Research on the long-term course of mental illnesses, especially schizophrenia

From 1963 through 1972, Ciompi was the chief investigator in an extended research program on the long-term course of severe mental illnesses. This unique reseach project, known as the "Enquête of Lausanne", had been initiated in 1962 by prof. Christian Müller, then director of the psychiatric university Clinic of Lausanne/Switzerland. Still representing one of the longest and largest psychiatric follow-up studies in the world, it is based on a sample of 5661 former in-patients aged over 65 in 1963, which had been first admitted 30-40 years in average. About 1000 survivors of all diagnostic groups were personally re-examined at their actual living places in Switzerland, and complementary information about their life-course was systematically collected from hospital files, treating psychiatrists, general practioners, authorities, relatives, etc. In addition, causes of death and mortality rates among the deceased were studied and compared with the corresponding data in the general Swiss population, in order to identify main factors of selection among the survivors.

This study showed that old age has often a mitigating effect on former mental disorders. Mortality was, however, clearly increased, especially in former alcoholics, maniaco-depressives, schizophrenics, drug-addicts, and cerebral diseases. Causes of death were mostly similar as in the general population, with some exceptions like the observation that schizophrenics died less frequently from cancer- an unexpected finding which was recently replicated.

A surprise was also the observation that the long-term course of 289 former schizophrenics, re-examined 36.8 years in average after their first admission, was both considerably more favourable and more variable than so far believed. In spite of the fact that most patients had never, or only minimally, been treated by neuroleptic drugs or other modern therapeutic methods, about ¼ of them were completely recovered since at least 5 years, and another ¼ was substantially improved. About ¼ were moderately impaired. Only about ¼ still suffered from severe psychotic disorders. Of particular interest was also the observation that the long-term outcome seemed to depend more on biographic and environmental factors than on heredity, thus providing new hope in an illness so-far believed to be almost incurable.

On these bases, Ciompi questioned the traditional understanding of schizophrenia and proposed an alternative model of the evolution of the psychosis in 3 phases (premorbid, acute, and chronic), centred around a revised version of the stress-vulnerability concept by Zubin and Spring (1977) and the interplay between unfavourable environmental and biological factors, with a crucial role attributed to pathogenic interactions between emotions and cognitions (see the concept of affect-logic): Critical life-events (such as, for instance, puberty, leaving home, mating, pregnancy, drug abuse, hormonal changes) provoke excessive emotional tensions which can lead to a sudden non-linear shift (a so-called bifurcation) from normal mental functioning to psychosis in vulnerable persons.

This multifactorial understanding of schizophrenia provided new opportunities for prevention, therapy and rehabilition which were systematically explored in Ciompi's consecutive research. Practical consequences included the reorganisation of local community based psychiatric services for crisis intervention and rehabilitation, and the creation of the open therapeutic community Soteria Berne (see Social and community psychiatry and Soteria Berne)

Main publications

In English

Luc Ciompi
THE PSYCHE AND SCHIZOPHRENIA.
The Bond between Affect and Logic
ISBN-10: 0674719905
ISBN-13: 978-0674719903
Harvard University Press, Cambridge/Mass. (USA) and London (GB), 1988

