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Cited by 649Schizophrenia research and treatmentMental Health and PsychiatryBipolar Disorder and Treatment

Natural Course of Schizophrenic Disorders: A 15-Year Followup of a Dutch Incidence Cohort

Wiersma, D., Nienhuis, F. J., Slooff, C. J., Giel, R.·1998·Schizophrenia Bulletin
DOI 10.1093/oxfordjournals.schbul.a033315
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Abstract

Data are presented on the 15-year natural course of schizophrenia and other nonaffective functional psychoses in a cohort of 82 first-contact cases from a circumscribed area in the Netherlands. The subjects were suffering from functional psychosis with International Classification of Diseases-Ninth Revision (ICD-9) diagnoses 295, 297, or 298.3-9 (broad definition of schizophrenia) on entry. Standardized assessments of psychopathology, psychological impairments, negative symptomatology, social disability, and use of mental healthcare were used. The study reveals a pattern of chronicity and relapses with a high risk of suicide: Two-thirds of the subjects had at least one relapse and after each relapse 1 of 6 subjects did not remit from the episode; 1 of 10 committed suicide; and 1 of 7 had at least one episode with affective psychotic symptoms that started on average 6 years after the onset of the schizophrenic disorder. Diagnoses were reclassified in five patients, according to DSM-III-R criteria for a bipolar disorder. The predictive power--in terms of time in psychosis and in partial or full remission--of demographic, illness, and treatment variables at onset of the illness was very limited. Insidious onset and delays in mental health treatment are risk factors that predict a longer duration of first or subsequent episodes. The importance of mental health treatment in regard to outcome is probably subject to change because an early warning and intervention strategy could prevent further damage and deterioration. Our data support the need for an adequate relapse prevention program as a priority for our mental health services.

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  • Relapses may lead to reduced response to previously effective antipsychotics, potentially contributing to treatment resistance.

    “Relapses may also lead to reduced response to previously effective antipsychotics, potentially contributing to treatment resistance [10–12].”

    From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [10]

    The Results section reports that the probability of chronicity increased with successive episodes, supporting the broader concern that relapses may be followed by deterioration. But it attributes that increase to negative symptoms, not reduced response to previously effective antipsychotics; the paper does not establish the proposed treatment-resistance mechanism. Page numbers were not available in our copy. (LLM, conf=0.83)

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Research works printed but not linked: 4

  1. Eaton, W.W.; Bilker, W.; Haro, J.M.; Hen-man, H.; Mortensen, P.B.; Freeman, H.; and Burgess, P. Long-term course of hospitalization for schizophrenia: Part II. Change with passage of time. Schizophrenia Bulletin, 18(2):229-241, 1992.
  2. Engelhardt, D.M.; Rosen, B.; Feldman, J.; Engelhardt, J.A.; and Cohen, P. A 15-year follow-up of 646 schizo- phrenic outpatients. Schizophrenia Bulletin, 8(3):493- 503, 1982.
  3. Hogarty, G.E. Prevention of relapse in schizophrenia. Journal of Clinical Psychiatry, 54(Suppl. 3):18-23, 1993.
  4. Wing, J.K.; Cooper, J.E.; and Sartorius, N. The Measure- ment and Classification of Psychiatric Symptoms. Cambridge, England: Cambridge University Press, 1974.

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Authors
Wiersma, D., Nienhuis, F. J., Slooff, C. J., & Giel, R.
Affiliations
University of Groningen (NL)
Corresponding author
Wiersma, D.
ORCID
Giel, R.
Venue
Schizophrenia Bulletin
Publisher
Oxford University Press (OUP)
Published
1998-01-01
Volume
24
Issue
1
Pages
75-85
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
DOI
10.1093/oxfordjournals.schbul.a033315
OpenAlex
W2121119246
Cited by
649
References
38
Citations by year
2026: 8 · 2025: 12 · 2024: 14 · 2023: 14 · 2022: 18 · 2021: 17 · 2020: 56 · 2019: 38 · 2018: 24 · 2017: 26 · 2016: 62 · 2015: 22 · 2014: 34 · 2013: 28 · 2012: 15
FWCI
8.73
Type
journal article
Language
en
Open access
closed
Locations
  • Schizophrenia Bulletin (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
schizophrenia
MeSH terms
Suicide Prevention, Activities of Daily Living, Adolescent, Adult, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Netherlands, Psychiatric Status Rating Scales, Recurrence, Rehabilitation, Vocational, Schizophrenia, Schizophrenic Psychology, Suicide, Cohort Studies, Incidence, Disease Progression

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