Medium-term course and outcome of schizophrenia depicted by the sixth-month subtype after an acute episode

Background/PurposeThe intermediate course of schizophrenia is a complex intertwined with the heterogeneity of the illness. This article attempts to simplify this complexity using a hypothetical tripartite based on the profile of symptoms at 6 months after acute treatment.MethodsThis is a prospective 5-year follow-up study including 163 schizophrenic inpatients in northern Taiwan comparing patients' demographic data at index admission, scores on the Positive and Negative Syndrome Scale (PANSS) for schizophrenia and social function scale measured at admission, 6-month follow-up, and annually, and scores on a neuropsychologic test battery measured approximately 5 years after recruitment.ResultsPatients were grouped into three subtypes based on their sixth-month symptomatology by Generalized Association Plots, designated as remitted (RM), persistent delusion/hallucination (PDH), and markedly blunting (MB) groups. These three subtypes presented with similar positive symptom profiles at recruitment, yet during follow-up, the PDH group tended to maintain the highest risk of having worse clinical symptomatology, social functioning, and neuropsychologic functioning, and the RM was the best outcome group.ConclusionThis three-subtype model provides a practical reference to predict medium-term outcomes by the subject's response to acute treatment and serves as a model to sort out part of the heterogeneous nature of schizophrenia that still should be examined by further psychopharmacological, neurobiological, and genetic studies.