Why are the outcomes in patients with schizophrenia so poor?

Despite many advances in the treatment of schizophrenia over the past 50 years, the outcomes for many patients with schizophrenia remain poor. While the majority of patients with a first episode of schizophrenia may be able to achieve and maintain a remission of symptoms, only 1 in 7 patients are likely to meet criteria for recovery. These findings could be easily reconciled if schizophrenia could be established to be a progressive brain disease. Results from longitudinal studies of brain structure, cognitive functioning, and clinical outcomes, however, do not support this view. The poor outcomes so commonly observed are likely best explained by poor access to treatment, poor engagement in ongoing care, poor treatment response, and poor adherence together with the cumulative negative impact of substance abuse, comorbid psychiatric disorders, cognitive deficits, and multiple social determinants of health.