Schizophrenia: encouraging outlook emerges.

Mental health workers have long viewed schizophrenia as a severe mental illness that usually gets worse over time. But new evidence gathered in three countries suggests that people diagnosed with schizophrenia tend to experience "progressive amelioration" over the two decades following their first admission to a psychiatric hospital.

"'Amelioration' doesn't mean 'cure,' but the data challenge widespread pessimism about the course of schizophrenia," contends psychiatrist William W. Eaton of Johns Hopkins University in Baltimore, who directed the international research effort. "A major implication is that long-term treatment for schizophrenia, which is often not available, may be worth the effort."

The findings generally support a 30-year study of schizophrenic patients in Vermont, in which more than half eventually showed substantial improvement (SN: 6/1/85, p.340).

Schizophrenia involves a perplexing fragmentation of thought and emotion. Psychotic symptoms, such as bizarre delusions and hallucinations, overlie more pervasive "deficit" symptoms, including an inability to deal with others or hold down a job, deadened emotions, and incoherent thoughts. Psychiatrists divide the disorder into several types, based on the mix of symptoms.

An estimated 1 percent of the world's population develops schizophrenia. The disorder usually first appears in adolescence or young adulthood.

Eaton and his associates examined data collected at all psychiatric facilities in the Australian state of Victoria, England's Salford Metropolitan District, and Denmark. The researchers identified a total of 1,850 schizophrenics tracked for 16 to 20 years following an initial stay in a psychiatric hospital.

Return admissions to a hospital for psychiatric treatment clustered in the four or five years after a participant's first hospital stay, Eaton's team reports in the current SCHIZOPHRENIA BULLETIN (volume 18, number 2). A statistical analysis of the data indicates that each additional admission to a psychiatric hospital among this population of schizophrenics lowered the risk of a further hospitalization by about 10 percent.

Between 50 percent and 80 percent of the sample, depending on the country of origin, returned to the hospital at least once during the follow-up period.

Analysis of a larger group of schizophrenic patients from these three countries-combined with data from a seven-and-a-half-year study of 13,870 first-admission schizophrenics in Maryland--indicates that those who develop this mental illness in their teens stand the greatest chance of requiring multiple hospital stays. Although clinicians often assign a particularly bleak outlook to single men with schizophrenia, neither gender nor marital status substantially affected the risk of rehospitalization when the researchers statistically controlled for the participants' age at first hospitalization.

Uncertainty still clouds long-term predictions concerning schizophrenia. For instance, another research group recently reported that patients with severe deficit symptoms, but not necessarily an early age of onset, fared most poorly over two decades (SN: 3/21/92, p.181).

And the Vermont study finds that among individuals followed for 30 years or more after a first admission for schizophrenia, early age of onset "washes out" as a risk factor, asserts psychologist Courtenay M. Harding of Yale University School of Medicine in New Haven, Conn., who directs that ongoing project.

Harding also suspects that schizophrenia may proceed differently in men and women, despite the findings of Eaton's group. Preliminary evidence suggests that estrogen may partially block the transmission of dopamine, a chemical messenger in the brain widely thought to play a key role in schizophrenia, Harding says. This may explain why schizophrenia often appears later among women, she maintains.

As a result of estrogen's influence, women may need especially low doses of standard antipsychotic drugs, which also interfere with dopamine transmission, Harding argues.

Still, she welcomes the finding of "progressive amelioration" among schizophrenics in Eaton's international study. Harding's team now plans to pursue the theory that an as yet unknown brain mechanism gradually works toward recovery in many cases of schizophrenia.

"The notion of 'once a broken brain, always a broken brain' may not be true," Harding contends.