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| The Persistence of a Pessimistic Prognosis |
The Persistence of a Pessimistic Prognosis
Although there is a body of literature describing and attempting to explain a more benign course of schizophrenia in the latter half of the twentieth century (e.g. Harrison and Mason, 1993; Zubin, Magaziner and Steinhauer, 1983), this notion has been disputed by a number of researchers. Meta-analyses conducted by Hegarty et al. (1994) and Warner (2004) failed to find unequivocal improvements in outcome between early and late twentieth century studies. Although there was an improvement in outcomes around mid-twentieth century, this was followed by a decline from the 1970s, with the percentage of good outcomes at the end of the century comparable to that at the beginning (Hegarty et al., 1994). The most surprising finding was from Warner’s (2004) meta-analysis, which focused solely on developed countries. No improvement in outcomes was found in Western countries in the periods before and after the introduction of antipsychotic medications (Warner, 2004). Moreover, although a decrease in hospital use between 1945 and 1955 was associated with an improvement in recovery rates, the later introduction of antipsychotics brought no further improvement in symptoms or social functioning (Warner, 2004). Why do poor outcomes persist in the West? A number of explanations have been put forward.
Although there is a body of literature describing and attempting to explain a more benign course of schizophrenia in the latter half of the twentieth century (e.g. Harrison and Mason, 1993; Zubin, Magaziner and Steinhauer, 1983), this notion has been disputed by a number of researchers. Meta-analyses conducted by Hegarty et al. (1994) and Warner (2004) failed to find unequivocal improvements in outcome between early and late twentieth century studies. Although there was an improvement in outcomes around mid-twentieth century, this was followed by a decline from the 1970s, with the percentage of good outcomes at the end of the century comparable to that at the beginning (Hegarty et al., 1994). The most surprising finding was from Warner’s (2004) meta-analysis, which focused solely on developed countries. No improvement in outcomes was found in Western countries in the periods before and after the introduction of antipsychotic medications (Warner, 2004). Moreover, although a decrease in hospital use between 1945 and 1955 was associated with an improvement in recovery rates, the later introduction of antipsychotics brought no further improvement in symptoms or social functioning (Warner, 2004). Why do poor outcomes persist in the West? A number of explanations have been put forward.
