title: Lifelong course of positive and negative symptoms in chronically institutionalized patients with schizophrenia.
abstract: 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.
authors.affiliation: Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Branislav
authors.initials: B
authors.lastname: Mancevski
authors.forename: John
authors.initials: J
authors.lastname: Keilp
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurzon
authors.forename: Robert M
authors.initials: RM
authors.lastname: Berman
authors.forename: Vladimir
authors.initials: V
authors.lastname: Ortakov
authors.forename: Jill
authors.initials: J
authors.lastname: Harkavy-Friedman
authors.forename: Gorazd
authors.initials: G
authors.lastname: Rosoklija
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Dwork
mesh_terms: 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
chemical_list: D014150:Antipsychotic Agents