Dia 1

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A systematic review and meta-analysis of
recovery from schizophrenic psychoses Erika
Jääskeläinen (1), Pauliina Juola (1), John
McGrath (2), Sukanta Saha (2), Juha Veijola (1),
Noora Hirvonen (1), Matti Isohanni (1), Jouko
Miettunen (1)  1 Department of Psychiatry,
University of Oulu and Oulu University Hospital,
Finland 2 Queensland Centre for Mental Health
Research, Australia.
Key message On average 17 of individuals having
schizophrenic psychosis experience recovery.
Objective To systematically collate studies
presenting amount of recovered individuals with
schizophrenic psychoses and to synthesize these
data with meta-analytic techniques.
Background Recovery in schizophrenia is still a
limitedly understood issue having extreme high
scientific and human importance. No systematic
review on this topic exist.
Methods ? Seven electronic databases, manual
literature searching, contacting authors via
email ? Keywords in electronic database search
schizo or psychotic or psychoss and recovery
or remission or outcome or course or prognosis
or follow-up or longitudinal were used as a
title search. The second search in abstracts
included keywords schizophrenia and recovery
or remission. ? Inclusion criteria English
language, presentation of primary data, not
therapy/drug trials/interventions, had at least
15 subjects, and had follow up data for at least
two years ? Recovery needed to be measured as
combination of clinical and social dimensions,
with at least two-year measurement window for
either of the outcome dimensions. ? All
abstracts and articles were critically analysed
by two of the authors (EJ and JMi).
Results
? The search identified 5950 potentially relevant
articles. After further screening, 59 studies
met our inclusion criteria (Figure). ? Between
0 to 60 of the subjects recovered (mean 17.3,
1090 quantiles 3.4-32.4). ? Mean annual
recovery rate was 1.5 (95 CI 1.1-1.9) ?
Compared to North-American and European studies
(n49), recovery was more common in studies from
other locations (n10 mean 24.4 vs. 15.8
meta-regression, z test 2.00, p0.050). ? The
time of starting the study (before vs. after
1965), length of follow-up (less vs. more than 10
years), diagnostic system (DSM vs. ICD vs. other)
and gender did not affect the percentage of
recovered individuals.
Figure. Included studies (n59) and the
percentage of recovered individuals.
Conclusions Based on this systematic review, at
least periods of recovery from schizophrenic
psychoses do occur. The proportion of patients
meeting recovery criteria do not seem to
increased during last decades. Relatively little
primary data on recovery in schizophrenia exist,
and various conceptual and methodological
pitfalls cause challenges when studying the
topic. More accurate reporting of
multidimensional recovery results and structured
consensus criteria for recovery in schizophrenia
are needed. Additionally, identifying predictors
of recovery would be useful for clinical work.
Correspondence MD, PhD Erika Jääskeläinen Departm
ent of Psychiatry, P.O.Box 5000 90014 University
of Oulu, Finland Email erika.jaaskelainen_at_oulu.fi
, tel. [phone]
References Please see handout. Acknowledgements
NARSAD, the Sigrid Juselius Foundation, the
Finnish Medical Foundation , Medical Society
Duodecim Oulu