Prognosis: What to Expect Next

The way a health condition progresses over time is called its prognosis. Each person’s schizophrenia prognosis will be different. There is no single path that symptoms take. Some people may have minimal symptoms and function well on their own. Others will have severe symptoms that affect every part of their life. These people may need to live somewhere they will have residential support, or they may need to be hospitalized sometimes.^1-3

Common courses of schizophrenia

There are some common terms for describing the way schizophrenia presents and progresses. Symptom onset can be abrupt (fast) or insidious (creep in over a longer period). Symptoms can also be continuous (nonstop) or intermittent (only occurring occasionally). Outcomes are individualized. If current prognosis is poor, then recommendations to support improvement in prognosis will be made.^1,2

Most people have an abrupt onset of intermittent symptoms. After this, they have only occasional issues. They may even go into remission. Remission means having only minimal or mild symptoms that do not affect daily functioning for at least 6 months.^1,2

Experts estimate that about 1 in 5 people have insidious, continuous symptoms that lead to poor outcomes. But as many as half of all people with schizophrenia are classified as having good outcomes. Their symptoms are manageable. They are able to work, and they can function well.¹

Bigger changes in functioning tend to happen earlier in the course of schizophrenia. Some people may not return to their original baseline, or daily functioning. Larger changes in functioning can continue to occur after episodes of psychosis.^1,3-5

Acute psychosis involves having severe symptoms including hallucinations or delusions. People in acute psychosis lose touch with reality to some degree. They may need to be hospitalized for a while if they are not safe at home.^1,3-5

Factors that affect outcome

It can be hard to predict how each person will progress. But there are a few factors linked with an increased risk for worse outcomes. They include:^1,4

• Having a slower onset of symptoms
• Being diagnosed as a child or young adolescent
• Having issues with thinking, memory, and information processing (cognition)
• Going a long time after symptoms or psychosis begins before starting treatment
• Experiencing major stress, like trauma, grief, or poverty
• Using recreational drugs, alcohol, or other substances
• Having many long-lasting “negative” symptoms, including lack of motivation, inability to express emotions, and social avoidance

On the other hand, there are factors that point toward a greater chance for better outcomes. These include:^1,4

• Being female
• Having a faster onset of symptoms
• Being treated by a healthcare team with many members and approaches (multidisciplinary team)
• Starting treatment quickly after symptoms or psychosis begin
• Taking all treatments and drugs as prescribed

Treatment-resistant schizophrenia

Antipsychotic drugs are the main treatment for schizophrenia. But some people do not respond to antipsychotic drugs. Others respond somewhat, but not enough to control symptoms well.^1,4

If a person has tried 2 or more antipsychotic drugs with good treatment adherence for at least 6 weeks each and had no improvement, they have treatment-resistant schizophrenia. About 30 to 40 percent of people with schizophrenia are resistant to treatment.^1,4

In the past, treatment options for these people were invasive. They included hospitalization and living in a treatment facility (residential treatment). Sometimes, they included taking multiple antipsychotic drugs at once.^4,5

Another option was electroconvulsive therapy (ECT). ECT involves giving electrical stimulation to the brain to cause small seizures. ECT has to be done in a hospital setting and supervised closely. Typically ECT is a same-day procedure. The patient goes to the hospital in the morning and returns home later that day.^4,5

However, a newer antipsychotic drug called clozapine has shown some success for treatment-resistant schizophrenia. It has side effects that require regular blood tests. But it might help prevent people from having to seek more invasive therapy.^1,4

Complications and comorbidities of schizophrenia

Schizophrenia and its treatment can increase the risk of developing other problems in the future. These issues are called complications. Common complications of schizophrenia include:^1,4-6

• Increased drug or alcohol use
• Relationship problems
• Trouble keeping a job
• Financial challenges
• Sexual dysfunction
• Risky sexual behavior
• Medication side effects like movement symptoms, increased infection risk, and weight gain

There are also other health conditions that can occur alongside schizophrenia. When two health conditions exist at the same time, they are called comorbid conditions or comorbidities. Some of these conditions can shorten life expectancy.^1,6

Common comorbidities of schizophrenia include:^1,4,5

• Other mental health conditions, like depression, anxiety, and obsessive-compulsive disorder (OCD)
• Substance use disorder
• Diabetes
• Cardiovascular disease, including heart disease, high blood pressure, and stroke
• Neurological issues, like dementia

Some complications lead to comorbidities. For example, risky sexual behavior can increase the risk for sexually transmitted infections (STIs). An STI would then be a comorbidity of schizophrenia.⁷

Checking in with your doctor regularly can help you manage these issues. They can advise you on your risk factors and how to avoid developing new complications and comorbidities. They also will monitor you for new health conditions and address them as soon as possible.

Life expectancy with schizophrenia

Schizophrenia itself is not thought to shorten the lifespan. But its complications and comorbidities can. For example, factors that can shorten life expectancy include:^1,5

• Heart disease
• Diabetes
• High blood pressure
• An inactive lifestyle

The most common cause of early death in schizophrenia is suicide. As many as 2 out of every 3 people with schizophrenia have thoughts of harming themselves. This is called suicidal ideation. Experts estimate that 1 in every 10 to 20 people with schizophrenia will complete suicide.^1,4,5

Sticking to a medication plan decreases a person’s risk of suicide. Treatment with clozapine may be especially helpful in reducing suicide risk.^1,4,5

If you are having thoughts of harming or killing yourself or others, seek help right awa. Call or text the Suicide and Crisis Lifeline at 988. Counselors are available any time, day or night.⁸