Scattered early reports that complete remission of schizophrenia was common in developing countries, in spite of the unavailability of treatment, suggested that course and outcome were more favourable in these settings (e.g. Lambo, 1960; Rin and Lin, 1962; German, 1972). The subsequent evolution of evidence did not disturb this initial impression (Murphy and Raman, 1971; Jablensky et al., 1992; Leff et al., 1992) (Table 2.2).
A study on the island of Mauritius (Murphy and Raman, 1971), examining 12-year outcomes of all patients with a clinical diagnosis of schizophrenia on first admission to the local hospital, found that 64% had no symptoms and were independent. The authors also compared their results with a British study (Brown et al., 1966) and concluded that schizophrenic psychosis had a better overall prognosis in Mauritius than in Britain.
In this context, the WHO embarked upon an ambitious course of research to examine the issue of varied outcomes in different cultural settings.
Two large multicentre studies, the International Pilot Study of Schizophrenia (IPSS) and the Ten Carpenter and Strauss (1991) assessed 40% of the original Washington DC IPSS cohort at 11 years and found little change in the functioning of patients (in terms of social contacts, employment or symptoms) compared with functioning at 2 years.
Table 2.2. Selected studies in developing countriesa
asmyp, asymptomatic; psych, psychotic; mod, moderate; min, minimal; rem, lasting remission; recov, recovered; SMR, standardized mortality ratio.
a Follow-up for 5 or more years; only data from last follow-up of the cohort is included unless otherwise indicated. The percentages for course and
outcome pertain to those where a given outcome is known.
b Best, single episode complete recovery; worst, continuous, episode of inclusion continues throughout follow-up.
c Data on outcome for IPSS study sites in developed countries appear in Table 2.3.
d Data based on entire study sample; outcomes reported for schizophrenia.
e Estimates based on Figure 1, p. 136, Lef et al., 1992.
Table 2.3. Selected studies in developed countriesa
asymp, asymptomatic; mod, moderate; sev, severe; f-u, follow-up.
a Follow-up for 5 or more years; only data from last follow-up of cohort included unless otherwise indicated. The percentages for course and outcomes pertain to those where a given outcome is known.
b Best, single episode complete recovery; worst, continuous, episode of inclusion continues throughout follow-up; good, no relapse, no schizophrenic symptoms at follow-up or first episode followed by complete or partial remission; poor, no return to normality.
c Data on outcome for IPSS study sites in developing countries appear in Table 2.2.
d Data based on entire study sample; outcomes reported for schizophrenia (Leff et al., 1992), and for functional psychosis (Wiersma et al., 1998).
e Estimates based on Figure 1, p. 196, Leff et al., 1992.
Geographical variation: developing and developed countries
Michaeline Bresnahan, Paulo Menezes, Vijoy Varma and Ezra Susser
Division of Epidemiology, Columbia University, New York, USA
Department of Preventative Medicine, University of Sao Paulo, Brazil
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