Natural course of schizophrenia: 2-Year follow-up study in a rural Chinese community

Abstract

Background: A number of studies have questioned whether the natural course of schizophrenia is more favourable in 'developing' than 'developed' societies and whether culture is a factor in producing a favourable course. Aims: This prospective study tests the hypothesis that the natural outcome of schizophrenia would be favourable in a Chinese rural area. Method: We investigated all patients with schizophrenia, including patients who had not received any treatment, among 149 231 rural community population in Xinjin County, Sichuan in 1994. Those patients who had never received treatment were followed up for two years. Results: Three-quarters of patients with schizophrenia who had not been treated remained symptomatic. As the duration of illness increased, the illness became more serious. The clinical outcome of the drug-treatment group was significantly better than for patients who had not received any treatment. Conclusions: The natural clinical outcome of schizophrenia in the Chinese rural community was poor, and occupational functioning of patients with schizophrenia was comparatively better. Schizophrenia itself has a specific natural course - antipsychotic drug treatment and psychosocial treatment will produce an improvement in prognosis. Declaration of interest: Funding from the China Medical Board of New York.