Objective: Our primary aims were (a) to identify the proportion of individuals with schizophrenia and related psychoses who met recovery criteria based on both clinical and social domains and (b) to examine if recovery was associated with factors such as gender, economic index of sites, and selected design features of the study. We also examined if the proportions who met our definition of recovery had changed over time. Method: A comprehensive search strategy was used to identify potential studies, and data were extracted for those that met inclusion criteria. The proportion who met our recovery criteria (improvements in both clinical and social domains and evidence that improvements in at least 1 of these 2 domains had persisted for at least 2 years) was extracted from each study. Meta-regression techniques were used to explore the association between the recovery proportions and the selected variables. Results: We identified 50 studies with data suitable for inclusion. The median proportion (25%–75% quantiles) who met our recovery criteria was 13.5% (8.1%–20.0%). Studies from sites in countries with poorer economic status had higher recovery proportions. However, there were no statistically significant differences when the estimates were stratified according to sex, midpoint of intake period, strictness of the diagnostic criteria, duration of follow-up, or other design features. Conclusions: Based on the best available data, approximately, 1 in 7 individuals with schizophrenia met our criteria for recovery. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased.

Background: Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear.Aims: To analyse the associations between DUP and long-term outcomes of schizophrenia.Method: A systematic literature search was performed using seven electronic databases and manual searches. Random effects weighted meta-analysis with correlation coefficients was used to pool the results.Results: We identified 3493 unique publications, from which 33 samples met our predefined selection criteria. Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13–0.18). Long DUP was not associated with employment, quality of life or hospital treatment.Conclusions: The small but mostly consistent correlation between long DUP and poor outcome indicates that early intervention in psychosis may have at least subtle positive effects on the long-term course of illness.

Objective: Our aim was to review recent studies and estimate the rate of cannabis use disorders (CUDs) in schizophrenia, as well as to examine the factors affecting this rate. Methods: We conducted an electronic search of 3 literature databases and a manual search of articles from 1996 to 2008. The key words used were “schizophreni*,” “psychos*s,” “psychotic,” “cannabis abuse,” “cannabis dependence,” “cannabis use disorder,” “substance use disorder,” “substance abuse,” “substance dependence,” and “dual diagnosis.” Articles that reported diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases were included. Regression analysis was used to examine how estimated rates of CUDs are affected by various study characteristics such as the classification system, inpatient vs outpatient status, study location, proportion of males, age of the sample, or duration of illness. Results: Thirty-five studies met our search criteria. The median current rate of CUDs was 16.0% (interquartile range [IQR] = 8.6–28.6, 10 studies), and the median lifetime rate was 27.1% (IQR = 12.2–38.5, 28 studies). The median rate of CUDs was markedly higher in first-episode vs long-term patients (current 28.6%/22.0%, lifetime 44.4%/12.2%, respectively) and in studies where more than two-thirds of the participants were males than in the other studies (33.8%/13.2%). CUDs were also more common in younger samples than in the others (current 38.5%/16.0%, lifetime 45.0%/17.9%). Conclusions: Approximately every fourth schizophrenia patient in our sample of studies had a diagnosis of CUDs. CUDs were especially common in younger and first-episode patient samples as well as in samples with a high proportion of males.

To examine the association between body size and depression in a longitudinal setting and to explore the connection between obesity and depression in young adults at the age of 31 years. This study forms part of the longitudinal Northern Finland 1966 Birth Cohort Study (N=12 058). The follow-up studies were performed at 14 and 31 years. Data were collected by postal inquiry at 14 years and by postal inquiry and clinical examination at 31 years. A total of 8451 subjects (4029 men and 4422 women) who gave a written informed consent and information on depression by three depression indicators at 31 years. Body size at 14 (body mass index (BMI) and 31 (BMI and waist-to-hip ratio (WHR)) years and depression at 31 years by three different ways: depressive symptoms by the HSCL-25-depression questionnaire (HSCL-25), the use of antidepressants and self-reported physician-diagnosed depression. Obesity at 14 years associated with depressive symptoms at 31 years; among male subjects using the cutoff point 2.01 in the HSCL-25 (adjusted odds ratio (OR) 1.97, 95% CI 1.06–3.68), among female subjects using the cutoff point 1.75 (adjusted OR 1.64, 95% CI 1.16–2.32). Female subjects who were obese both at baseline and follow-up had depressive symptoms relatively commonly (adjusted OR 1.40, 95% CI 1.06–1.85 at cutoff point 1.75); a similar association was not found among male subjects. The proportion of those who used antidepressants was 2.17-fold higher among female subjects who had gained weight compared to female subjects who had stayed normal-weighted (adjusted OR 2.17, 95% CI 1.28–3.68). In the cross-sectional analyses male subjects with abdominal obesity (WHR 85th percentile) had a 1.76-fold risk of depressive symptoms using the cutoff 2.01 in the HSCL-25 (adjusted OR 1.76, 95% CI 1.08–2.88). Abdominally obese male subjects had a 2.07-fold risk for physician-diagnosed depression (adjusted OR 2.07, 95% CI 1.23–3.47) and the proportion of those who used antidepressants was 2.63-fold higher among obese male subjects than among male subjects without abdominal obesity (adjusted OR 2.63, 95% CI 1.33–5.21). Abdominal obesity did not associate with depression in female subjects. Obesity in adolescence may be associated with later depression in young adulthood, abdominal obesity among male subjects may be closely related to concomitant depression, and being overweight/obese both in adolescence and adulthood may be a risk for depression among female subjects.

We examine whether pregnancy weight (pre-pregnancy body mass index (BMI) and/or weight gain) is related to core symptoms of attention deficit hyperactivity disorder (ADHD) in school-age offspring. Follow-up of prospective pregnancy cohorts from Sweden, Denmark and Finland within the Nordic Network on ADHD. Maternal pregnancy and delivery data were collected prospectively. Teachers rated inattention and hyperactivity symptoms in offspring. High scores were defined as at least one core symptom rated as ‘severe’ and two as ‘present’ (approximately 10% of children scored in this range). Logistic regression and latent class analyses were used to examine maternal pregnancy weight in relation to children's ADHD core symptoms. Teacher rated 12 556 school-aged children. Gestational weight gain outside of the Institute of Medicine guidelines was not related to ADHD symptoms (below recommendations: odds ratio (OR): 0.96; 95% confidence interval (CI): 0.81, 1.14; above recommendations: OR: 0.98; 95% CI: 0.82, 1.16). To examine various patterns of pre-pregnancy BMI and weight gain, we used latent class analysis and found significant associations between classes that included pre-pregnancy overweight or obesity and a high ADHD symptom score in offspring, ORs ranged between 1.37 (95% CI: 1.07, 1.75) and 1.89 (95% CI: 1.13, 3.15) adjusted for gestational age, birth weight, weight gain, pregnancy smoking, maternal age, maternal education, child gender, family structure and cohort country of origin. Children of women who were both overweight and gained a large amount of weight during gestation had a 2-fold risk of ADHD symptoms (OR: 2.10, 95% CI: 1.19, 3.72) compared to normal-weight women. We show for the first time that pre-pregnancy BMI is associated with ADHD symptoms in children. Our results are of public health significance if the associations are causal and will then add ADHD symptoms in offspring to the list of deleterious outcomes related to overweight and obesity in the prenatal period.