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The first internationally understandable epidemiological studies 

The first internationally understandable epidemiological studies
The first internationally understandable epidemiological studies

John E. Cooper

and Norman Sartorius

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date: 17 December 2018

For the International Pilot Study of Schizophrenia of the WHO (IPSS) eight Field Research Centres were set up, in(Denmark), Cali (Columbia), Agra (India), Ibadan (Nigeria), Taipei (Taiwan), Washington (USA) and London (UK). A ninth, Prague (Czechoslovakia) was added in 1967. In each centre a “convenience sample” of 120 patients likely to be suffering from schizophrenia were was assessed by means of the PSE and other schedules; diagnoses were made according to the Glossary to ICD-8. Patients with typical syndromes of schizophrenia were easily found in all centres, and followed up for 2 years. An unexpected finding emerged in the follow-up, in that there were higher proportions of patients in the favourable outcome categories in the centres in the under-developed countries (such as India and Nigeria) than in the developed countries (such as Denmark, London and the USA). This finding was one of the principal motivations for the subsequent epidemiologically-based Determinants of Outcome of Severe Mental Disorders (DOSMED) study. For this, a wider set of cultures was covered by the addition of FRCs in Chandigarh (India), Nagasaki (Japan), Honolulu (USA) and Dublin (Ireland). In the UK, Nottingham replaced London. Each FRC defined a catchment area of at least several hundred thousand persons aged 15- 54 years, from which all persons who developed a new (lifetime first) potentially schizophrenic illness were assessed and included in a two-year follow-up study. The tendency for a better outcome for patients in the developing centres was confirmed, but remained unexplained. Using a comparatively narrow definition of schizophrenia, its incidence was not significantly different between the centres, but using a wider definition some differences were found. These findings were confirmed again by the latest WHO report published as the International Study of Schizophrenia (ISOS). In this, the IPSS and the DOSMED data are put together with data from a number of other similar studies sponsored by the WHO, to give follow-up assessment on a total of more than 1000 patients in 14 countries, over follow-up periods of 15-20 years.

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