Schizophrenia and the Phases of Recovery

by Christina Bruni Patient Expert

In one of my first SharePosts here I wrote about Optimism and Hope for Successful Treatment Outcomes, and I'll link to it at the end of this article. The criteria for remission from schizophrenia is having symptoms that are absent, minimal or negligible on the PANSS scale for six months. Yes, the timeframe is six months. I'm not pulling this statement out of a hat like a magician; it's the criteria set by the APA working group on schizophrenia.

Also: upwards of 85 percent of people diagnosed with SZ reach the stabilizing, stable and recovery phases of the illness. How do I know this? Robert Liberman, M.D., the Distinguished Professor of Psychiatry at the UCLA School of Medicine talks about this in his Ask Dr. Bob column in the spring 2011 issue of SZ magazine. I'll link to the magazine's Web site at the end so you can subscribe to it too. His current research is on recovery from schizophrenia.

A reader of the magazine wondered how long it takes for someone with SZ to get stabilized because his own doctor said it takes between four and 15 years. Before I give Dr. Bob's response I want to talk about my own take on this. I was placed on the atypical in April 2007 and within three days I noticed an improvement, yet the drug continued to work its charm two years later.

I use three years as the amount of time because in my own life in 1987 when I was placed on the Stelazine it took me three years to find my first job as an administrative assistant. In 1992, a three-month drug holiday failed. In 1997, I went back to school for a library science degree, and it wasn't until 2000-three years later-that I discovered my purpose in life and had a much better time of it.

My contention is that you should give yourself at least 10 years after your breakdown in which to see improvements. It will be no comfort to you when I say recovery is not quick and it is not easy. You need to give yourself the gift of a lifetime in which to make strides.

A diagnosis of schizophrenia isn't the end; it's the beginning of what can be a better life. So what does Dr. Bob have to say about this?

The American Psychiatric Association has defined five phases of illness severity and recovery. First up is the acute phase, marked by the onset of severe psychotic symptoms like delusions, hallucinations, incoherent speech and bizarre behavior. The use of effective medication and support in the months and years after the first episode, coupled with a person's favorable response to treatment and the reduction of symptoms, leads him into the stabilization phase.

How long it takes to shift from acute to stabilizing differs from person to person and with the quality of treatment. The lead-in time is quicker "when medications have optimal effect" and when the treatment team develops tools for illness self-management and coping techniques to reduce stressors. Family education and support and social skills training and cognitive behavior therapy (CBT) also speed the process.

The next phase is termed stable because it infers minimal or few symptoms or even absolutely no symptoms. The symptoms here do not impact a person's daily functioning. It is also when a person can entertain an active role in social and recreational activities and limited work and school involvements.

Once a person remains stable for a year or more without relapse, and resumes normal social, recreational and independent and work or school involvements, he enters the recovery phase. Recovery is marked by having no symptoms beyond those that occur occasionally to a mild degree. In recovery, work or school is possible, you can manage your money carefully, take medications and go to medical appointments without help. Here you have at least one social outing in the community with a peer who is not a relative.

Dr. Bob agrees that achieving full recovery may take up to three years, which is the time frame I alluded to at the start of this SharePost. Recovery does involve occasional relapses that when caught early can be reversed so that a person gets back to the stabilizing and recovery phases. So recovery is not a state of perfection. It's not a conditional term. You don't have to "always" be in remission and "never" have symptoms in order to be in recovery.

Recovery is a noble goal. Alas: about 15 percent of persons with SZ don't achieve the stabilization, stable and recovery phases. The attainment of daily activities and personal goals is elusive. This fifth phase of refractory schizophrenia can be treated with clozapine (Clozaril), cognitive behavior therapy, and cognitive remediation.

In the coming SharePosts, I'll talk about the types of schizophrenia and go on to detail the types of treatments for this medical condition, including a look at the drugs used to treat it and psychosocial modalities.

I'll end here by echoing the idea that most people diagnosed with schizophrenia can do well and see improvements throughout our lives.

Optimism and Hope for Successful Treatment Outcomes for Schizophrenia.

SZ Magazine is a great resource for people diagnosed with schizophrenia, their family members and loved ones, caregivers and even professionals.

Christina Bruni
Meet Our Writer
Christina Bruni

Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.