One hundred years of schizophrenia: a meta-analysis of the outcome literature.
One hundred years of schizophrenia: a meta-analysis of the outcome literature.
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DOI：
10.1176/ajp.151.10.1409
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发表时间：
1994-10
影响因子：
17.7
通讯作者：
Hegarty Jd;R. Baldessarini;M. Tohen;C. Waternaux;G. Oepen
中科院分区：
文献类型：
--
作者：
Hegarty Jd;R. Baldessarini;M. Tohen;C. Waternaux;G. Oepen
目的本研究旨在评估20世纪精神分裂症预后文献中可能与诊断和治疗实践变化相关的历史趋势，并检验生物治疗方法的改进和诊断标准的变化对预后产生影响的假设。方法：对1895年至1992年关于精神分裂症或早发性痴呆结局的国际文献进行荟萃分析，确定了821项研究;其中320项研究，368个队列中的51，800名受试者，符合研究的纳入标准。结果在平均5.6年（范围= 1-40）的随访后，只有40.2%的患者被认为有改善。当患者根据广义标准（46.5%改善）或未定义标准（41.0%改善）而不是狭义标准（27.3%改善）进行诊断时，结局明显更好。19世纪中叶后，病情好转的患者比例显著增加（1956-1985年与1895-1955年，48.5%与35.4%），这可能反映了治疗的改善以及精神分裂症概念的拓宽。然而，在过去的十年中，平均有利结局率下降到36.4%，这可能反映了狭义诊断概念的重新出现。总体而言，不到一半的精神分裂症患者在平均随访近6年后表现出实质性的临床改善。尽管在本世纪中叶之后，改善率有了相当大的提高，但自1970年代以来，改善率一直在下降。这些历史变化可能反映了治疗的改善、诊断标准的转变以及与医疗保健变化相关的选择偏倚。
OBJECTIVE This study was undertaken to assess the twentieth-century literature on outcome in schizophrenia for historical trends that might be associated with changes in diagnostic and therapeutic practice and to test the hypothesis that both improved biological treatment and changes in diagnostic criteria have influenced outcome. METHOD Meta-analysis of the international literature on outcome in schizophrenia or dementia praecox from 1895 to 1992 identified 821 studies; 320 of these, with 51,800 subjects in 368 cohorts, met the inclusion criteria for the study. RESULTS Only 40.2% of patients were considered improved after follow-ups averaging 5.6 years (range = 1-40). Outcome was significantly better when patients were diagnosed according to systems with broad criteria (46.5% were improved) or undefined criteria (41.0% were improved) rather than narrow criteria (27.3% were improved). The proportion of patients who improved increased significantly after mid-century (for 1956-1985 versus 1895-1955, 48.5% versus 35.4%), probably reflecting improved treatment as well as a broadened concept of schizophrenia. However, in the past decade, the average rate of favorable outcome has declined to 36.4%, perhaps reflecting the re-emergence of narrow diagnostic concepts. CONCLUSIONS Overall, less than half of patients diagnosed with schizophrenia have shown substantial clinical improvement after follow-up averaging nearly 6 years. Despite considerable gains in improvement rates after mid-century, there has been a decline since the 1970s. These historical changes probably reflect improved treatment, shifts in diagnostic criteria, and selection bias related to changes in health care.