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The metamorphosis of schizophrenia: from chronicity to vulnerability

Published online by Cambridge University Press:  09 July 2009

Joseph Zubin ,
Jay Magaziner  and
Stuart R. Steinhauer
Joseph Zubin*
Affiliation:
Biometrics Research, Veterans Administration Medical Center, Pittsburgh, Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
Jay Magaziner
Affiliation:
Biometrics Research, Veterans Administration Medical Center, Pittsburgh, Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
Stuart R. Steinhauer
Affiliation:
Biometrics Research, Veterans Administration Medical Center, Pittsburgh, Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
*
1Address for correspondence: Dr J. Zubin, Biometrics Research, 151R, Veterans Administration Medical Center, Highland Drive, Pittsburgh, PA 15206, USA.
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Synopsis

On the evidence of long-term follow-up studies of cohorts of patients in Europe the outcome of schizophrenia appears to be changing from chronicity to an episodic course with a more favourable outlook. While the reasons for this change are unclear it is suggested that schizophrenia is characterized essentially by a state of vulnerability to the disorder. This vulnerability may or may not give rise to an episode of illness, depending on the incidence of triggering life event stressors and on the moderating influences of social networks, ecological factors, and premorbid personality. The traditional view of schizophrenia as an essentially chronic condition reflects not so much the natural history of the disorder as iatrogenic influences, lack of satisfactory extra-mural care, the accumulation of a relatively small proportion of truly chronic illnesses and the failure to recognize the termination of an episode of illness in patients with poor premorbid personalities. Evidence for the episodic nature of schizophrenia is presented.

Type
Research Article
Information
Psychological Medicine , Volume 13 , Issue 3 , August 1983 , pp. 551 - 571
Copyright
Copyright © Cambridge University Press 1983

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