THE NATURAL HISTORY OF THE REMITTING SCHIZOPHRENIAS
GEORGE E. VAILLANT M.D.1
1 Dept. of Psychiatry, Harvard Medical School, and Massachusetts Mental Health Center, Boston, Mass.
The lifetime clinical histories of 12 remitting schizophrenics, whose lives spanned up to 85 years, are reviewed. Such fully remitting schizoprenics constitute the 10%-15% best outcomes of an unselected schizophrenic population. After first admission 8 led independent, useful lives for 25 years or more.
The clinical course of these 12 patients could be grouped into 3 patterns: i) those who remained well without further hospitalization, ii) those who were readmitted to a hospital but with a diagnosis of manic-depressive psychosis and with no reappearance of their previous schizophrenic thought disorder, iii) those who relapsed— often many years later-and remained chronically hospitalized. Six other patients are reported who fitted the syndrome of schizophrenic thought disorder, recovery, manicdepressive psychosis, and recovery.
On first admission all 12 of these patients could have been predicted to have done well; all showed "reactive" features. Longterm follow-up of these patients, however, revealed that at some time during their lives 75% were again hospitalized for psychosis. Thus, there seems no justification separating remitting schizophrenics from the broader classification of " the group of schizophrenias."
The findings of this study suggest that acute schizo-affective psychosis, as defined by Kasanin, is a more appropriate diagnosis for patients who recover from schizophrenic thought disorder than terms like adolescent turmoil, schizophreniform state, or reactive psychosis.
