the investigation of Lausanne into the long-term evolution of the Schizophrénie was a princeps study and remains often quoted even if some of the results were refined, modified even cancelled by more recent and more modern research from the methodological point of view. It shows - contrary to the generally accepted ideas - that schizophrenia can evolve/move favorably on the long run, after acute beginnings and sometimes of unfavourable long periods. Before reading the continuation, it should be held account owing to the fact that the diagnosis of schizophrenia of the time differs from the current one, which radically does not change its conclusions on this point at least. The text of Christian Müller and Luc Ciompi was published in 1976 under the title: " Lebensweg und Alter of Schizophrenen; eine katamnestische Langzeitstudie (a) ins Senium " and is usually called in French: " the investigation of Lausanne ". It relates to schizophrenic subjects of the beginning of the disease until its becoming at the advanced age. Seul Manfred Bleuler (wire of Eugen Bleuler) at the time had been able to follow and study 220 patients over 20 years. The Müller-Ciompi study carries on 5561 cases of the University Psychiatric Center of Lausanne. It concerns all the people of less than 65 years and which, before 1963, were hospitalized in psychiatry first once at Cery. Among the 5661 cases, 1642 schizophrenes (or demented people early) according to the criteria of Emil Kraepelin and Bleuler were retained. On these 1642 cases, 75% had died (born between 1873 and 1897) at the time of the study. 7% had to be also eliminated, thus remained 289 schizophrenes 18% of the starting figure. Two analyzes: - causes of mortality, mortality slightly more frequent than in population " normale" , higher at catatonic 252% and low schizophrenia at schizo-paranoid (total figure 172%, pop normal 100%). The causes, are known since 1942 thanks to 181 autopsies (32%) out of 570 deaths. Many died cause nonknown, tuberculosis, diseases ORL, ictus, malignant etc Few tumors, rate commits suicide less important than in other psychiatric diseases. Rate of cure, improvement or of stationary state for the whole of the patients of the sample:
- 47% non-rehospitalized including 2/3 duration of less than 6 months.
- 47% of the unit lasted one year.
- 23% hospitalized more than 20 years.
- more hospitalizations for the patients of age of second half of life.
long-term Evolution :
it beginning of the disease (1/8e dubious) was often acute and chronic (more or less 6 months starting from the primary symptoms to the complete table of the psychosis). Oscillating evolution for 50%,47% simple-continuous, 7% dubious. States " terminals according to Bleuler (1972) 27% cured, 22% light and 24% means, 18% low registers (9% dubious) half (49% of all the schizophrenes) thus evolved/moved in a favorable way (cure or light final state). Broadly: 0% cured, 42 improved, 29% unchanged, 5,9% péjoré, 1,7 dubious. With the result that 3/5 of the schizophrenes can evolve/move favorably into growing old! As for the organic insanities of the senescence, Müller and Ciompi conclude that they are a little more frequent than in a population " moyenne" same age. It is still noticed that they are more frequent when schizophrenia evolves/moves unfavourably. The question of the organicity of schizophrenia is thus relativized since that it never adopts the profile of a typical disease psycho-organics. Another object of research is the state of the social situation and the adaptation to old age. The same evolutionary tendency is là-aussi correlated, 3/5 of the studied subjects lived either apart from the hospital, often for a very long time, or only 13%, or in their family 26% and 17% in hearths, pensions, etc Their health condition for a 75 years Middle Age were good for more half which could moreover still carry on an activity. 17% were married, the other single people, widowers, divorced, etc
the psychic state during old age : 1/3 were regarded as good, 2/3 of the serious disorders (31%) and means (37%). Variable present for the eavaluation of the favorable and unfavourable factors : - anamnestic: good adaptation prémorbide (family, the fact of being married, vocational training are favorable factors,
No influence: sex, intelligence, education, structure of fault in childhood, and bio-topological constitution and heredity which however have an influence on the mental health during all the life.
At the psychopathological level, favorable evolution if beginning acute, duration of the 1st hospitalization of less than one year, presence of phenomena of depersonalization and derealisation, symptoms depressive, visual hallucinations, is delirious, first psychiatric hospitalization before 45 years and membership of the sub-group of theparanoid ones. Therefore, the evolution is better if the beginning were acute, intense and polymorphic. The surprise is that there was no difference significant between the surface pre-nerve sedative and post-neruoleptic (1950). Broadly and taking into account methodological skews, the long-term situation of the schizophrenes hardly improved since 1900 at the period of the realization of the study (this is also to relativize with the short-term advantages of nerve sedatives). No forecast criterion over the first year of the disease is predictive evolution. One observes even afterwards very serious evolutions over several decades of the late and spectacular improvements. to know if the disease is malignant or benign, one should thus await the end of the lifetime. Schizophrenia is not a disease which " in theory " or " in rule générale" present an unfavourable evolution. The evolution is open like the east the life and subjected to a multiplicity of factors . Conclusion: Generalizations to be operated with prudence. 1/3 to 2/3 of the schizophrenes evolve/move favorably in the long run. Results comparable with those of the study Bleuler Mr. It there not or little correlation between schizophrenia and syndrome psycho-organics senescence
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