Huxley Peter, Krayer Anne, Poole Rob, Prendergast Louise, Aryal Sanjaya, Warner Richard
Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK.
Department of Sociology, University of Essex, Colchester, UK.
Brain Behav. 2021 Jun;11(6):e02172. doi: 10.1002/brb3.2172. Epub 2021 May 15.
We report a review of outcomes in schizophrenia in the twenty-first century, replicating and extending work undertaken by the late Richard Warner in his seminal book, "Recovery from Schizophrenia: Psychiatry and Political Economy" (1985;2004).
Warner's methods were followed as closely as possible. Only observational/naturalistic studies were included. Six scientific databases were searched from 2000 to 2020. 6,640 records were retrieved. 47 met inclusion criteria.
Overall, complete recovery is higher in this study than in Warner's (37.75% cf 20.4%), especially for first episode psychosis (FEP) (57.1% cf 20.7%). Clinical recovery, annualized remission rate (ARR), and employment outcomes were significantly superior for first episode psychosis compared with multiple episode psychosis (MEP). ARR shows a trend toward reduction over time, from 2.2 before the financial crash of 2008 to 1.6 after (t = 1.85 df 40 p = .07). The decline is statistically significant for the MEP group (t = 2.32 df18 p = .03). There were no differences in outcome by region, sample characteristics, outcome measures used, or quality of studies. Heterogeneity of clinical outcome measures across the literature makes evidence synthesis difficult. Weak and inconsistent reporting of functional and employment outcomes mean that findings lack meaning with respect to lived experience.
Future research strategies should aim to reduce heterogeneity in clinical outcome measures and to increase the emphasis on capture and reporting of more sophisticated measures of social and functional outcome. Outcome domains should be disaggregated rather than conflated into unitary recovery constructs.
我们报告了对21世纪精神分裂症治疗结果的综述，重复并扩展了已故的理查德·华纳在其开创性著作《从精神分裂症中康复：精神病学与政治经济学》（1985年；2004年）中所做的工作。
尽可能严格遵循华纳的方法。仅纳入观察性/自然主义研究。检索了2000年至2020年的六个科学数据库。共检索到6640条记录。47项符合纳入标准。
总体而言，本研究中的完全康复率高于华纳研究中的（37.75%对比20.4%），尤其是首次发作精神病（FEP）（57.1%对比20.7%）。与多次发作精神病（MEP）相比，首次发作精神病的临床康复、年化缓解率（ARR）和就业结果显著更优。ARR呈现出随时间下降的趋势，从2008年金融危机前的2.2降至之后的1.6（t = 1.85，自由度40，p = 0.07）。MEP组的下降具有统计学意义（t = 2.32，自由度18，p = 0.03）。不同地区、样本特征、所使用的结果测量方法或研究质量在结果上没有差异。整个文献中临床结果测量方法的异质性使得证据综合变得困难。功能和就业结果的报告薄弱且不一致，这意味着研究结果对于实际生活体验缺乏意义。
未来的研究策略应旨在减少临床结果测量方法的异质性，并更加注重捕捉和报告更复杂的社会和功能结果测量方法。结果领域应进行分解，而不是合并为单一的康复结构。
