Long term institutional stay has decreased markedly in people with schizophrenia, although there are still many individuals with a history of long-term institutional stay residing in the community. In addition, although the average duration of acute admissions for schizophrenia is also decreasing, there are indications that psychotic episodes leading to acute admissions are associated with risk for cognitive and functional declines and changes in brain structure. In this paper we review the literature on cognitive changes with aging and institutionalization in schizophrenia, reaching to the conclusion that the reasons for current chronic institutionalization largely include severe psychosis and aggressive behavior. Thus, these factors may be the operative factor in the age-related declines in cognition and functioning reported in this population. We also present evidence to suggest that these changes may be similar to those seen in younger patients who experience repeated psychotic episodes leading to hospitalization. Our conclusion is that there is minimal evidence that hospitalization, long or short, leads to cognitive and functional changes, but rather that the reason for these hospitalizations may underlie cognitive and functional declines. Prevention of relapse and discovering treatments to assist patients with resistant symptoms may reduce the risk of cognitive and functional declines across the lifespan in people with schizophrenia.
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