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Schizophrenia – Falling Incidence and Better Outcome?

Published online by Cambridge University Press:  02 January 2018

Glynn Harrison*
Affiliation:
Department of Psychiatry, University Hospital, Nottingham NG7 2UH
Peter Mason
Affiliation:
Schizophrenia Research Unit, Department of Psychiatry, University Hospital, Nottingham NG7 2UH
*
Correspondence

Abstract

It has been suggested that schizophrenia is a disappearing disease. The evidence for this assertion is reviewed, and also for a parallel theory advanced in recent years that the disorder may be undergoing a benign metamorphosis in its course and outcome. It is concluded that the evidence is presently unconvincing given the methodological problems inherent in most follow-up studies; changes have taken place in clinicians' assumptions, in treatments, and in the quality of follow-up studies, rather than in the disorder itself. Nevertheless, possible time trends in the incidence and outcome of schizophrenia call for further scientific investigation.

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Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

Achte, K. A. (1967) On prognosis and rehabilitation in schizophrenia and paranoid psychoses. Acta Psychiatrica Neurologia Scandinavica (suppl. 125), 33.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Astrup, C. & Noreik, K. (1966) Functional Psychoses - Diagnostic and Prognostic Models. Springfield, IU: Charles C. Thomas.Google Scholar
Bleuler, E. (1950) Dementia Praecox or the Group of Schizophrenias (trans. ed Zint, J.). New York: International University Press.Google Scholar
Bleuler, M. (1941) Krankheitsverlauf, Personlichen und Verwandtschaft Schizophrener und ihre gegenseitigen Beziehurgen. (Disease course, personality and kinship of schizophrenics and their mutual relationships.) Leipzig: Thieme. Cited by Bleuler (1978).Google Scholar
Bleuler, M. (1978) The Schizophrenic Disorders: Long-Term Patient and Family Studies (transi. Clemens, S. M.). New Haven: Yale University Press. (Translation of Die Schizophrena Geistesstorungen im Lichte Langjahriger Kranken-und Familiengeschichten. Stuttgart: Georg Thieme Verlag, 1972.) Google Scholar
Breier, A., Schreiber, J. L., Dyer, J., et al (1991) National Institute of Mental Health longitudinal study of chronic schizophrenia: prognosis and predictors of outcome. Archives of General Psychiatry, 48, 239246.Google Scholar
Breier, A., Schreiber, J. L., Dyer, J., Pickar, D., et al (1992) Long-term outcome in schizophrenia in reply. Archives of General Psychiatry, 49, 503.Google Scholar
Brooks, G. W. (1959) Opening a rehabilitation house. In Rehabilitation of the Mentally III: Social and Economic Aspects (eds Greenblatt, M. & Simon, B.), pp. 127139. Washington, DC: American Association for the Advancement of Science.Google Scholar
Brooks, G. W. (1960) Rehabilitation of hospitalised chronic schizophrenic patients. In Chronic Schizophrenia (eds Appleby, L., Scher, J. M. & Cumming, J.), pp. 248257. Glencoe: Free Press.Google Scholar
Carpenter, W. T. & Strauss, J. S. (1991) The prediction of outcome in schizophrenia IV: Eleven-year follow-up of the Washington IPSS cohort. Journal of Nervous and Mental Disease, 179, 517525.CrossRefGoogle ScholarPubMed
Chittick, R. A., Brooks, G. W., Irons, F. S., et al (1961) The Vermont Story: Rehabilitation of Chronic Schizophrenic Patients. Burlington, VT: Queens City Printers.Google Scholar
Ciompi, L. (1980) Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophrenia Bulletin, 6, 606618.Google Scholar
Der, G., Gupta, S. & Murray, R. (1990) Is schizophrenia disappearing? Lancet, 335, 513516.Google Scholar
Eagles, J. M. & Whalley, L. J. (1985) Decline in the diagnosis of schizophrenia among first admissions to Scottish mental hospital from 1969—1978. British Journal of Psychiatry, 146, 151154.Google Scholar
Faergeman, P. M. (1963) Psychogenic Psychosis. London: Butterworth & Co.Google Scholar
Feighner, J. P., Robins, E., Guze, S. B., et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 5763.Google Scholar
Gardos, G., Cole, J. O. & La Brie, R. A. (1982) A 12-year follow-up study of chronic schizophrenics. Hospital and Community Psychiatry, 33, 983984.Google Scholar
Harding, C. M., Brooks, G. W., Ashikaga, T., et al (1987) The Vermont longitudinal study of persons with severe mental illness. I: Methodology, study sample and overall status 32 years later. American Journal of Psychiatry, 144, 718726.Google Scholar
Harding, C. M., Brooks, G. W., Ashikaga, T., et al (1987) The Vermont longitudinal study of persons with severe mental illness. II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144, 727735.Google ScholarPubMed
Harding, C. M., Brooks, G. W., Ashikaga, T., (1988) Course types in schizophrenia: An analysis of European and American studies. Schizophrenia Bulletin, 14, 633643.Google Scholar
Harrison, G., Cooper, J. E. & Gancaryczyk, R. (1991) Changes in the administrative incidence of schizophrenia. British Journal of Psychiatry; 159, 811816.Google Scholar
