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The development of psychotic symptoms marks the formal onset of first-episode schizophrenia. It is common for some time to pass in a prodromal phase before the patient is brought in for medical attention and diagnosed with schizophrenia.[Lieberman et al., 2001]
During the course of the illness, patients will experience subsequent psychotic relapses, and patients often fail to recover to the same degree as they had prior to the most recent episode. This process of relapse, treatment failure, and incomplete recovery leads many patients to a debilitating, chronic course of illness.[Lieberman et al., 2001]
Patients accumulate morbidity in the form of residual or persistent symptoms and functional decline when compared to their premorbid status.[Lieberman et al., 2001]
Although the majority of patients with schizophrenia exhibit a severe pattern of deterioration, different degrees and different temporal sequences do occur. Despite these variations, the deterioration process predominantly occurs during the early phases of the illness.[Lieberman et al., 2001]
With treatment, some patients achieve symptomatic remission following a first episode.[Lieberman et al., 2006]
However, others may go on to experience clinical progression and deterioration in the years following a first episode, reaching a plateau during the chronic phase.[Lieberman et al., 2006; Agius et al., 2010]
References:
Lieberman JA, Perkins D, Belger A, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry. 2001; 50 (11): 884-897.
Lieberman JA, Jarskog LF, Malaspina D. Preventing clinical deterioration in the course of schizophrenia: the potential for neuroprotection. J Clin Psychiatry. 2006; 67 (6): 983-990.
Agius M, Goh C, Ulhaq S, McGorry P. The staging model in schizophrenia, and its clinical implications. Psychiatr Danub. 2010; 22 (2): 211-220.