SCHIZOPHRENIA IN A LONGITUDINAL PERSPECTIVE clinical and neurocognitive aspects

University dissertation from Department of Clinical Sciences, Lund University

Abstract: Objective: To explore the long-term course and to study factors of potential relevance for the treatment and rehabilitation process of patients with schizophrenia and schizophrenia-like disorders. Specific issues concerned cognitive reduction, tardive dyskinesia (TD), prolactin-induced side effects, remission and lack of insight.

Method: A naturalistic multicenter study of 225 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders and treated with risperidone at study entry, of whom 166 participated in a 5 year longitudinal extension of the original study. Patients were assessed annually with respect to relevant background and clinical factors. Specific to the study is the extended use of parallel patient and clinician ratings.

Results: The setting of the main study seem to have resulted in an extremely low attrition rate and high objective drug treatment adherence. Patients were much more apt at self-rating symptoms, global illness and side-effects than expected. Having had many previous acute episodes was associated with more pronounced cognitive reduction. TD was not common, associated with an extra magnitude of cognitive slowing and appeared to be only partly drug related. High levels of prolactin could not be linked to any side effects. Remission was not attained by 40% of the patients. Remission reflected clinicians? but not patients? ratings of symptoms and was linked to social outcome but not to cognition. One third of the patients had a clinically significant lack of insight, which was associated with low premorbid IQ and with executive problems.

Conclusions: The extended use of parallel ratings by clinicians and patients, and the focus on optimizing drug treatment appear to have fostered an unusual degree of patient involvement in their own treatment and thereby excellent treatment adherence. These features can be implemented in routine clinical management as a ?small steps in the right direction? strategy. To attain cure we need a grand break-through in our understanding of the disease.