The prognosis of schizophrenia across cultures

Taken as a whole, the reported cross-cultural studies of schizophrenia suggest that both the frequency of occurrence of the disease and the outcome for individual patients vary across cultures. Some of the observed variation in incidence rates is most likely secondary to differences in the use of diagnostic criteria, and this source of error is difficult to quantify. On the other hand, good evidence suggests that much of the variability in prognosis may be related to the sociocultural context of the patient's family. Personal dynamics within the family may therefore be an important mediator of the observed cross-cultural differences in the outcome of schizophrenia. The purpose of this paper is to review three areas of research in schizophrenia; namely, the importance in variation of the "first rank symptoms" and expressed emotion in families from different societies, and the findings of the World Health Organization International Pilot Study of Schizophrenia to demonstrate that patients with this disorder in developing countries have a more positive prognosis than do comparable patients in western industrialized societies.