Evolution of schizophrenia: symptoms and prognosis

The course of schizophrenia can be studied by considering different aspects. For example, depending on the manifestation, development and reduction of cognitive, behavioral or affective symptoms.

Likewise, and as with other psychiatric and medical diagnoses, the course of these manifestations depends on many variables. Some of these are psychological and biological susceptibility, as well as the conditions or recovery patterns the person is in.

Below, we’ll take a brief review of the research that has analyzed the course of schizophrenia, focusing specifically on symptoms from the cognitive dimension.

    Schizophrenia course and prognosis

    The term “schizophrenia” refers to a psychiatric classification, and is generally defined as a chronic and severe disorder that affects the way people think, feel and act. It is one of the less common mental disorders, although more representative of psychiatry.

    As the definition above explains, schizophrenia develops in both a behavioral dimension (the way we act) and an emotional dimension (the way we feel). and another cognitive (In thought). The latter is, in fact, one of the most representative dimensions of the diagnosis.

    This is because many people with schizophrenia hear or see things that others cannot. These things can be threatening, but not necessarily.

    Depending on how they are presented and how they are received by other people, the development and evolution of cognitive type manifestations can be an obstacle for the person to develop their daily activities and interactions on a regular basis.

    The above it largely depends on individual development and medical history, As well as the treatment options available to the person and their family. Therefore, one of the most relevant questions for the scientific community has been the study of the evolution of these manifestations and the variables involved in them.

      How do cognitive manifestations develop?

      In a review of 30 longitudinal (i.e. time-consuming) studies on the evolution of cognitive symptoms in schizophrenia, Ojeda et al. (2007) report that cognition is significantly altered from baseline.

      They also report that the deterioration increases gradually and especially in institutionalized patients, And no cases have been reported reaching the cognitive impairment degree of neurodegenerative disorders.

      We will see some details about these studies, from the onset of the first psychotic episodes to long-lasting schizophrenia.

      1. In the first psychotic episodes

      Studies carried out since the first psychotic episodes confirm the presence of cognitive impairment in the early stages of schizophrenia development.

      However, the same studies suggest that after performing attention tasks, verbal fluency, psychomotor skills, and visual and verbal memory; this deficit tends to improve markedly in the first year. The latter has been associated with stabilizing positive symptoms during the first twelve months.

      In other studies conducted at the beginning of the 2 and 5 years of the disease, the stability of symptoms is also reported. They also report stability in language and visual memory tasks, And a noticeable improvement in others, such as conceptual tasks and attention / concentration.

      However, other studies that also followed the first two years report little improvement or even slight deterioration in visuospatial reasoning and processing speed. On the other hand, longer explorations suggest that the evolution of cognitive manifestations shows general stability in the early years, although a gradual deterioration towards later periods.

      2. In long-term schizophrenia

      The first studies on long-term or chronic schizophrenia, carried out since the 1960s, had reported a general stability of performance, with a slight deterioration in the dimension of language. The latter was debated later, as it was not known whether this deterioration was due to schizophrenia or was caused by the natural process of aging.

      In general, subsequent studies confirm the stability of cognitive symptoms during schizophrenia, although in some cases significant improvements and in others deterioration is reported. In the latter, one of the important variables was institutionalization, because many people were in long-term hospitalization.

      In fact, since the latter has increased interest in knowing the differentiation between the course of schizophrenia and other clinical pictures. It has also increased scientific analysis of variables involved in the stability, improvement or deterioration of cognitive functions in people with schizophrenia. Schizophrenia has recently been linked to the development of dementia, Especially in hospitalized geriatric patients.

      Bibliographical references:

      • National Institute of Mental Health (2015). Schizophrenia. Accessed October 11, 2018.Available at https://www.nimh.nih.gov/health/publications/espanol/la-esquizofrenia/index.shtml.
      • Ojeda, N., Sánchez, P., Elizagárate, E., Yoller, AB, Ezcurra, J., Ramírez, I. and Ballesteros, J. (2007). Evolution of cognitive symptoms in schizophrenia: a review of the literature. Spanish acts in psychiatry, 35 (4): 253-270.

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