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Differential outcome of schizophrenia: where we are and where we would like to be

  • Oye Gureje (a1) and Alex Cohen (a2)

Summary

Studies examining comparative outcomes of schizophrenia in high-income countries with those in low- and middle-income countries remain of interest to researchers and may be of value in understanding some environmental factors that influence the course and outcome of the disorder. The view that the disorder has a better outcome in low- and middle-income countries compared with high-income countries, even though widespread and supported by a set of World Health Organization (WHO) studies, requires further testing and exploration. Unfortunately, although not insurmountable, the obstacles for such studies both in terms of implementation and interpretation are considerable.

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Copyright

Corresponding author

Oye Gureje, WHO Collaborating Center for Research and Training in Mental Health, Neurosciences, Drug and Alcohol Abuse, Department of Psychiatry, University of Ibadan, Nigeria, Africa. Email: ogureje@comui.edu.ng

Footnotes

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See pp. 194–201, this issue.

Declaration of interest

None.

Footnotes

References

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Differential outcome of schizophrenia: where we are and where we would like to be

  • Oye Gureje (a1) and Alex Cohen (a2)
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eLetters

response : letter to the editor.

Hina Agha, doctor
05 October 2011

By Dr. Hina AghaST5 General Adult Psychiatry . Kent & Medway NHS and Social Care Partnership Trust. In response to the article published in Spet 2011 issue vol 199 NO. 3 ofBritish Journal of Psychiatry , 'Differential outcome of schizophrenia: where we are and where we would like to be' by Dr. Oye Gurejee and Alex Cohen. A very important issue has been addressed which is the need of standardisation for the diagnosis and treatment of Schizophrenia across all the nations of the world. The WHO studies point towards differential outcomes for schizophrenia across different parts of the world ie. betterrecovery rates in Low and middle income countries ( LMIC) However there is a huge gap in the economic & health status and provision of health services to people from high income countries (HICC) and LMIC. Mental health remains to be a cultural taboo in the background of low and in someareas nonexistent literacy rate in LMIC . Also mental health remains to be at the lower end in the priority list of the government budgets of these countries.4 Hence we face a situation where we are not sure about the reliability of our diagnostic facilities applied to LMIC. In LMIC the scant structure of health services3 at government level force people to go for private .This highly skewed any collected data 1as where the money is scared mental health would be the last priority for a household budget. This leaves us with a situation where we see schizophrenia cases either from financially or/and educational well off masses , where the relatives couldafford the private treatment .Or where the cases are very severe and have been left untreated for probably a long time. This is often the case where the caring relatives dies or losses strength to continue to look after the mentally ill relative. This also raises a question; are we facing a culture of sick role in HIC where the standard of living is higher , more education and public awareness , health cover by the government and more structured mental health services. With this sick role and the associated benefits are wenegatively contributing towards functional recovery? And what exactly doesthe 'functional recovery ' mean . Is it a concept in the western clinician's mind and is it culturally and socially desirable in LMIC. We need more work in Global mental health ( International Psychiatry) to have a broader understanding of Schizophrenia with an aim to improve the prognosis by addressing environmental /social factors. 2Reference:1.Bhurghra Dinesh. The Global Prevalence of Schizophrenia . PLoS 2005;2(5)e151.2. Krabbendam L, Van Os J. Schizophrenia and urbanicity : a major environmental influence -conditional on genetic risk.Schizoph. Bull. 2005;31(4):795-799.3.Mari de Jesus Jair, Razzouk Denise et al.Packages of care for schizophrenia in low and middle income countries.PLoS Oct 2009 .6;10: e1000165.4.Prince Martin , Patel Vikram, Saxena Shekar et al .No health without mental health . Lancet. Global Mental Health series 1. Vol 370,Sept 8,2007.

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Conflict of interest: None declared

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