From the eras of Hippocrates and Sydenham to the present, the course and outcome of illnesses have been seen as keys to diagnosis and to understanding basic pathologic and healing processes. But in the realm of schizophrenia and other severe psychiatric disorders, course is far more complex than was once thought. To progress in understanding this complexity, a tendency has been to study in isolation one or two of the factors influencing outcome. As helpful as this has been, a complementary broad approach is also essential to provide more perspective for identifying which characteristics, inter-actions, and evolutions may be of maximum explanatory value. Such an approach can build on information already available to collect data systematically and repeatedly over time on a wide range of characteristics in a group of subjects. We will proceed to study the course of schizophrenia and other severe disorder by utilizing several methodologic approaches, each suited to the type of question being studied. A group (N=50) of patients will be followed over two years with a series of closely spaced interviews using a battery of both structured and semi-structured instruments administered by experienced clinician-researchers. A subgroup of patients' family members (N=15) will also be interviewed to provide additional information on the patient's course. A combination of four approaches will be used to analyze the information from the 745 interviews conducted: quantitative analyses, pattern recognition, iterative development of hypotheses, and life charts. From these data we will: 1) describe in a systematic fashion the major characteristics and interactions in the two-year course of schizophrenia; 2) operationalize further the concepts describing the course of disorder that we have identified previously and use these concepts to test several hypotheses; 3) obtain further information about the active role of the patient in shaping his or her disorder and describe this role more completely; 4) chart the impact of life events and treatment as they interact with phases of illness and recovery; and 5) synthesize our results into a more comprehensive and detailed model for understanding the course of schizophrenia and other major psychiatric disorders.
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