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Schizophr Bull. 2013 Nov;39(6):1363-72. doi: 10.1093/schbul/sbs135. Epub 2012 Nov 20.
Schizophrenia has historically been considered to be a deteriorating disease, a view reinforced by recent MRI findings of progressive brain tissue loss over the early years of illness. On the other hand, the notion that recovery from schizophrenia is possible is increasingly embraced by consumer and family groups. This review critically examines the evidence from longitudinal studies of (1) clinical outcomes, (2) MRI brain volumes, and (3) cognitive functioning. First, the evidence shows that although approximately 25% of people with schizophrenia have a poor long-term outcome, few of these show the incremental loss of function that is characteristic of neurodegenerative illnesses. Second, MRI studies demonstrate subtle developmental abnormalities at first onset of psychosis and then further decreases in brain tissue volumes; however, these latter decreases are explicable by the effects of antipsychotic medication, substance abuse, and other secondary factors. Third, while patients do show cognitive deficits compared with controls, cognitive functioning does not appear to deteriorate over time. The majority of people with schizophrenia have the potential to achieve long-term remission and functional recovery. The fact that some experience deterioration in functioning over time may reflect poor access, or adherence, to treatment, the effects of concurrent conditions, and social and financial impoverishment. Mental health professionals need to join with patients and their families in understanding that schizophrenia is not a malignant disease that inevitably deteriorates over time but rather one from which most people can achieve a substantial degree of recovery.
精神分裂症在历史上被认为是一种进行性疾病，这种观点最近得到了 MRI 发现的支持，即在疾病早期大脑组织会逐渐丧失。另一方面，精神分裂症康复是可能的观点越来越被消费者和家庭群体所接受。这篇综述批判性地评估了来自纵向研究的证据，包括（1）临床结果、（2）MRI 脑体积和（3）认知功能。首先，研究表明，尽管大约 25%的精神分裂症患者有较差的长期预后，但其中很少有人表现出与神经退行性疾病特征一致的功能逐渐丧失。其次，MRI 研究表明，在精神病发作的最初阶段存在微妙的发育异常，然后大脑组织体积进一步减少；然而，这些后期的减少可以用抗精神病药物、物质滥用和其他次要因素的影响来解释。第三，尽管患者与对照组相比表现出认知缺陷，但认知功能似乎不会随时间恶化。大多数精神分裂症患者都有实现长期缓解和功能恢复的潜力。一些人随着时间的推移出现功能恶化的事实可能反映了治疗的机会不足或不坚持、并发疾病的影响以及社会和经济贫困。心理健康专业人员需要与患者及其家属一起理解，精神分裂症不是一种恶性疾病，它不会随着时间的推移而不可避免地恶化，而是大多数人可以从中获得相当程度的康复。
