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Open Access Research

Schizophrenia in real life: courses, symptoms and functioning in an Italian population

Maria Cristina Turola1*, Gloria Comellini1, Anna Galuppi2, Maria Giulia Nanni3, Emanuela Carantoni4 and Chiara Scapoli4

Author Affiliations

1 Integrated Department of Mental Health and Drug Abuse, Local Health Agency, Ferrara, Italy

2 Section of Child Neurology and Psychiatry, Children’s Hospital A. Meyer, University of Florence, Florence, Italy

3 Section of Psychiatry, University of Ferrara, Ferrara, Italy

4 Department of Biology and Evolution, University of Ferrara, Ferrara, Italy

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International Journal of Mental Health Systems 2012, 6:22  doi:10.1186/1752-4458-6-22

Published: 9 October 2012

Abstract

Background

In the general belief, schizophrenia is associated with the concepts of seriousness, incurability, dangerousness: this is incorrect. In recent decades, the interest in course studies increased and different trends emerged, not necessarily chronic, with the possibility of remission.

The plan of this research was to draw a picture of the schizophrenia syndrome in a specific geographic area, in the past and at present time: this allows to detect needs, weaknesses and strengths, for a better planning of future interventions.

Methods

The course of all cases diagnosed as schizophrenia (N = 1,759) in the period 1978–2008, was retrospectively studied in the entire population of an Italian province by observing, for a mean period of 12 years per person, age at first psychiatric consultation, number and length of admissions for both acute symptoms and residential-rehabilitation programs, number of interventions in outpatients. The cases under treatment (N = 842), were evaluated in terms of symptoms, using the Brief Psychiatric Rating Scale, and in terms of functioning, using the Personal and Social Functioning Scale.

Results

The disease course differs significantly between genders: males have an earlier age at first consultation (about 7 years earlier), higher admission rates, greater number of outpatient interventions and personal and social functioning significantly worse.

Hospitalization resulted often unnecessary: 23.1% of cases were never hospitalized and 67.2% spent less than one week per year in hospital.

A quarter of the cases meets the international criteria for remission and more than 75% are asymptomatic or mildly symptomatic; only 5.3% of cases shows severe symptoms. However, Personal and Social Functioning highlights, in about 1/3 of cases, relevant or serious problems mainly in Work and Relationships areas, whilst Aggressiveness is a serious problem only in 9%.

Conclusions

In this population, schizophrenia in real life shows great individual variability in course, symptoms and functioning: in most cases nowadays it appears a less severe and chronic disease than in the past, but further improvements are needed on disability prevention and social inclusion.

Keywords:
Schizophrenia; Course; Outcome; Hospitalization index; Remission; Personal and social functioning