Recovery from psychotic illness: a 15- and 25-year international follow-up study.
BACKGROUND
Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.


OBJECTIVE
To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.


METHODS
Historic prospective study. Standardised assessments of course and outcome.


RESULTS
About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.


CONCLUSIONS
A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
Harrison
G
G
Division of Psychiatry, University of Bristol, UK. G.Harrison@bristol.ac.uk
Hopper
K
K
Craig
T
T
Laska
E
E
Siegel
C
C
Wanderling
J
J
Dube
K C
KC
Ganev
K
K
Giel
R
R
an der Heiden
W
W
Holmberg
S K
SK
Janca
A
A
Lee
P W
PW
León
C A
CA
Malhotra
S
S
Marsella
A J
AJ
Nakane
Y
Y
Sartorius
N
N
Shen
Y
Y
Skoda
C
C
Thara
R
R
Tsirkin
S J
SJ
Varma
V K
VK
Walsh
D
D
Wiersma
D
D
D000328:Adult; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation; D015996:Survival Rate; D016896:Treatment Outcome