Cross-cultural differences in the short-term prognosis of schizophrenic psychoses

Results of the 2-year followup of the patients included in the International Pilot Study of Schizophrenia (World Health Organization 1973) indicate that patients diagnosed schizophrenic on the basis of standardized assessments and clearly specified criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centers in developing countries had, on the average, considerably better course and outcome than schizophrenic patients in the centers in developed countries. Part of the variation of course and outcome was related to sociodemographic (e.g., social isolation and marital status) and clinical (e.g., type of onset and precipitating factors) predictors, but another larger part remained statistically unexplained. This suggests that variables usually used to describe psychopathology, the environment, and history of psychiatric patients in European and North American cultures may not account for cross-cultural differences. Clinical diagnosis on initial evaluation appeared to be a good predictor of subsequent symptomatology, but not of the length of the episodes, the total time during which the patient would be psychotic, pattern of course, or the degree of social impairment. A 5-year followup of the IPSS patients has also been completed, and the collected data are being analyzed.