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• Ciompi, L.: Catamnestic long-term studies on the course of life of schizophrenics. Schizophrenia Bull. 6: 606-618, 1980
• Ciompi, L.: The natural history of schizophrenia in the long term.Brit. J. Psychiatr. 136: 413-420, 1981
• Ciompi, L.: The social outcome of schizophrenia. In: Wing, J.K., Kielholz, p., Zinn, W.M. (Eds) Rehabilitation of patients with schizophrenia and with depressions. Huber, Bern-Stuttgart-Wien, 1981
• Ciompi, L.: Schizophrenic deterioration. Brit. J. Psychiat. 143: 79-80, 1983
• Ciompi, L.: Is there really a schizophrenia? The long-term course of psychotic phenomena. Brit. J. Psychiatr. 145:636-640,1984
• Ciompi, L.: Aging and schizophrenic psychosis. Acta Psychiat. Scandin. Suppl.319, 71: 93-105, 1985
• Ciompi, L.: Research implications of recent trends in the treatment of schizophrenia. In: Helgason, T. (ed.) The Long-Term-Treatment of Functional Psychoses. Cambridge University press, Cambridge 1985, pp. 123-137
• Ciompi, L.: Learning from outcome studies. Toward a comprehensive biological-psychological understanding of schizophrenia. Schizophrenia Research 1: 373-384, 1988
• Ciompi, L.: The dynamics of complex biological-psychosocial systems. Four fundamental psycho-biological mediators in the long-term evolution of schizophrenia. Brit. J. Psychiatry 155: 15-21, 1989
• Ciompi, L.: Affects as central organising and integrating factors. A new psychosocial/biological model of the psyche. Brit. J. Psychiat. 159: 97-105, 1991
• Ciompi, L.: Affect logic: an integrative model of the psyche and its relations to schizophrenia. Brit. J. Psychiatry 164:51-55, 1994
• Ciompi, L.: Non-linear dynamics of complex systems. The chaos-theoretical approach to schizophrenia. In; Brenner, H.-D., Böker, W., Genner, R. (eds) Toward a comprehensive therapy of schizophrenia. Hogrefe & Huber, Seattle-toronto-Bern-Göttingen 1997, pp. 18-31
• Ciompi, L.: The concept of affect logic. An integrative psycho-socio-biological approach to understanding and treatment of schizophrenia. Psychiatry 60: 158-170, 1997
• Ciompi, L.: Is schizophrenia an affective disease? The hypothesis of affect-logic and its implications for psychopathology. In: Flack W.F., Laird J.D.(eds) Emotions in psychopathology: theory and research. Oxford University Press, New York Oxford 1998, pp. 283-297
• Ciompi L.: An affect-centered model of the psyche and its consequences for a new understanding of nonlinear psychodynamics. In Tschacher, W., Dauwalder, J.P. (eds): Dynamics, synergetics, autonomous agents. Nonlinear system approach to cognitive psychology and cognitive science. World Scientific, Singapure-New Jersey-London-Hong Kong, 1999, pp.123-131

In German

• Ciompi, L., Müller, C.: Katamnestische Untersuchungen zur Altersentwicklung psychischer Krankheiten. Nervenarzt 40:349-353, 1970
• Ciompi, L.: Über Altersveränderungen vorbestehender psychischer Krankheiten und ihre Beziehung zur Therapie. Aktuelle Gerontologie 2:271-77, 1971
• Ciompi, L.: Katamnestische Untersuchungen zur Entwicklung des Alkoholismus im Alter. In: Steinmann, B., Geronotology, Huber, Bern-Stuttgart 1973, S. 279-284
• Ciompi, L., Müller, C.: Lebensweg und Alter der Schizophrenen. Eine katamnestische Langzeitstudie bis ins Senium. Springer, Berlin-Heidelberg-New York, 1976
• Müller, C.: Psychische Erkrankungen und ihr Verlauf sowie ihre Beeinflussung durch das Alter. Huber, Bern,1981

In French

• Ciompi, L. Lai, G-P.: Depression et vieillesse. Etudes catamnestiques sur le vieillissement et la mortalité de 555 anciens patients dépressifs. Huber, Bern-Stuttgart, 1969
• Luka, L. Ciompi, L.: Etude catamnestique sur l'évolution de la manie dans la vieillesse. Schweiz. Arch. Neurol., Neurochir. Psychiat 107:123-153, 1970
• Ciompi, L., Eisert, M.: Mortalité et cause de décès chez les alcooliques. Psychiatr. Soc. 4:159-168, 1971
• Ciompi, L., Medvecka, J. Etude comparative de la mortalité à long terme dans les maladies mentales. Schweiz. Arch. Neurol. Psychiat. 111-135, 1976

In Italian

• Ciompi, L., Dauwalder, H.P., Agué, C.: Un programma di ricerca sulla riabilitazione del malato psichiatrico. Psicoterapia e scienze umane 21: 47-64, 1987.
• Ciompi, L. Logica affettiva. Una ricerca sulla schizofrenia. Feltrinelli, Milano 1994