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Redefining outcome measures in schizophrenia: integrating social and clinical parameters

Shrivastava, Amresha; Johnston, Meganb; Shah, Nileshc; Bureau, Yvesd

Current Opinion in Psychiatry: March 2010 - Volume 23 - Issue 2 - p 120–126
doi: 10.1097/YCO.0b013e328336662e
Schizophrenia: Edited by W. Wolfgang Fleischhacker

Purpose of review Schizophrenia is a complex neurobehavioral disorder for which there are many promising new treatments. There is, however, a discrepancy in outcome measure reports when they are obtained from patients, relatives, caregivers, or professionals, making it difficult to determine the level of recovery. This lack of agreement may result from limitations of the measurement tools themselves, which are not comprehensive and may be measuring different aspects of outcome. Alternatively, it could be that the conceptual understanding of outcome and recovery require development.

Recent findings For various reasons, patients assessed as ‘recovered’ remain excluded from mainstream society. We are of the opinion that present outcome measures do not capture real-life situations. We propose that the concept of recovery be carefully defined and the gold standard of outcome should incorporate social and clinical parameters. We attempt to redefine recovery. Patients who have shown clinical improvement do not necessarily do well in everyday situations even though there is obvious clinical improvement. Therefore, it has been repeatedly argued that a consensus of recovery should be determined and that routine clinical practice should then adapt to the agreed criteria.

Summary We argue that the outcome measures should be multidimensional and consist of at least two parameters: clinical remission and social outcome.

aDepartment of Psychiatry, University of Western Ontario, Regional Mental Healthcare, St. Thomas, Canada

bUniversity of Toronto, Toronto, Ontario, Canada

cLTMG Hospital, University of Mumbai, Sion, Mumbai, India

dUniversity of Western Ontario, London, Ontario, Canada

Correspondence to Amresh Shrivastava, Department of Psychiatry, University of Western Ontario, Regional Mental Healthcare, 467 Sunset Drive, St. Thomas, ON N5H 3V9, Canada Tel: +1 519 631 8510; fax: +1 519 631 2512; e-mail:,

© 2010 Lippincott Williams & Wilkins, Inc.