Recovery in Schizophrenia: Longitudinal Course

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DESCRIPTION (provided by applicant): Recently there has been controversy concerning whether as schizophrenia patients get older there are changes in course and outcome. Some or many may recover as they begin to get older, with this involving potential reductions in symptoms and improved global functioning. If these changes occur they could be linked to biological theory about age-related declines in dopamine as people get older. The research involves a 27 year prospectively designed follow-up of a large sample of early onset schizophrenia patients and two control samples. These patients were originally assessed early in their disorder. Since their early acute phase assessment they have been studied systematically 6 times over a 20-year period. Our 20-year longitudinal data indicate the beginning of a decline in psychosis, and an improvement in the percent of schizophrenia patients showing recovery as they begin to get older. This change began at the 15 and 20-year follow-ups, and is statistically significant in some major areas (e.g., global functioning). It is still an open issue as to whether this improvement will reach a plateau, continue or even accelerate at the 27 year follow-up as the originally early onset schizophrenia patients reach 50 years, the second half of life. There has not been a systematic prospective multi-follow-up longitudinal study over a prolonged period despite the different views and the importance to theory about whether poor schizophrenia course and outcome continues or whether there is improvement or "burn out" of psychotic symptoms and complete recovery in some or many as they get older. The current application was designed to help fill this gap in our knowledge about potential changes in schizophrenia symptoms and potential recovery as they get older. This 27-year multi-follow-up will provide data on the cumulative percent of modern-day schizophrenia patients who ever show complete recovery for a period of one of more years. The focus of this proposed 27-year longitudinal study as these patients reach 50 years of age, the second half of life, will be on improvement and on the percent showing recovery as a function of increasing age. Three specific sets of hypotheses will be studied: a) hypotheses about a potential "burn out" of psychotic symptoms as schizophrenia patients begin to age, b) hypotheses about improvement and recovery in schizophrenia as they begin to get older, and c) hypotheses about a specific subtype of schizophrenia which may account for much of the improvement in course and outcome as they get older.