Original article
Long-term evaluation of mental status in schizophrenic patients after a first psychiatric hospitalization according to symptomatic remission criteria

Background: The aim of the study was to assess the psychopathological status among first episode schizophrenic patients at 7-11 years after their first psychiatric hospitalisation and to analyse retrospectively severity of symptoms in remitted (R) and non-remitted (NR) patients.

Material and methods: Sixty-four patients hospitalised for the first time in the period 1998-2002 were enrolled. They were assessed 1 month following the hospitalization (Time 1), 12 months later, 4-6 years after Time 1, and 7-11 years after Time 1. The overall mean follow-up was 8.1 years.

Results: Of the 64 patients 55% achieved remission at Time 1, 50% at Time 2, 36% at Time 3, and 34% at Time 4. At Times 1 and 4 negative symptoms were the most frequently observed. The retrospective analysis showed that patients who achieved remission at Time 4 had significantly better PANSS (Positive and Negative Syndrome Scale) than NR over the observation (p < 0.001).

In the R group the PANSS did not change between Times 1 and 4, but in the NR group a significant increase was noted. Duration of untreated psychosis (DUP) was found to significantly differentiate the R and NR patients (p = 0.01).

Conclusions: 1. At an average of 8 years after the first hospitalisation 2/3 of the patients did not achieve remission. 2. The percentage of patients who failed to achieve remission increased significantly during the first decade of the disease. 3. More severe symptoms in the early stage of the disease and longer DUP seem to determine significantly the unfavourable course and long-term treatment outcome of schizophrenia.