Recovery from Schizophrenia This page intentionally left blank Recovery from Schizophrenia An International Perspective A Report from the WHO Collaborative Project, The International Study of Schizophrenia Edited by Kim Hopper Glynn Harrison Aleksandar Janca Norman Sartorius 1 2007 1 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2007, Research Foundation for Mental Hygiene, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Recovery from schizophrenia : an international perspective—results from the WHO-coordinated international study of schizophrenia (ISoS) / edited by Kim Hopper ... [et al.]. p. ; cm. Includes bibliographical references. ISBN-13: 978-0-19-531367-3 ISBN-10: 0-19-531367-4 1. Schizophrenia—Epidemiology. I. Hopper, Kim. [DNLM: 1. World Health Organization. 2. Schizophrenia—therapy. 3. Follow-Up Studies. 4. International Cooperation. 5. Treatment Outcome. WM 203 R3124 2007] RC514.R385 2007 362.2'6—dc22 2006026433 1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper Contents Contributors vii Introduction xi Acknowledgments xvii Abbreviations xix Part I Background 7 Identifying Prognostic Factors That Predict Recovery 1 Twenty-five Years of WHO- in the Presence of Loss to Coordinated Activities Follow-Up 69 Concerned with Schizophrenia 3 Christiana Drake, Richard Levine, Norman Sartorius and Eugene M. Laska 2 Study Methodology 10 Part III The Centers Carole Siegel, Eugene M. Laska, Joseph A. Wanderling, Sherryl Baker, sectioniii.a International Pilot Study Glynn Harrison, Rheta Bank, of Schizophrenia (IPSS) 75 and Morris Meisner Ctirad Skoda Part II Findings 8 IPSS: Agra, India 77 K. C. Dube and Narendar Kumar 3 An Overview of Course and Outcome in ISoS 23 9 IPSS: Cali, Colombia 85 Kim Hopper, Glynn Harrison, Carlos A. León and Agatha León and Joseph A. Wanderling 10 IPSS: Prague, Czech Republic 100 4 Predictors of Long-Term Ctirad Skoda, Pavel Baudis, Course and Outcome for and Eva Dragomirecká the DOSMeD Cohort 39 Carole Siegel, Joseph A. Wanderling, sectioniii.b Determinants of Outcome Shang Lin, and Sherryl Baker of Severe Mental Disorder (DOSMeD) 113 5 Long-Term Diagnostic Stability Vijoy K. Varma in International Cohorts of Persons with Schizophrenia 11 Chandigarh, India 115 and Related Psychoses 50 Vijoy K. Varma and Savita Malhotra Thomas J. Craig, Joseph A. Wanderling, and Aleksandar Janca 12 Dublin, Ireland 129 6 Long-Term Mortality Experience Aine Finnerty, Fiona Keogh, Anne O’Grady Walshe, and Dermot Walsh of International Cohorts of Persons with Schizophrenia 13 Honolulu, Hawai’i 141 and Related Psychoses 61 Anthony J. Marsella, Edward Suarez, Thomas J. Craig, Dei-In Tang, Thomas Leland, Heather Morse, Norman Sartorius, Eugene M. Laska, Barbara Digman, Alice Scheuer, and and Robert Cancro Martin M. Katz vi CONTENTS 14 Moscow, Russia 152 sectioniii.d Retrospective Analysis (RA)/Invited Centers 241 Sergey Tsirkin R. Thara 15 Nagasaki, Japan 164 Yoshibumi Nakane, Koichi Takada, 21 Beijing, China 243 Kazuyasu Yoshitake, and Keiko Hatada Changhui Chen and Yucun Shen 16 Nottingham, U.K. 177 22 Hong Kong 255 Glynn Harrison and Peter Mason Peter W. H. Lee, F. Lieh-Mak, K. Y. Mak, Amy S. M. Fung, M. C. Wong, 17 Rochester, New York 189 and Julia Lam Lyman C. Wynne and Sharon Holmberg 23 Chennai (Madras), India 266 sectioniii.c Reduction and Assessment R. Thara, S. Rajkumar, of Psychiatric Disability and A. Albert Joseph (RAPyD or Disability) 201 Durk Wiersma and Fokko J. Nienhuis Conclusion 277 Kim Hopper, Glynn Harrison, 18 Groningen, The Netherlands 203 Aleksandar Janca, Norman Sartorius, Durk Wiersma, Fokko J. Nienhuis, and Durk Wiersma Cees J. Slooff, Robert Giel, and Appendices Tabular Material Ate de Jong a Baseline and Short-Term 19 Mannheim, Germany 215 Follow-Up 285 Wolfram an der Heiden, Bertram Krumm, Sabine Müller, b Course and Outcome Marianne Schäfer, Bettina Schwerd, and for Alive Cohort 302 Iris Weber c Deceased Subjects 348 20 Sofia, Bulgaria 227 Kimon Ganev, Georgi Onchev, and Index 355 Plamen Ivanov Contributors Sherryl Baker, Ph.D. Eva Dragomirecká, M.D. Former Research Scientist Senior Researcher, Department of Social Psychiatry Nathan Kline Institute for Psychiatric Research Prague Psychiatric Center Orangeburg, New York Prague, Czech Republic Rheta Bank, M.A.