A 45-year follow-up study of adolescent schizophrenia. Part II: Age of disease onset, type of onset of the disorder and presence of developmental burden in the context of disease course and long-term social functioning of patients

OBJECTIVES: Research on predictors of adolescent schizophrenia, especially that based on long-term follow-up studies, is rare in the literature. In our analysis, we examine the relationships of the age of disease onset, type of onset of the disorder and the presence of developmental burden with clinical and social indicators of the disease course. METHODS: A total of 69 patients hospitalized at an average age of 16 years (time point 0) due to schizophrenia (retrospectively re-diagnosed according to ICD-10 criteria) and re-examined 5 years later (time point 1 - personal examination of 41 individuals) were re-evaluated for clinical and social parameters 45 years after initial hospitalization (time point 2 - personal examination of 21 individuals). Besides personal examination, other methods of data collection were also used, including hospital queries. RESULTS: The hidden type of onset of schizophrenia revealed numerous and various correlations with both the symptomatic picture and the clinical course of schizophrenia, and with distant social functioning of the subjects, translating into a classical Bleuler symptomatic picture, weaker response to treatment, and worse functioning in personal and professional life. The presence of significant separations in childhood proved to be a factor conducive to insight and less intense psychopathology in the distant course of schizophrenia. The family burden of schizophrenia correlated with the catatonic picture in the future and with more hospitalizations and earlier death. CONCLUSIONS: The hidden type of onset of schizophrenia is the most important predictor of its later course.