Outcome of schizophrenia: some transcultural observations with particular reference to developing countries

  • Parmanand Kulhara
Original Paper Review

Abstract

The present paper provides a description of data based and methodologically sound studies of outcome of schizophrenia from developing and non-Western countries and compares the results. Major studies reviewed include the 2- and 5-year follow-up of the cohort of the International Pilot Study of Schizophrenia, the patients of the World Health Organization Collaborative Study on the Determinants of Outcome of Severe Mental Disorders, a few Indian studies including the study sponsored by the Indian Council of Medical Research and some studies from Colombia and South-East Asia. The studies are compared in terms of the quality of methodology and the rate of attrition. Although the outcome criteria of these studies are not similar, it is obvious that the outcome of schizophrenia in developing countries is generally more favourable. The reasons for this are far from clear. Research concerning the issues pertaining to better outcome of schizophrenia in developing countries in the context of socio-cultural differences is woefully lacking. This is an area that deserves research attention.

Key words

Schizophrenia Outcome Course Follow-up 

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References

  1. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders (DMS-III), 3rd edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders (DMS-III-R), 3rd edn, revised. American Psychiatric Association, Washington, DCGoogle Scholar
  3. Brown GW, Bone M, Dalison B, Wing JK (1966), Schizophrenia and social care. Oxford University Press, LondonGoogle Scholar
  4. Dube KC, Kumar N, Dube S (1984) Long term course and outcome of the Agra cases in the International Pilot Study of Schizophrenia. Acta Psychiatr Scand 70:170–179Google Scholar
  5. Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R (1972) Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 26:57–63Google Scholar
  6. Fuller-Torrey E (1987) Prevalence studies of schizophrenia. Br J Psychiatry 150:598–608Google Scholar
  7. German GA (1972) Aspects of psychiatry in sub-Saharan Africa. Br J Psychiatry 121:461–479Google Scholar
  8. Helzer JE, Brockington IF, Kendell RE (1981) Predictive validity of DSM-III and Feighner definitions of schizophrenia. Arch Gen Psychiatry 38:791–798Google Scholar
  9. Indian Council of Medical Research (1988) Multicentered collaborative study of factors associated with the course and outcome of schizophrenia. ICMR, New DelhiGoogle Scholar
  10. Jablenksy A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A (1992) Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med: monogr (Suppl 20)Google Scholar
  11. Kulhara P, Wig NN (1978) The chronicity of schzophrenia in North-West India: results of a follow-up study. Br J Psychiatry 132:186–190Google Scholar
  12. Kulhara P, Chandiramani K (1988) Outcome of schizophrenia in India using various diagnostic systems. Schizophr Res 1:339–349Google Scholar
  13. Kulhara P, Mattoo SK, Chandiramani K, Bhave S, Avasthi A (1986) Diagnostic systems for schizophrenia: a cross-sectional study of condcordance from India. Acta Psychiatry Scand 74: 55–61Google Scholar
  14. Kulhara P, Avasthi A, Chandiramani K (1989) Prognostic variables in schizophrenia. Ind J Psychiatry 31:51–62Google Scholar
  15. Leff J, Wig NN, Ghosh A, Bedi H, Menon DK, Kuipers L, Korten A, Ernberg G, Day R, Sartorius N, Jablensky A (1987) Influence of relatives expressed emotion on the course of schizophrenia in Chandigarh. Br J Psychiatry 151:166–173Google Scholar
  16. Leff J, Sartorius N, Jablensky A, Korten A, Ernberg G (1992) The International Pilot Study of Schizophrenia: five-year follow-up findings. Psychol Med 22:131–145Google Scholar
  17. Lee PWH, Leih-Mak F, Yu KK, Spinks JA (1991) Pattern of outcome in schizophrenia in Hong Kong. Acta Psychiatr Scand 84: 346–352Google Scholar
  18. Leon CA (1972) Psychiatry in Latin America. Br J Psychiatry 121: 121–136Google Scholar
  19. Leon CA (1989) Clinical course and outcome of schizophrenia in Cali, Colombia: a 10-year follow-up study. J Nerv Ment Dis 177:593–606Google Scholar
  20. Lo WH, Lo T (1977) A ten-year follow-up of Chinese schizophrenics in Hong Kong. Br J Psychiatry 131:63–66Google Scholar
  21. Murphy HBM, Raman AC (1971) The chronicity of schizophrenia in indigenous tropical people. Br J Psychiatry 118:489–497Google Scholar
  22. Neki JS (1973) Psychiatry in South-East Asia. Br J Psychiatry 123: 257–269Google Scholar
  23. Sartorius N, Jablensky A, Korten A, Ernberg G, Anker M, Cooper JE, Day R (1986) Early manifestations and first contact incidence of schizophrenia in different cultures. Psychol Med 16: 909–928Google Scholar
  24. Sartorius N, Jablensky A, Ernberg G, Korten A, Gulbinat W (1987) Course of schizophrenia in different countries: some results of a WHO International comparative 5-year follow-up study. In: Hafner H, Gattaz WF, Janzarik W (eds) Search for the causes of schizophrenia. Springer, Berlin Heidelberg New York, pp 107–113Google Scholar
  25. Schneider K (1959) Clinical psychopathology (translated by Hamilton MW). Grune and Stratton, LondonGoogle Scholar
  26. Spitzer RL, Endicott E, Robins E (1978) Research diagnostic criteria for a selected group of functional disorders, 3rd edn. Biometric Research, New York State Psychiatric Institute, New YorkGoogle Scholar
  27. Stevens J (1987) Brief psychoses: Do they contribute to the good prognosis and equal prevalence of schizophrenia in developing countries? Br J Psychiatry 151:393–396Google Scholar
  28. Stevens J, Wyatt RJ (1987) Similar incidence of schizophrenia world-wide: case not proven. Br J Psychiatry 151:131–132Google Scholar
  29. Strauss JS, Gift TE (1977) Choosing an approach for diagnosing schizophrenia. Arch Gen Psychiatry 34:1248–1253Google Scholar
  30. Tsoi WF, Wong KE (1991) A 15-year follow-up study of Chinese schizophrenic patients. Acta Psychiatr Scand 84:217–220Google Scholar
  31. Verghese A, John JK, Rajkumar S, Richard S, Sethi BB, Trivedi JK (1989) Factors associated with the course and outcome schizophrenia in India: results of a two-year multicentre follow-up study. Br J Psychiatry 154:499–503Google Scholar
  32. Waxler NE (1979) Is the outcome for schizophrenia better in non-industrial societies? The case of Sri Lanka. J Nerv Ment Dis 167:144–158Google Scholar
  33. Wig NN, Menon DK, Bedi H, Leff J, Kuipers L, Ghosh A, Day R, Korten A, Ernberg G, Sartorius N, Jablensky A (1987) Distribution of expressed emotion component in relatives of schizophrenic patients in Aarhus and Chandigarh. Br J Psychiatry 151: 160–165Google Scholar
  34. Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of psychiatric symptoms. Cambridge University Press, CambridgeGoogle Scholar
  35. World Health Organization (1973) Report of the International Pilot Study of Schizophrenia. WHO, GenevaGoogle Scholar
  36. World Health Organization (1978) Mental disorders: glossary and guide to their classification in accordance with the 9th revision of the International Classification of Diseases. WHO, GenevaGoogle Scholar
  37. World Health Organization (1979) Schizophrenia: an international follow-up study. Wiley, ChichesterGoogle Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Parmanand Kulhara
    • 1
  1. 1.Department of PsychiatryPGIMERChandigarhIndia

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