I Findings from Long-Term Outcome Studies
Past and Future Directions in Psychosis Research
EVELYN J. BROMET
This chapter offers a series of observations about the changes in orientation and the findings of studies of long-term outcomes of individuals with schizophrenia and affective psychoses. Although we know considerably more about the short-term (under 5 years from first diagnosis) course and functioning of these individuals, there are many fewer long-term studies, especially having at least 10 years of follow-up. Several comprehensive reviews of the follow-up literature have been published.1-9 The key purpose here is to synthesize the contributions of older and more recent studies and make suggestions for reshaping future research so that all stakeholders—scientists, patients, family members, and providers—have input into conceptualizing and operationalizing the “bio,” “psycho,” and “social” aspects of the biopsychosocial model. Prior to the early 1980s, when the World Health Organization (WHO) began the Determinants of Outcome of Severe Mental Disorders (DOSMED) study,10 most longitudinal research findings were based on consecutive admission samples from single inpatient facilities.3,8,11 Fewer than half of the patients in these studies were considered improved at follow-up.3 DOSMED was a game changer for study design, but, as shown in this chapter, the refinements in sampling, diagnosis, and measurement, and the newly available psychiatric services and treatments, did not markedly alter the overall picture about clinical or social improvement. What is beginning to change, however, is the broadening of our perspective about risk factors and outcomes.11 The chapter concludes with recommendations about domains of functioning and research partnerships that will enrich our understanding of the illness course and clinical, social, and cognitive outcomes of the millions of people who suffer from a psychotic illness.