* Christiana Drake, Ph.D. Former Director, Educational Technology Professor of Statistics Department University of California, Davis Nathan Kline Institute for Psychiatric Research Davis, California Orangeburg, New York K.C. Dube, M.D.* Pavel Baudis, M.D. Former Professor of Psychiatrist and Senior Medical Superintendent Psychiatrist Mental Hospital Formerly with ISoS Collaborative Study Agra, India Prague Field Research Center Prague, Czech Republic Aine Finnerty Robert Cancro, M.D., Med.D.Sc. St. Canice’s Hospital Kilkenny, Ireland Former Director Nathan Kline Institute for Psychiatric Research Amy S. M. Fung Lucius N. Littauer Professor of Psychiatry Formerly with ISoS Collaborative Study New York University Medical Center Hong Kong Field Research Center New York, New York Hong Kong Changhui Chen, M.D. Kimon Ganev, M.D. Professor and Physician, Retired Clinical Director Beijing Medical University Mental Health Centre Dinamika Beijing, China Visiting Lecturer New Bulgarian University Thomas J. Craig, M.D. Sofia, Bulgaria Chief Quality and Performance Officer Robert Giel, M.D. Department of Veterans Affairs Washington, DC Emeritus Professor University Medical Center Groningen Ate de Jong, Ph.D. Department of Psychiatry University Medical Center Groningen University of Groningen Department of Psychiatry Groningen, The Netherlands University Medical Center Glynn Harrison, M.D., FRCPsych Groningen, The Netherlands Norah Cooke Hurle Professor of Mental Health Barbara Digman University of Bristol Formerly with ISoS Collaborative Study Former Professor of Community Mental Health Honolulu Field Research Center University of Nottingham Honolulu, Hawaii United Kingdom * Deceased. vii viii CONTRIBUTORS Wolfram an der Heiden, Dipl.-Psych Narendar Kumar, M.D. Deputy Head Deputy Director General Schizophrenia Research Group Indian Council for Medical Research Central Institute of Mental Health New Delhi, India Mannheim, Germany Julia Lam Keiko Hatada Formerly with ISoS Collaborative Study Formerly with ISoS Collaborative Study Hong Kong Field Research Center Nagasaki Field Research Center Hong Kong Nagasaki, Japan Eugene M. Laska, Ph.D. Sharon Holmberg, Ph.D., RN Director, Statistical Sciences Laboratory Associate Professor of Nursing Nathan Kline Institute for Psychiatric Research Decker School of Nursing Orangeburg, New York Binghamton University Peter W.H. Lee, M.D. Binghamton, New York Professor in Clinical & Health Psychology Kim Hopper, Ph.D. Department of Psychiatry Research Scientist The University of Hong Kong Nathan Kline Institute for Psychiatric Research Hong Kong Orangeburg, New York Thomas Leland, M.D. Professor of Clinical Sociomedical Sciences Chief Psychiatrist Mailman School of Public Health, Columbia Kalihi-Palama Mental Health Services University Clinical Professor, Department of Psychiatry New York, New York John Burns School of Medicine Plamen Ivanov Hawaii Formerly with ISoS Collaborative Study Agatha León, Ph.D. Sofia Field Research Center Director Sofia, Bulgaria Chiquitines Aleksandar Janca, M.D., FRCPsych, FRANZCP Cali, Columbia Professor and Head, School of Psychiatry Carlos A. León, M.D. and Clinical Neurosciences