Recovery from psychotic illness: A 15- and 25-year international follow-up study

Abstract

BackgroundPoorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.AimsTo 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.MethodHistoric prospective study. Standardised assessments of course and outcome.ResultsAbout 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.ConclusionsA 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.

Services for people at high risk improve outcomes in patients with first episode psychosis

“…A 24‐month follow‐up period started from the date of referral to OASIS or the conventional service where the diagnosis of first episode psychosis was made. This time period was selected because it permitted assessment of outcomes in the entire sample, and because the outcomes in the first 2 years after illness onset predict the long‐term outcomes 13.…”

Determinants of functioning and well-being among individuals with schizophrenia: An integrated model

“…Historic economic changes also are related to employment opportunities and rates among people with mental illness (Warner, 1994). Similarly, longstanding cultural/historical differences may account for differences in level of community stigma or availability of work opportunities that may explain some of the international differences in outcomes observed in the World Health Organization (WHO) studies (Harrison et al, 2001). While we consider these genetic and historical/cultural factors to be important, in general we believe that they operate through the domains we have included in the model.…”

“…Functioning and well-being outcomes for schizophrenia are diverse (e.g., Harding, Brooks, Ashikaga, Strauss, & Breier, 1987;Harrison et al, 2001), and have resisted simple explanation. Earlier reviews of the factors that influence functioning and well-being outcomes for schizophrenia (Avison & Speechley, 1987;Ciompi, 1988) noted that a variety of psychosocial and biological influences were likely to be important, but there was relatively little research on these variables.…”

Fostering Recovery from Life-transforming Mental Health Disorders: A Synthesis and Model

“…Consistent with this focus, most existing models have been developed as part of treatment programs (Ahern & Fisher, 1999;Anthony & Liberman, 1986;Spaniol, Koehler, & Hutchinson, 1994;Townsend, Boyd, Griffin, & Hicks, 1999), concentrating little on aspects of recovery outside the immediate realm of mental health services. Broader models are now under development (Ralph et al, 2000), however, and reports addressing both the recovery process and wholeperson outcomes are becoming available (Harrison et al, 2001;Liberman et al, 2002;Onken, Dumont, Ridgway, Dornan, & Ralph, 2003;Spaniol, Wewiorski, Gagne, & Anthony, 2002;Torgalsboen & Rund, 2002). That is, we have begun to take on the difficult task of understanding recovery in the global sense, examining the production of recovered lives, and the definitions, meanings, and adaptations constructed by individuals for whom one of life's critical tasks has become making sense of what it means to be affected by a serious mental disorder.…”

“…The question is, how? Researchers, practitioners, and consumers are beginning to identify many of the important elements of the recovery process (American Psychiatric Association, 1994b;Davidson & Strauss, 1995;Deegan, 1988;Fisher, 1994;Harrison et al, 2001;Lehman & Steinwachs, 1998;Liberman et al, 2002;Onken et al, 2003). But how and, perhaps more importantly, when, do we address these elements, and how do we intervene to increase positive and reduce negative cascades of events?…”