Twenty years' follow-up of first psychiatric presentation for schizophrenia: what could have been prevented?

Of 2388 patients seeking psychiatrists for the first time in Iceland during the years 1966 and 1967, 107 suffered from schizophrenia. They were followed to the end of the year 1987 with particular emphasis on preventive measures. The majority of these schizophrenic patients experienced serious difficulties in achieving a satisfactory quality of life. Over half of them never married, 32% of those who married had divorced and a similar number had lost the support of their families. Patients who underwent treatment improved but only 29% achieved an acceptable level of health. Such figures point to the fact that changes are required in basic treatment structure if this situation is to be altered. A serious shortage of compliance emerged both among patients and their relatives. This shortage had a serious effect on outcome. The necessity for specific methods of prevention is emphasized.