Schizophrenia: A New Guide for Clinicians

tively. This requires a flexible perspective on the diagnosis and treatment of the illness. Inherent to this is an expectation that change will occur as the illness progresses despite the best-intended plans to create stability for the patient. In the early phase of schizophrenia most patients present with positive symptoms-less often, with negative symptoms-with both symptom types fluctuating but responsive to treatments. Cognitive dysfunction becomes apparent as the patient attempts to continue employment or school. In the middle phase, negative symptoms increase in prevalence, becoming at least as common as positive symptoms, and there is a greater degree of symptom stability. Cognitive symptoms can plateau, but also become a source of frustration for the patient and his family. In the late phase, there is gradual improvement of positive symptoms and social functioning, and negative symptoms may dominate the clinical picture. As we become more adept at medication and psychosocial interventions and apply them as early as possible it will become more evident whether these phases are immutable hallmarks of schizophrenia or potential areas of improvement and success.

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