The course of schizophrenia


The course of psychoses is very different and depends on many factors, the most important of which is whether the patient takes the right medications, in appropriate doses and for an appropriate period. Initially, one should rely entirely on the physician's opinion as regards treatment.

After some time, along with increased awareness of patients, who have different experiences with prescribed drugs, the patient becomes, to some extent, an expert on his or her treatment and may suggest the best method of treatment to his/her physician.

Such an expert may also be a person close to the patient, most often parents, in particular, if such persons participate in support groups or psychoeducation of families.


One should bear in mind that compliance with recommended medication is the most important factor which prevents relapses of the disease. Persons, not adhering to recommended therapeutic programmes, reveal in a half of cases a relapse of disease within a year from the previous episode, while the risk of their hospitalisation is 5 times higher.

It appears then that taking medications in a prescribed manner reduces the risk of relapse of schizophrenia, as compared to people who do not take medications or take them irregularly (about five times) – the effectiveness of treatment is higher in comparison to the effects of treatment of chronic somatic diseases, such as peptic ulcer disease or asthma.

Types of schizophrenia courses

As it has already been mentioned above, the course of schizophrenia, but also of other psychoses, depends essentially on whether the patient properly takes medicines, as prescribed by a psychiatrist. Psychotic courses are very different but they can be grouped into the following three types. The factors, which determine the course of psychosis, are: the severity of symptoms and the incidence of relapses.

Patient with a mild course of schizophrenia (stable) The patient with a moderate course of schizophrenia (often stable) Patient with a severe course of schizophrenia (unstable)
demonstrates minor symptoms of schizophrenia during improvement (remission) or does not have them at all at that time,

has had just one or two schizophrenia episodes by the age of 45,

the patient regularly takes drugs prescribed by a psychiatrist.
the patient has had several episodes of schizophrenia by the age of 45, usually during more stressful periods of time,

the patient has had certain moderate symptoms between episodes (during remission),

there are rare periods when the patient does not take drugs or takes them irregularly.
relapses occur often, even every few months,

during remission, acute symptoms are observed which disrupt daily functioning,

the patient usually does not take prescribed medication, opposes further treatment,

the patient has other mental problems (e.g. alcohol or drug abuse) or somatic problems (other diseases such as heart or kidney condition) which make recovery more difficult.

About some 100 years ago, when Eugen Bleuler introduced the term "schizophrenia", people with unfavourable, chronic course of schizophrenia constituted the majority of patients with that type of psychosis.

It is worth knowing that...

In the last decade, the group of people with a mild or moderate course of the disease has significantly increased, whereas the number of people with severe, extremely unfavourable course of schizophrenia has significantly decreased (to about 10%). Mainly newer and better methods of treatment have brought about the qualitative change.

Periods (phases) in the course of schizophrenia

There are three major periods in the course of each schizophrenia type. These are:

  • exacerbation phase - it is a period of a significant intensification of symptoms, usually positive once. It may start suddenly or slowly – in the course of a few months or even between ten and twenty months. The sooner the symptoms are discovered, the sooner medications are administered, in result of which the person will faster pass through the period of exacerbation of schizophrenia and enter the next one – the period of stability;
  • stabilisation phase - in this period, in result of administered medications, symptoms of schizophrenia gradually decrease and the patient slowly returns to functional normality;
  • remission phase - schizophrenic symptoms are mild or none. In this period, the patient takes reduced doses of medication (maintenance treatment). During remission, there is a gradual improvement of the patient's general well-being.

Differences in the course of schizophrenia in women and men?

Differences in the course of schizophrenia in men and women are quite substantial and largely relate to differences in hormone balance, especially with neuroprotective (protecting nerve cells in the brain) effects of female sex hormones.

Women Men
older age at onset younger age at onset
better premorbid functioning worse pre-morbid functioning
fewer hospitalizations more hospitalizations
better response to antipsychotics worse responding to antipsychotic drugs
lower intensity of negative symptoms (particularly in women with schizophrenia onset at later age) higher intensity of negative symptoms
higher severity of positive and depressive symptoms lower severity of positive and depressive symptoms
bigger chances for having a child (approx. 50% of women with schizophrenia are pregnant at least once) low chance of fatherhood  (probably only 10% of men with schizophrenia become fathers)
less support from parents (relatively older parents) greater support from parents,  especially mothers (younger parents)


Naturally, all of these differences may be completely irrelevant in case of a particular person – they relate to comparison of large patient groups.

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