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Am J Psychiatry 1994; 151:1409-1416
Copyright © 1994 by American Psychiatric Association
One hundred years of schizophrenia: a meta-analysis of the outcome literature
JD Hegarty, RJ Baldessarini, M Tohen, C Waternaux and G Oepen
Department of Psychiatry, Harvard Medical School, Boston, MA.
OBJECTIVE: This study was undertaken to assess the twentieth-century
literature on outcome in schizophrenia for historical trends that might be
associated with changes in diagnostic and therapeutic practice and to test
the hypothesis that both improved biological treatment and changes in
diagnostic criteria have influenced outcome. METHOD: Meta- analysis of the
international literature on outcome in schizophrenia or dementia praecox
from 1895 to 1992 identified 821 studies; 320 of these, with 51,800
subjects in 368 cohorts, met the inclusion criteria for the study. RESULTS:
Only 40.2% of patients were considered improved after follow-ups averaging
5.6 years (range = 1-40). Outcome was significantly better when patients
were diagnosed according to systems with broad criteria (46.5% were
improved) or undefined criteria (41.0% were improved) rather than narrow
criteria (27.3% were improved). The proportion of patients who improved
increased significantly after mid- century (for 1956-1985 versus 1895-1955,
48.5% versus 35.4%), probably reflecting improved treatment as well as a
broadened concept of schizophrenia. However, in the past decade, the
average rate of favorable outcome has declined to 36.4%, perhaps reflecting
the re- emergence of narrow diagnostic concepts. CONCLUSIONS: Overall, less
than half of patients diagnosed with schizophrenia have shown substantial
clinical improvement after follow-up averaging nearly 6 years. Despite
considerable gains in improvement rates after mid- century, there has been
a decline since the 1970s. These historical changes probably reflect
improved treatment, shifts in diagnostic criteria, and selection bias
related to changes in health care.
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