Recovery From Schizophrenia: An International Perspective: A Report From The Who Collaborative Project, The International Study Of Schizophrenia

In the late 1960s, the World Health Organization initiated a series of international studies of the incidence, characteristics, course, and consequences of schizophrenia. Those studies - the largest ever in the history of psychiatry - provided important data about the disorder in groups of patients living in different countries and cultures, and first focused attention on the differences in short-term prognosis for schizophrenia between the third world and industrialized countries. In the 1990s, the International Study of Schizophrenia (ISoS) set out to relocate those subjects and to determine their clinical and social status some 15 to 25 years later.

Recovery from Schizophrenia is a comprehensive account of what ISoS found, reporting follow-up results for over 1000 subjects examined in the earlier WHO studies (and in several local studies as well). The body of this volume consists of detailed descriptions of the long-term course and outcome of schizophrenia, together with portraits of the field research sites in 14 countries. Introductory and synoptic chapters lay out the origin and design of the WHO studies culminating in ISoS, and synthesize the study's main findings. ISoS shows that, with appropriate treatment, schizophrenia has a favorable outcome for a substantial portion of those afflicted. The surprising finding of the short-term follow-up studies - that outcome was better in the developing than in the developed countries - is confirmed here for long-term course. Yet while prognosis continues to favor subjects in developing countries, the varied outcomes for those in developed nations still offers ample reason for hope.

This book is the first of its kind. The massive multinational investigations upon which it is based are unique in psychiatry and cross-cultural epidemiology. Recovery from Schizophrenia will be a valuable resource for researchers, epidemiologists, policymakers, and mental health professionals worldwide, providing evidence that supports investment in the care of persons with schizophrenia.

Doody Review Services

Reviewer:Michael Joel Schrift, D.O., M.A.(University of Illinois at Chicago College of Medicine)
Description:Schizophrenia, unfortunately, continues to be studied as if it is a single disease. The DSM reifies schizophrenia into a discrete disorder but schizophrenia is actually a syndrome, analogous to mental retardation and dementia, with multiple etiologies and, therefore, multiple outcomes. In addition, the genetic predispositions for schizophrenia and affective illness overlap (Maier W, Lichtermann D, Minges J, Hallmayer J, Heun R, Benkert O, et al. Continuity and discontinuity of affective disorders and schizophrenia. Results of a controlled family study. Arch Gen Psychiatry 1993;50:871-83; Rende R, Hodgins S, Palmour R, Faucher B, Allaire JF. Familial overlap between bipolar disorder and psychotic symptoms in a Canadian cohort. Can J Psychiatry 2004;50:189-94). This book supports the notion that a heterogeneous "disorder" has a heterogeneous outcome. This is a comprehensive account of the 1990s-initiated International Study of Schizophrenia which was conducted in 14 countries and involved the detailed descriptions of over 1,000 subjects on their long-term course and outcome. The conclusions of this study were: the long-term outcome in over half the subjects was good; the first two years of the illness predict later functioning; the diagnostic stability for the diagnosis of schizophrenia was higher compared to schizoaffective disorder and acute schizophrenia; mortality risk is increased in schizophrenia and other psychoses; the course and outcome was more favorable in developing nations than in developed countries; the findings regarding employment, homelessness, and comorbidity are as you might expect. The editors and contributors need to be applauded for this monumental international effort.
Purpose:The purpose of this book is to summarize the findings of this large international long-term study of schizophrenia.
Audience:The intended audience includes psychiatrists, psychiatric researchers, and others interested in the nosology of the major psychoses.
Features:The book's 23 chapters are grouped into three parts. Part I details the background of the 25-year study and the research methodology. Part II synthesizes the findings in regards to the course and outcome, long-term predictors, diagnostic stability, mortality, and prognostic factors that predict recovery. Part III is a presentation of the findings from the individual study centers and ends with a concluding chapter that highlights the findings from the study. Each chapter ends with relevant citations of the scientific literature. The index is quite detailed. Appendixes consist of tabular material of the baseline and short term follow-up data; course and outcome for the alive cohort; and deceased subjects.
Assessment:The relevant findings of this study are summarized in the first paragraph of this review. It does not seem to me that the findings from this study as summarized in this book will change any paradigms regarding schizophrenia. The findings do support that schizophrenia is a syndrome not a disorder.