Natural History of Schizophrenia Subtypes

To explore the validity of different approaches for subtyping schizophrenia, the conditions of 187 schizophrenic patients from the Chestnut Lodge follow-up study were rediagnosed with the use of classic subtype criteria. Independently collected data allowed construction of a longitudinal profile of the natural history of illness for patients who met operational criteria for paranoid (n = 78), hebephrenic (n = 26), and undifferentiated (n = 83) schizophrenia. Paranoid schizophrenia had an older age at onset, often developed rapidly in individuals with good premorbid functioning, tended to be intermittent during the first 5 years of illness, and was most associated with good outcome or recovery. Hebephrenia had an earlier age at onset, often developed insidiously, and was associated with a greater family history of psychopathology, poor premorbid functioning, and, frequently, a continuous illness with a poor long-term prognosis. While also early and insidious in onset, unlike hebephrenia, undifferentiated schizophrenia was poorly distinguished from the patients' premorbid state, associated with an early history of behavioral difficulties, and often resulted in a continuous but stable disability. We discuss implications for nosology. Although distinctive patterns were discernible, the considerable heterogeneity within subtypes calls for continued efforts to develop and explore alternate classification schemes.