Harrison, G., Cooper, J. E. & Gancaryczyk, R. (1993) Disappearing schizophrenia? Schizophrenia Monitor (in press). London: Current Medical Literature.Google Scholar
Henisz, J. A. (1966) A follow-up study of schizophrenic patients. Comprehensive Psychiatry, 12, 524.Google Scholar
Huber, G., Gross, G. & Schuttier, R. (1980) Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin, 6, 593605.Google Scholar
Jablensky, A., Sartorius, N., Ernberg, G., et al (1992) Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine (monograph suppl. 20).CrossRefGoogle Scholar
Kendell, R. E., Malcolm, D. E. & Adams, W. (1993) The problem of detecting changes in the incidence of schizophrenia. British Journal of Psychiatry, 162, 212218.Google Scholar
Kleist, K. (1960) Schizophrenic symptoms and cerebral pathology. Journal of Mental Science, 106, 246253.Google Scholar
Kraepelin, E. (1913) Psychiatrie Ein Lehrbuch fur Studierende und Arzte, 8. Aufl. III Band, Leipzig: Barth.Google Scholar
Kraepelin, E. (1919) Dementia Praecox (trans. ed. Barclay, R. M.). Edinburgh: E. S. Livingstone.Google Scholar
Kuipers, L. & Bebbington, P. (1988) Expressed emotion research in schizophrenia: theoretical and clinical implications. Psychological Medicine, 18, 893909.Google Scholar
Langfeldt, G. (1969) Schizophrenia: diagnosis and prognosis. Behavioural Science, 14, 173182.Google Scholar
Lee, P. W. H., Lieh-Mak, F., Yu, K. K., et al (1991) 21st century schizophrenics: Better outcome? Lower costs? Journal of the Hong Kong College of Psychiatrists, 1, 3745.Google Scholar
Leff, J. (1988) Psychiatry Around the Globe. Gaskell: London.Google Scholar
Leff, J., Wig, N. N., Bedi, H., et al (1990) Relatives' expressed emotion and the course of schizophrenia in Chandigarh: a two-year follow-up of a first contact sample. British Journal of Psychiatry, 156, 351356.Google Scholar
Leff, J., Wig, N. N., Bedi, H., Sartorius, N., Jablensky, A., et al (1992) The international pilot study of schizophrenia: five-year follow-up findings. Psychological Medicine, 22, 131145.Google Scholar
Lehmann, H. E. (1981) Psychopharmacological treatment of schizophrenia. Schizophrenia Bulletin, 7, 2745.Google Scholar
Leonhard, K. (1961) The cycloid psychoses. Journal of Mental Science, 107, 633648.Google Scholar
McGlashan, T. H. (1984a) The Chestnut Lodge follow-up study. I: Follow-up methodology and study sample. Archives of General Psychiatry, 41, 573585.Google Scholar
McGlashan, T. H. (1984b) The Chestnut Lodge follow-up study. II: Long-term outcome of schizophrenia and the affective disorders. Archives of General Psychiatry, 41, 586601.Google Scholar
McGlashan, T. H. (1988) A selective review of recent North American longterm follow-up studies of schizophrenia. Schizophrenia Bulletin, 14, 515542.Google Scholar
Malamud, W. & Render, N. (1939) Course and prognosis in schizophrenia. American Journal of Psychiatry, 95, 1039.Google Scholar
Morrison, J. R. (1974) Changes in the subtype diagnosis of schizophrenia: 1920—1966. American Journal of Psychiatry, 131, 674677.CrossRefGoogle ScholarPubMed
Morrison, J. R., Clancy, J., Crowe, R., et al (1972) The Iowa 500-I: Diagnostic validity in mania, depression and schizophrenia. Archives of General Psychiatry, 27, 457461.Google Scholar
Rennie, T. A. C. (1939) Follow-up study of five hundred patients with schizophrenia admitted to the hospital from 1913—1923. Archives of Neurology and Psychiatry, 42, 877.Google Scholar
Sartorius, N., Jablensky, A., Korten, A., et al (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909928.CrossRefGoogle ScholarPubMed
Schwartz, F., Terkelsen, K. G. & Smith, T. E. (1992) Long-term outcome in schizophrenia. Archives of General Psychiatry, 49, 502.Google Scholar
Shapiro, R. & Shader, R. (1979) Selective review of previous follow-up studies of schizophrenia and other psychoses. In Schizophrenia: An International Follow-up Study, pp. 1143. New York: John Wiley.Google Scholar
Shepherd, M., Watt, D., Falloon, I., et al (1989) The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychological Medicine (monograph suppl. 15).Google Scholar
Stalker, H. (1939) Prognosis in schizophrenia. Journal of Mental Science, 85, 1224.Google Scholar
Tsuang, M. T. & Winokur, G. (1974) Criteria for subtyping schizophrenia. Clinical differentiation of hebephrenic and paranoid schizophrenia. Archives of General Psychiatry, 31, 4347.Google Scholar
Varga, E. (1966) Changes in the Symptomatology of Psychotic Patterns. Budapest: Akademiai Kiado.Google Scholar
Wig, N. N., Menon, D. K., Bedi, H., et al (1987) Expressed emotion and schizophrenia in North India: I. Cross-cultural transfer of ratings of relatives' expressed emotion. British Journal of Psychiatry, 151, 156173.Google Scholar
World Health Organization (1979) Schizophrenia: An International Follow-up Study. New York: John Wiley.Google Scholar
Zubin, J., Magaziner, J. & Steinhauer, S. R. (1983) The metamorphosis of schizophrenia: from chronicity to vulnerability. Psychological Medicine, 13, 551571.Google Scholar
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