Hi XXXXXXX

The prognosis of disorganized schizophrenia and schizoaffective disorder are different. These two disorders probably lies at two ends of the schizophrenia spectrum with regard to prognosis, with disorganized schizophrenia having the worst and schizoaffective disorder having the best prognosis, relatively.

Disorganized schizophrenia is considered to have a relatively very poor prognosis among the different subtypes of schizophrenia. These patients are typically more disabled, and are more resistant to treatment. They have a deteriorating course with significant socio-occupational dysfunction and often need institutionalization.

Schizoaffective disorder on the other hand, has much better prognosis than any type of schizophrenia. It is generally agreed that its prognosis lies somewhere between that of people with schizophrenia and people with bipolar disorder. In other words, the prognosis appears to be better for patients with schizoaffective disorder than those with schizophrenia but worse than those with bipolar disorder.

In addition, the following common factors have also been associated with a worse prognosis:
- Early age of onset of illness
- Male sex
- Family history of schizophrenia
- Poor pre-morbid functioning
- Poor social support

The family needs to be aware that schizophrenia is a chronic condition that requires long-term treatment. General goals of treatment are to reduce the severity of psychotic symptoms, prevent recurrences of symptomatic episodes and associated deterioration of functioning, and help patients function at the highest level possible.

It is important to understand that medication can only control the symptoms, but not cure the disease completely, and that there is always a high risk for relapse. The family also needs to be educated that people with this condition may feel as if treatment isn't necessary, and may be tempted to ignore treatment recommendations. So, they need close monitoring and supervision regarding treatment. It's not safe to make any changes to mental health medications without talking to a doctor. Psychotic symptoms may relapse if medications are stopped.

During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help ensure the safety of the affected person and others, ensure proper nutrition, sleep and hygiene. Partial hospitalization and residential care also may be options. In some cases, where there is poor response to medication, or if medication is not suitable or causing unmanageable side effects or if the patient becomes very sick or suicidal, electro-convulsive therapy (ECT) may need to be considered.

The family also needs to be made aware that these patients are at a higher risk for substance abuse and suicide. They are also found to be more prone for medical problems like diabetes, obesity, high cholesterol, etc. and so they need regular follow-ups and periodic medical check-ups.

Rehabilitation with community support services, vocational skills and social skills training, etc. are also important components of treatment in chronic, disabled patients. The family also needs to know that a good social support system and minimizing environmental stress can improve overall functioning.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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