Relapsing versus non relapsing course of schizophrenia: a cohort study in a community based mental health service.

Schizophrenia still remains a severe, disabling and costly disease for the individuals affected, their families and for mental health services (Knapp et al., 2004). The outcome is heterogeneous, the prognosis appears devastating for about 25% and poor, with an undulating course, for half of the patients (Modestin et al., 2003). Therefore, predicting the prognostic trajectories of the disease at the individual level, is a critical point for implementing proper interventions and optimizing the resources of mental health services. Several predictors have been identified, but a large portion of general variance of outcome remains unexplained. Among others: illness characteristics (Dickerson et al., 1996; Norman et al., 1999), environment (Butzlaff & Hooley, 1998), correct and effective treatment options, mental health services orientation and commitment (Ruggeri et al., 2003), compliance to intervention (Gaebel, 2004) and treatment and social support (Harding & Keller, 1998; Bromet & Fennig, 1999) should be remembered. Relapses and hospitalizations are outcome measures widely used in clinical research even though they are not strongly associated with symptom severity and prognosis (Mueser et al., 1998). Additional indicators of outcome are: satisfaction with daily occupations and quality of life (Eklund et al., 2001), the number of beds available in the area and the possibility to refer the patient discharged from hospital to community care for further care (Sytema et al., 2002). It should be noted, in fact, that Wykes et al. (1998) provided evidence that intensive community services are able to reduce hospital admission, even though the impact in measures of disability and symptoms is negligible. Whatever the outcome, assessed in terms of relapses and/or re-hospitalization, it is a largely unexplored issue in countries where mental health services are strongly committed to community care.