Clinical, societal and personal recovery in schizophrenia spectrum disorders across time: States and annual transitions

PHAMOUS investigators, Stynke Castelein*, Marieke E. Timmerman, Mark Van Der Gaag, Ellen Visser

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)
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Background Recovery in schizophrenia is a complex process, involving clinical, societal and personal recovery. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time. Aims This study aimed to examine different states of recovery and transition rates between states. Method The Pharmacotherapy Monitoring and Outcome Survey (2006-2017) yearly assesses patients with schizophrenia in the Northern Netherlands. Data from 2327 patients with one up to 11 yearly measurements on clinical, societal and personal recovery were jointly analysed with a mixture latent Markov model (MLMM). Results The selected MLMM had four states that differed in degree and pattern of recovery outcomes. Patients in state 1 were least recovered on any domain (16% of measurements), and partly recovered in states 2 (25%; featured by negative symptoms) and 3 (21%; featured by positive symptoms). Patients in state 4 (38%) were most recovered, except for work, study and housekeeping. At the subsequent measurement, the probability of remaining in the same state was 77-89%, transitioning to a better state was 4-12% and transitioning to a worse state was 4-6%; no transitions occurred between states 1 and 4. Female gender, shorter illness duration and less schizophrenia were more prevalent in better states. Conclusions Quite a high recovery rate was present among a substantial part of the measurements (38%, state 4), with a high probability (89%) of remaining in this state. Transition rates in the other states might increase to a more favourable state by focusing on adequate treatment of negative and positive symptoms and societal problems.

Original languageEnglish
Pages (from-to)401-408
Number of pages8
JournalThe British Journal of Psychiatry
Issue number1
Early online date7-May-2021
Publication statusPublished - Jul-2021


  • Epidemiology
  • psychotic disorders
  • schizophrenia
  • social functioning
  • outcome studies

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