Lifelong course of positive and negative symptoms in chronically institutionalized patients with schizophrenia.
BACKGROUND
Despite widespread policies of deinstitutionalization, a substantial number of patients with schizophrenia require continuous custodial care. The hospital records of such patients provide contemporaneous documentation of symptoms throughout the illness, permitting a longitudinal study of the course of symptoms. We sought to describe this course, and to determine the influences of sex, age of onset, and treatment on its evolution.


METHODS
Using the modified Diagnostic Evaluation After Death, we performed standardized chart reviews of 99 chronic inpatients who remained in state institutions through the 1960's and 1970's and subsequently died in those institutions. Data were available from the onset of illness until death.


RESULTS
We found significant decreases in positive symptoms and increases in negative symptoms over the course of the illness. Symptom patterns were analyzed by repeated measures ANOVA. Onset before age 25 was associated with greater numbers of negative symptoms at a given age (p = 0.05). Female sex was associated with greater numbers of positive symptoms (p=0.04). The widespread introduction of neuroleptic drugs in the mid-1950's did not affect the trends in symptom patterns.


CONCLUSIONS
The lifetime course of schizophrenia in chronically institutionalized individuals is characterized by a decrease in positive symptoms and an increase in negative symptoms. Schizophrenia with earlier onset is associated with greater numbers of negative symptoms throughout life. In this sample of patients, chronically hospitalized until death, neuroleptic drugs failed to effect a persistent decrease in positive symptoms.
Mancevski
Branislav
B
Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
Keilp
John
J
Kurzon
Matthew
M
Berman
Robert M
RM
Ortakov
Vladimir
V
Harkavy-Friedman
Jill
J
Rosoklija
Gorazd
G
Dwork
Andrew J
AJ
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003482:Custodial Care; D003702:Delusions / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D007326:Institutionalization; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy; D012565:Schizophrenic Psychology; D012737:Sex Factors
D014150:Antipsychotic Agents