
Key message: Schizophrenia is a progressive and recurring disease characterized by multiple psychotic relapses. Following a relapse, patients often fail to recover to baseline health and this may lead to functional decline
Background
The majority of patients with schizophrenia experience recurring psychotic relapses. Clinical deterioration may occur in the context of these relapses, meaning that patients may not recover from subsequent psychotic episodes as quickly or as fully as they did from previous episodes, and they may also experience greater degrees of residual symptomology and disability
The process of relapse, treatment failure, and incomplete recovery leads to a debilitating, chronic course of illness in many patients, and to persistent disturbances and deficits in perceptions, thought processes, and cognition
Patients accumulate morbidity in the form of residual or persistent symptoms and functional decline compared with their premorbid status. The process of accruing morbidity in the context of exacerbations and (relative) remissions has been attributed to progression of the illness and described as “clinical deterioration”
Although the majority of patients with schizophrenia exhibit a severe pattern of deterioration, different degrees and different temporal sequences do occur. Despite these variations, the deterioration process predominantly occurs during the early phases of the illness (prepsychotic prodromal period and during the first 5–10 years after the initial episode)