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Question:
At a recent preview of [A Brilliant Madness] at WGBH in Boston, inference was made that the effects/grip of schizophrenia might lessen or "plateau out" (my words) with age. Is there evidence of this, and if so, what are the studies? At what age might one expect lessening of the intensity of the disease? What variables affect its intensity? Are there genetic studies underway?

M.K.
Nahant, Massachusetts


Answered by Irving I. Gottesman, Ph.D.:
It is not merely a cop out to start out by saying that "it depends." A consensus does exist that concludes that an appreciable proportion of individuals who develop schizophrenia and are then followed for 10 to 30 years or more appear to recover from their worst periods of psychosis. Although some of my fellow researchers use the term "completely recovered," I am more realistic and can talk about social recovery. That proportion may be as high as 25% or so, quite impressive given the dire prognostication alleged to have been observed by Kraepelin early in the 20th century. One of many complications to interpreting the follow up data is that 10% to 13% of sufferers commit suicide (see C. B. Caldwell and I. I. Gottesman in the Schizophrenia Bulletin in 1990) and are lost to follow up; another is that the anonymity of homelessness claims many of the victims and they too are lost to follow up. Bleuler (the son of Eugen Bleuler who gave us the term schizophrenia in 1908) provides case histories in his 1978 book (Chapter 4) from Yale University Press that mirror the kind of recovery seen in John Nash Jr. Bleuler also suggests that the worst periods of symptom severity occur during the first 5 years; after that the patient will not get worse and may improve, given an optimal supportive environment and optimal medication.

The best studies of 30 year or more follow up come mainly from Switzerland and Germany (M. Bleuler, G. Huber, L. Ciompi) and one from Vermont; the latter is by Dr. Courtenay Harding who summarizes all the studies (1988 in the Schizophrenia Bulletin and 1992 in the British Journal of Psychiatry).

In regard to your query about genetic studies underway, they are too numerous to list. It is rare to find a single issue of the major journals without one or more reports of ongoing genetic work at various levels: genetic epidemiology, endophenotypes, gene linkage and association, gene expression, and epigenesis. Scan the following journals in particular: Molecular Psychiatry, Neuropsychiatric Genetics, American Journal of Psychiatry, Archives of General Psychiatry, and Nature Genetics.


Irving I. Gottesman


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