Abstract
ObjectiveWe report a review of outcomes in schizophrenia in the twenty‐first century, replicating and extending work undertaken by the late Richard Warner in his seminal book, “Recovery from Schizophrenia: Psychiatry and Political Economy” (1985;2004).MethodWarner's methods were followed as closely as possible. Only observational/naturalistic studies were included. Six scientific databases were searched from 2000 to 2020. 6,640 records were retrieved. 47 met inclusion criteria.ResultsOverall, complete recovery is higher in this study than in Warner's (37.75% cf 20.4%), especially for first episode psychosis (FEP) (57.1% cf 20.7%). Clinical recovery, annualized remission rate (ARR), and employment outcomes were significantly superior for first episode psychosis compared with multiple episode psychosis (MEP). ARR shows a trend toward reduction over time, from 2.2 before the financial crash of 2008 to 1.6 after (t = 1.85 df 40 p = .07). The decline is statistically significant for the MEP group (t = 2.32 df18 p = .03). There were no differences in outcome by region, sample characteristics, outcome measures used, or quality of studies. Heterogeneity of clinical outcome measures across the literature makes evidence synthesis difficult. Weak and inconsistent reporting of functional and employment outcomes mean that findings lack meaning with respect to lived experience.ConclusionFuture research strategies should aim to reduce heterogeneity in clinical outcome measures and to increase the emphasis on capture and reporting of more sophisticated measures of social and functional outcome. Outcome domains should be disaggregated rather than conflated into unitary recovery constructs.
Highlights
This paper reports a review of outcomes in schizophrenia in the twenty-first century and is an extension of the work undertaken by the late Dr Richard Warner in his seminal book, “Recovery from Schizophrenia: Psychiatry and Political Economy” (1985 (Warner, 1985); 2004 (Warner, 2004))
In 1985, Warner used empirical evidence to strongly challenge the prevailing view of schizophrenia, which largely arose through the influence of Kraepelin (Kendler, 2020), who suggested that psychosis was strongly characterized by poor clinical and social outcomes
Are remission rates stable, are they influenced by different definitions of remission and by different persistence criteria, are they affected by duration of follow-up or other study features? How do clinical, social, and employment outcomes differ in multiple episodes of psychosis (MEP) and first episode psychosis (FEP) studies and are outcomes better in LMICs? To explore the evidence supporting Warner's hypothesis concerning the importance of changes in the political economy, we have taken the opportunity to look for any noticeable difference in outcomes for data gathered before and after the 2008 crash
Summary
This paper reports a review of outcomes in schizophrenia in the twenty-first century and is an extension of the work undertaken by the late Dr Richard Warner in his seminal book, “Recovery from Schizophrenia: Psychiatry and Political Economy” (1985 (Warner, 1985); 2004 (Warner, 2004)). The present work was started with Dr Warner's involvement, and the preliminary results were presented at the XVII World Congress of Psychiatry in Berlin in 2017. We intended to conduct a systematic review and meta-analysis, but study heterogeneity and paucity of data, including data capture problems and reporting weaknesses, means that meta-analysis was not possible. The relevance of these issues is considered further below
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