Lifetime prognosis of schizophrenia: extended observation (more than 40 years) of 129 patients with typical schizophrenia

Abstract

AbstractBackground: The excess mortality among patients with schizophrenia has been documented by epidemiological studies. These studies have shown that suicide accounts for most of this mortality. In contrast, the natural deaths of patients with schizophrenia have been commonly related to cardiovascular disease in these studies.Methods: In this study, the clinical features of 129 patients with typical schizophrenia were examined in order to study the lifetime prognosis of patients with schizophrenia in Japan. These patients had their first visit to Kawagoe Dojinkai Hospital in 1963 and had been continuously observed for over 40 years.Results: As at January 2003, the status of these 129 patients was categorized as follows: 27 patients were inpatients (mean age was 72.9 years), 20 patients were outpatients (mean age was 68.8 years), 2 patients were outpatients of another hospital, 20 patients had been admitted into nursing homes, 53 patients had passed away and 7 patients were missing. Clinical features were recorded for 44 (23 male patients with a mean age of 68.6 years and 21 female patients with a mean age of 64.2 years) out of the 53 patients who had passed away. The causes of death consisted of malignancy (13 cases), pneumonia (eight cases), heart failure (five cases), cerebral infarction (three cases), diabetes mellitus (three cases), cardiac infarction (two cases), ileus (two cases), asphyxia (one case), liver cirrhosis (one case), gastric ulcer (one case), heat stroke (one case), homicide (one case) and suicide (three cases). Two patients were discovered to have passed away alone at home.Conclusion: The mean age of death was found to be lower than the life expectancy. However, only three patients committed suicide. These findings suggest that patients with schizophrenia may possess some biological vulnerability. Further study is needed to evaluate the effects of long‐term antipsychotic medication. Clinically, medical checks for malignancy and care services for elderly patients are needed. Furthermore, in order to prevent future occurrences of patients dying alone in their own home, a social support system should be established.