Long-Term Course
The intensity of psychosis tends to diminish with
age. Many clients with long-term impairment regain
some degree of social and occupational functioning.
Over time, the disease becomes less disruptive to the
person’s life and easier to manage, but rarely can the
client overcome the effects of many years of dysfunc-
tion (Buchanan & Carpenter, 2000). In later life,
these clients may live independently or in a struc-
tured, family-type setting and may succeed at jobs
with stable expectations and a supportive work envi-
ronment. Kruger (2000) found that, over the very
long term of 2 to 4 decades, the symptoms of people
with schizophrenia abated and improved; their func-
tional abilities increased as well.
Antipsychotic medications play a crucial role in
the course of the disease and individual outcomes.
They do not cure the disorder; however, they are cru-
cial to its successful management. The more effective
the client’s response and adherence to his or her med-
ication regimen, the better is the client’s outcome.
Larsen et al. (2001) found that early detection and ag-
gressive treatment of the first psychotic episode are
associated with improved outcomes.
RELATED DISORDERS
Other disorders are related to but distinguished from
schizophrenia in terms of presenting symptoms and
the duration or magnitude of impairment. The DSM-
IV-TR (APA, 2000) categorizes these disorders as:
- Schizophreniform disorder:The client ex-
hibits the symptoms of schizophrenia but for
less than the 6 months necessary to meet the
diagnostic criteria for schizophrenia. Social
or occupational functioning may or may not
be impaired. - Schizoaffective disorder:The client exhibits
the symptoms of psychosis and, at the same
time, all the features of a mood disorder,
either depression or mania. - Delusional disorder:The client has one
or more nonbizarre delusions—that is,
the focus of the delusion is believable.
Psychosocial functioning is not markedly
impaired, and behavior is not obviously
odd or bizarre. - Brief psychotic disorder:The client experi-
ences the sudden onset of at least one psy-
chotic symptom, such as delusions, halluci-
nations, or disorganized speech or behavior,
which lasts from 1 day to 1 month. The
episode may or may not have an identifiable
stressor or may follow childbirth.- Shared psychotic disorder (folie à deux):Two
people share a similar delusion. The person
with this diagnosis develops this delusion in
the context of a close relationship with some-
one who has psychotic delusions.
Two other diagnoses, schizoid personality disorder and
schizotypal personality disorder, are not psychotic
disorders and should not be confused with schizo-
phrenia even though the names sound similar.
These two diagnoses are covered in Chapter 16, Per-
sonality Disorders.
- Shared psychotic disorder (folie à deux):Two
ETIOLOGY
Whether or not schizophrenia is an organic disease
with underlying physical brain pathology has been
an important question for researchers and clinicians
for as long as they have studied the illness. In the
first half of the 20th century, studies focused on try-
ing to find a particular pathologic structure associ-
ated with the disease, largely through autopsy. Such
a site was not discovered. In the 1950s and 1960s, the
emphasis shifted to examination of psychological and
social causes. Interpersonal theorists suggested that
schizophrenia resulted from dysfunctional relation-
ships in early life and adolescence. None of the inter-
personal theories has been proven, and newer sci-
entific studies are finding more evidence to support
neurologic/neurochemical causes. However some ther-
apists still believe that schizophrenia results from
dysfunctional parenting or family dynamics. For par-
ents or family members of persons diagnosed with
schizophrenia, such beliefs cause agony over what
they did “wrong” or what they could have done to help
prevent it (Torrey, 1995).
Newer scientific studies began to demonstrate
that schizophrenia results from a type of brain dys-
function. In the 1970s, studies began to focus on
possible neurochemical causes, which remain the
primary focus of research and theory today. These
neurochemical/neurologic theories are supported
by the effects of antipsychotic medications, which help
to control psychotic symptoms, and neuroimaging
tools such as computed tomography (CT), which have
shown that the brains of people with schizophrenia
differ in structure and function from the brains of
control subjects.Biologic Theories
The biologic theories of schizophrenia focus on genetic
factors, neuroanatomic and neurochemical factors
(structure and function of the brain), and immuno-
virology (the body’s response to exposure to a virus).14 SCHIZOPHRENIA 299