This analysis examines the notion of progressive deterioration in schizophrenia, using long-term followup data on hospital episodes in defined cohorts from psychiatric case registers in Victoria, Australia; Denmark; and Salford, England. The analyses differentiate heterogeneity existing at the first hospitalization for schizophrenia, which produces a widely varying natural course, from heterogeneity that develops over time, as episodes of hospitalization occur. Episodes of hospitalization for schizophrenia tend to cluster earlier rather than later in the treatment career, suggesting a progressive amelioration rather than deterioration. When overall chronicity is adjusted, each additional episode of hospitalization lowers the risk for a further hospitalization by about 10 percent.
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