Majority of Patients With Schizophrenia Remain Marginalised Even After Recovery: Presented at CPA

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Title: Majority of Patients With Schizophrenia Remain Marginalised Even After Recovery: Presented at CPA
URL: http://www.pslgroup.com/dg/22B702.htm
Doctor's Guide
September 9, 2008

By Thomas S. May

VANCOUVER -- September 9, 2008 -- A considerable proportion of patients with schizophrenia remain marginalised, even after they have been deemed to have recovered clinically, according to a study of patients with schizophrenia living in Mumbai, India, presented here at the 58th Annual Meeting of the Canadian Psychiatric Association (CPA).

It is generally believed that the long-term outcome of schizophrenia is more favourable in developing countries compared with industrialised societies.

"The use of the term recovered in outcome studies of schizophrenia has, for a long time, been problematic, because of the many different definitions in use," said lead researcher Amresh Srivastava, MD, Department of Psychiatry, University of Western Ontario, London, Ontario.

Dr. Srivastava conducted the study while he was at Silver Mind Hospital and Mental Health Foundation of India, Mumbai, India.

In the field of schizophrenia, a distinction should be made between symptomatic and functional recovery, Dr. Srivastava also noted, "in order to place it in line with other fields of medicine."

"Although a high rate of remission of symptoms has been reported in long-term studies from India, there is no clear evidence if such patients were able to gain social integration or not," Dr. Srivastava said in a poster presentation on September 5.

For their study, Dr. Srivastava and colleagues used multidimensional outcome criteria, to examine the recovery status of patients who were considered to be "clinically recovered" and to address the question of whether routine clinical measures of outcome reflect real-life situations.

The investigators enrolled 107 patients with a diagnosis of schizophrenia in their 10-year, prospective study.

Results showed that 67 (62.7%) patients could be considered to be recovered using the Clinical Global Impression Scale (CGIS).

However, using Meltzer's 13 outcome criteria, the researchers found that overall functioning for the majority of clinically recovered patients was "less than desirable." For example, 66% of these 67 patients were not economically independent, 69% could not pursue their desired education goals, and 63% experienced rehospitalisation.

These results suggest that long-term outcomes in schizophrenia are "not so impressive," Dr. Srivastava said.

"The long-term outcome of schizophrenia in a metropolitan city of India does not appear to be very impressive, in terms of global recovery and social improvement," he added.

"Clinically classified as recovered, patients show lower rates of improvement on multidimensional parameters," Dr. Srivastava explained. "Future research needs to focus on developing more refined measurements for outcome, explore heterogeneity and determinants of good outcome, and develop more effective treatment."

[Presentation title: The Long-Term Good Outcome in Schizophrenia Is Not Yet Good Enough. Abstract P21]

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