Professor Emeritus University of Western Australia Universidad del Valle Director, World Health Organization Cali, Columbia Collaborating Center for Research & Training Richard Levine, Ph.D. in Mental Health Perth, Australia Associate Professor Department of Mathematics and Statistics A. Albert Joseph, MSc San Diego State University Biostatistics, SCARF San Diego, California Chennai, India Felice Lieh-Mak, M.D. Martin M. Katz, Ph.D. Emeritus Professor Past Director, Clinical Research Branch The University of Hong Kong National Institute of Mental Health Hong Kong Bethesda, Maryland Shang Lin, Ph.D. Fiona Keogh Research Associate and Associate Professor Researcher Department of Health Studies Mental Health Commission University of Chicago Dublin, Ireland Chicago, Illinois Bertram Krumm K.Y. Mak Formerly with ISoS Collaborative Study Formerly with ISoS Collaborative Study Mannheim Field Research Center Hong Kong Field Research Center Mannheim, Germany Hong Kong CONTRIBUTORS ix Savita Malhotra, M.D. Norman Sartorius, M.D., Ph.D., FRCPsych Professor of Psychiatry Previous Director, Division of Mental Health Post Graduate Institute of Medical Education World Health Organization and Research Professor of Psychiatry Chandigarh, India University of Geneva, Switzerland President, World Psychiatric Association Anthony J. Marsella, Ph.D., D.H.C. Scientific Director, Global Programme against Stigma Emeritus Professor, Department of Psychology and Discrimination Because of Schizophrenia University of Hawaii Marianne Schäfer Honolulu, Hawaii Formerly with ISoS Collaborative Study Peter Mason, M.D. Mannheim Field Research Center Psychiatrist Mannheim, Germany Formerly with ISoS Collaborative Study Alice Scheurer Nottingham Field Research Center Nottingham, United Kingdom Formerly with ISoS Collaborative Study Honolulu Field Research Center Morris Meisner, Ph.D. Honolulu, Hawaii Research Scientist Bettina Schwerd Nathan Kline Institute for Psychiatric Research Orangeburg, New York Formerly with ISoS Collaborative Study Mannheim Field Research Center Heather Morse Mannheim, Germany Formerly with ISoS Collaborative Study Yucun Shen, M.D. Honolulu Field Research Center Honolulu, Hawaii Academician The Chinese Academy of Engineering Sabine Müller Professor and Honorary Director Formerly with ISoS Collaborative Study Institute of Mental Health, Peking University, China Mannheim Field Research Center Member; World Health Organization Expert Mannheim, Germany Advisory Panel on Mental Health Yoshibumi Nakane, M.D. China Professor and Chairman, Department Carole Siegel, Ph.D. of Neuropsychiatry Director, Statistics and Services Research Division University School of Medicine Nathan Kline Institute for Psychiatric Research, Nagasaki, Japan Orangeburg, New York Fokko J. Nienhuis, Ph.D. Ctirad Skoda, M.D.* University Medical Center Groningen Former Psychiatrist and Director of ISoS Department of Psychiatry Collaborative Study University of Groninge, Prague Field Research Center Groningen, The Netherlands Prague, Czech Republic Anne O’Grady Walshe, M.D. Cees J. Slooff, M.D., Ph.D. Consultant Psychiatrist University Medical Center Groningen Tallaght Hospital Department of Psychiatry Dublin, Ireland University of Groningen Groningen, The Netherlands Georgi Onchev, M.D., Ph.D. Senior Lecturer in Psychiatry, Department Edward Suarez, Ph.D. of Psychiatry Director, Adult Patient Rehabilitation Services Medical University Hawaii State Hospital Sofia, Bulgaria Hawaii S. Rajkumar, M.D. Koichi Takada Professor Formerly with ISoS Collaborative Study Mid Western Area Health/University of Newcastle Nagasaki Field Research Center Australia Nagasaki, Japan
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