Twenty-Year Course of Schizophrenia: The Madras Longitudinal Study

Objective: To follow up 90 first-episode schizophrenia patients after 20 years and to study the course of symptomatology, work, social functioning, and pattern of illness during this period. Methods: The Present State Examination and the Psychiatric and Personal History Schedule were administered at fixed points during follow-up. The measures adopted to ensure a good follow-up rate (67%) after 20 years under adverse conditions are described. Results: Complete data were obtained from 61 subjects; 16 had died, and 13 could not be traced. After 20 years, 5 patients had recovered completely, and another 5 were continuously ill. Most of the cohort had multiple relapses with or without complete remission between them. The Global Assessment of Functioning Scale showed that symptoms and social functioning in this sample approximated results from developing countries and were much better than those of developed nations. There were not many sex differences. Marriage and occupational rates were higher than those observed in many published reports. Conclusions: This is one of the few long-term follow-up studies from the developing world. It reveals a pattern of course and functioning distinctly better than that found in many such studies from the developed nations.