‘I disagree with the comment about bipolar and schizophrenia being chronic, remitting etc. There are a minority who are so badly affected that they never live independently, but the majority go on to either recover, or manage their illness very well, working, hobbies etc and have a good quality of life.’
The point I was making about the chronicity of schizophrenia/bipolar disorders is that in the film ‘Ruth’ is presented to us has having recovered from her mental health crisis with no mention of follow up. For anyone who doesn’t know, it’s often common practice in healthcare for a patient to be seen by a doctor on at least a short term basis after a problem has resolved as there may be a chance of it coming back, and psychiatry is no exception to this. We know from the film that she already has a diagnosis of BPAD and so she must have had trouble before. The episode presented to us is quite severe, so I would say that her chance of having another relapse is high, especially with bipolar disease
Schizophrenia is considered to have a wide variety in outcomes, that said, there are not millions of long term studies; here are the ones mentioned in the Shorter Oxford Textbook of Psychiatry:
Kraeplin Dementia praecox and paraphrenia 1919
Concluded that only 17% of his patients were socially well adjusted many years later
Mayer-Gross Die Schizophrenie in Bumke’s Handbuch der Geisteskrankheiten Vol 9 Springer Berlin 1932
Reported social recovery in 30% patients at 16 years all from the same clinic
Brown et al (1966) reported social recovery in 56% in Schizophrenia and social care Maudsley Monography 17 Oxford University Press London
Manfred Bleuler (1972,1974) followed up 208 patients who had been admitted into hospital in Switzerland between 1942 and 1943. Twenty years after admission 20% had complete remission of symptoms and 24% were severely disturbed.
Ciompi did a larger study looking at 1642 records diagnosed as having schizophrenia between 1900 and 1962, with an average follow up of 37 years. A third of patient were found to have good or fair social outcome. Symptoms were often less severe in later life.
Johnstone E.C. (1991) Disabilities and Circumstances in Schizophrenic patients: A follow up study British Journal of Psychiatry 159 supplement 13 5-46, did a 3-13 year follow up of patients with schizophrenia discharged from 1975 – 1985 and found that almost half had a good social outcome.
Tsoi and Wong (1991) A fifteen year follow up of Chinese Schizophrenic patients Acta Psychiatrica Scandinavica 84 217-220 did a 15 year follow up of 330 patients with first admission Schizophrenia and in this found that almost one third recovered but 17% remained unable to function outside the hospital.
Finally in the USA Carone et al (1991 – a busy year) found that only 15% of patients meeting DSM-III criteria for schizophrenia recovered after 5 years.
Full admission: I haven’t read any of these papers/books, and for these papers to be comparable then they should all use similar definitions for schizophrenia and select similar patients – there would be no utility is comparing patients after their first admission and patients who have been admitted countless times. With these caveats, it appears that prognosis has improved since schizophrenia was first studied. In the earlier studies the patients would have had no access to modern pharmaceutical treatments
The factors associated with good prognosis in Schizophrenia:
Sudden onset; Short episode;No previous psychiatric history; Prominent affective symptoms; Paranoid type of illness; Older age of onset; Married; No personality disorder; Employed; Good social support; Good compliance with treatment
Poor prognosis is associated with:
Insidious onset; Long episode;Previous psychiatric history; Negative symptoms; Enlarged lateral ventricles; Male gender; Younger age of onset; Single/separated/widowed/divorced; Personality disorder; Poor work record; Social isolation; Poor complicance with treatment
The average length of a manic episode (treated or untreated) is six months
At least 90% of patients with mania experience further episodes of mood disturbance
Over a 25 year follow up on average bipolar patients experience 10 further episodes of mood disturbance
The interval between episodes becomes progressively shorter with both age and the number of episodes
Nearly all bipolar patients recover from acute episodes, but less than 20% of patients with this disorder achieve a period of 5 years of clinical stability with good social and occupational peformance
It is estimated that 10% of patient with unipolar depression will eventually turn out to have a bipolar illness.
So, with both bipolar affective disorder and schizophrenia, I do think that if a patient has one episode they are likely to be troubled by the illness at a later date and this is what I meant by a chronic condition.