Abnormal Psychology

Schizophrenia and Other Psychotic Disorders 537

psychotic symptoms, one of which was her complaint that the bones in her neck

were slipping out of place.

Active Phase

During the active phase (which is also sometimes referred to as an episode of

schizophrenia or psychotic episode), symptoms become full-blown, thereby meet-

ing the diagnostic criteria for schizophrenia. It is usually positive symptoms that

lead to the diagnosis. For up to 80% of people having a fi rst episode of schizo-

phrenia, the symptoms subside after treatment—they go into remission(Robinson

et al., 1999).

However, for some people, the symptoms persist, even with medication; these

patients are chronically ill. Approximately 60–70% of people who have had an epi-

sode of schizophrenia go on to have additional episodes (Torrey, 2001), but keep in

mind that this also means that 30–40% of people who experience one episode never

have another.

Middle-to-Late Phase

For people who continue to have active episodes of schizo-

phrenia, cognitive functioning may decline significantly

during the fi rst 5 years of the illness; also, as they remain

or become more disorganized, their ability to care for

themselves declines. For example, they may reach a point

where they cannot keep themselves properly groomed,

or even dress themselves. However, by 10 years after the

fi rst episode, these people usually stabilize and seldom be-

come worse. By 30 years after schizophrenia fi rst devel-

oped, their functioning may have improved somewhat (see

Table 12.4), particularly when some type of treatment has

been effective. In fact, most of the Genain sisters improved

(Mirsky et al., 2000). Iris and Nora were able to work

part-time as volunteers; in their 40s and beyond, these

two sisters were able to live outside of a hospital setting

(Rosenthal, 1963; Mirsky et al., 2000).

Gender Differences

Men are somewhat more likely to develop schizophrenia than are women (McGrath,

2006. and do so at an earlier age. Specifi cally, men are more likely to develop the

disorder between the ages of 18 and 25, whereas women are more likely to de-

velop the disorder later in life, between the ages of 26 and 45. Compared to men,

women usually have fewer negative symptoms of schizophrenia (Maric et al.,

in press; McGorry, 2001) and more mood symptoms (Maurer, 2001), and they are

less likely to have substance abuse problems or to exhibit suicidal or violent behav-

ior (Seeman, 2000). Moreover, women generally functioned at higher levels before

their illness developed.

Culture

Two fi ndings bear on the role of culture and schizophrenia. First, across various

countries, schizophrenia is more common among people in urban areas and lower

socioeconomic classes than among people in rural areas and higher socioeconomic

classes (Freeman, 1994; Mortensen et al., 1999), as we’ll discuss in more detail

later in this chapter. Moreover, there are ethnic differences in prevalence rates in

the United States: Blacks are twice as likely as Whites or Latinos to develop schizo-

phrenia (Dassori et al., 1995; Keith et al., 1991). These prevalence differences may

refl ect the infl uence of a variety of moderating variables, such as social class and

different rates of help seeking among the ethnic groups.

Second, people with schizophrenia in non-Western countries are generally bet-

ter able to function in their societies than are their Western counterparts; that is,

they have a better prognosis (American Psychiatric Association, 2000). We’ll discuss

Table 12.4 • 10-Year and 30-Year Course of Schizophrenia

10 Years Later 30 Years Later

Completely recovered 25% 25%

Much improved, relatively

independent

25% 35%

Improved, but requiring

extensive support network

25% 15%

Hospitalized, unimproved 15% 10%

Dead, mostly by suicide 10% 15%

Source: Torrey, 2001, p. 130.