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Schizophrenia--falling incidence and better outcome?
1Department of Psychiatry, University Hospital, Nottingham.
Summary
Schizophrenia is not disappearing or becoming milder. Methodological issues in studies suggest changes in clinical practices, not the disease itself. Further research on schizophrenia time trends is needed.
Area of Science:
- Psychiatry
- Epidemiology
- Clinical Psychology
Background:
- Recent theories suggest schizophrenia may be a "disappearing disease" or undergoing a benign metamorphosis.
- This implies potential changes in the disorder's incidence, prevalence, or clinical course over time.
Purpose of the Study:
- To critically review the evidence supporting the "disappearing schizophrenia" hypothesis.
- To evaluate the parallel theory of schizophrenia's benign metamorphosis.
- To assess the validity of observed changes in schizophrenia's course and outcome.
Main Methods:
- Systematic review and critical analysis of existing follow-up studies on schizophrenia.
- Examination of methodological limitations in previous research.
- Assessment of potential confounding factors such as changes in diagnostic criteria, treatment, and study quality.
Main Results:
- Current evidence for schizophrenia's disappearance or benign change is unconvincing.
- Methodological flaws in follow-up studies limit reliable conclusions.
- Observed changes are more likely attributable to shifts in clinical assumptions, treatments, and study quality.
Conclusions:
- The theory that schizophrenia is disappearing or becoming benign is not supported by current evidence.
- Changes in clinical practice and research methodology, rather than the disease itself, likely explain perceived trends.
- Further rigorous scientific investigation into potential time trends in schizophrenia incidence and outcome is warranted.