52-2 How do chronic and acute schizophrenia differ?

Nearly 1 in 100 people will experience schizophrenia this year, joining the estimated 24 million worldwide who have this disorder (Abel et al., 2010; WHO, 2011). It typically strikes as young people are maturing into adulthood. It knows no national boundaries, and it affects both males and females. Men tend to be struck earlier, more severely, and slightly more often (Aleman et al., 2003; Eranti et al., 2013; Picchioni & Murray, 2007). The risk of schizophrenia is higher for those who experience childhood abuse: They are three times more likely than their unabused counterparts to develop this disorder (Matheson et al., 2013). Other types of childhood adversity, such as bullying, also increase the risk (Varese et al., 2012).

When schizophrenia is a slow-developing process, called chronic schizophrenia, recovery is doubtful (WHO, 1979). This was the case with Maxine’s schizophrenia, which took a slow course, emerging from a long history of social inadequacy and poor school performance (MacCabe et al., 2008). Those with chronic schizophrenia often exhibit the persistent and incapacitating negative symptom of social withdrawal (Kirkpatrick et al., 2006). Men, whose schizophrenia develops on average four years earlier than women’s, more often exhibit negative symptoms and chronic schizophrenia (Räsänen et al., 2000). In one study that followed people with chronic schizophrenia over 34 years, the majority showed worsened symptoms and functioning (Newman et al., 2012).

When previously well-adjusted people develop schizophrenia rapidly following particular life stresses, this is called acute schizophrenia, and recovery is much more likely. They more often have the positive symptoms that are more likely to respond to drug therapy (Fenton & McGlashan, 1991, 1994; Fowles, 1992).