Long-Term Schizophrenia: Degeneration vs Regeneration

The prognosis in schizophrenia has been colored by a number of findings.

  1. Symptomatic-In the natural history of schizophrenia, the patients become more withdrawn and they seem to be more refractory to any kind of intervention. An example of this is the “Tenure Man,” who appeared to be more fixed in his symptoms and behavior than he had been when first observed by Paul, ten years previously.
  2. Atrophy of the brain: over a period of several years or decades, there is a progressive thinning of the brain in those individuals, who have not recovered.
  3. Negative Symptom individuals, in particular, show a decline of as much as two standard deviations below normal on neurocognitive tests. With all of this, it would seem to indicate that these individuals would be refractory to psychosocial interventions; however, we have observed improvement in individual cases. For example, the “Tenure Man,” but more compelling is a recent finding that individuals with the longest standing course of schizophrenia start to show a significant improvement, over the control group, during the follow-up period. This would seem to show that psychotherapy can have a delayed effect on these individuals, which may not show up for 18-24 months. Keith can send you the details on this.

Textbooks of psychiatry, in general, portray chronic schizophrenia as a deteriorating disorder; however, our clinical experience and our randomized controlled trial suggest that with Recovery-Oriented Cognitive Therapy, these individuals can become rejuvenated. I would like to know what has happened to the brain in these rejuvenated individuals. Is it possible that new gray matter, especially, in the synapses has occurred?