and often somewhat scary and unpredictable. Since people with schizophrenia can be agitated or confused in stressful or over stimulated situations, they can appear threatening or violent. However, most research indicates that these consumers pose little risk of assault.

How the person tends to relate with others

People with schizophrenia tend to have a great deal of trouble with interpersonal relationships. People with more severe or chronic schizophrenia tend to have few friends; they often have never had a serious or "romantic" relationship. Since the symptoms of schizophrenia tend to be frightening, painful and difficult for family members, over time the consumer may become cut-off, or distanced from their parents and siblings. People with chronic schizophrenia may live alone, and are at risk for homelessness.