Shah, Nilesh

Srivastava, Amresh

Stitt, Larry

Thakar, Meghan

English

Scholarship@Western

Outcome in Schizophrenia: How Good Is  Good Outcome  Schizophrenia in Long-term in Developing Countries

Western UniversityScholarship@WesternPsychiatry Presentations Psychiatry Department9-2008Outcome in Schizophrenia: How Good Is "GoodOutcome" Schizophrenia in Long-term inDeveloping CountriesAmresh SrivastavaUniversity of Western Ontario, amresh.srivastava@sjhc.london.on.caMeghan ThakarSilver Mind Hospital, Mumbai, IndiaNilesh ShahLTMG Hospital, Mumbai, IndiaLarry StittUniversity of Western Ontario, larry.stitt@schulich.uwo.caFollow this and additional works at: https://ir.lib.uwo.ca/psychiatrypresPart of the Psychiatry and Psychology CommonsCitation of this paper:Srivastava, Amresh; Thakar, Meghan; Shah, Nilesh; and Stitt, Larry, "Outcome in Schizophrenia: How Good Is "Good Outcome"Schizophrenia in Long-term in Developing Countries" (2008). Psychiatry Presentations. 9.https://ir.lib.uwo.ca/psychiatrypres/9How Good is ‘Good Outcome’ Schizophrenia in Long-term in Developing countries. Amresh Shrivastava1, Meghan Thakar2, Nilesh Shah3 , Larry S:; 4    1. Department of Psychiatry University of Western Ontario, Canada. & Director, PRERANA Psychiatric Services & Silver Mind Hospital, Mumbai, India  2. Clinical psychologist. Silver Mind Hospital, Mumbai, India 3. Professor & Head of Psychiatry, LTMG Hospital , Mumbai, India  4. department of Biosta:cs & Epidemiology, University of Western Ontario, London, Ontario, Canada Outcome in Schizophrenia  Declaration  •  Declaration of Conflict of Interest ▫  Janssen Group ▫  Eli Lilly ▫  Astra Zeneca ▫  Nicholas Piramal-Rosch ▫  Sun Pharma- India ▫  Prempharma , Canada •  in Capacity of  ▫  Consultant ▫  Advisor ▫  Drug trial coordinator ▫  Research Investigator ▫  Reviewer ▫  Speaker ▫  Educational Groups 18 million Introduction:  • The illness of schizophrenia has always been a matter of concern for its nature and extent of outcome particularly for its regional and cultural differences. •   The concept of outcome has been evolving and this study examines the scenario of good outcome in developing countries. • Methods Re-examination of recovered patients in ten years long term, naturalistic, prospective study using Meltzer et al’s 13 outcome criteria & on a new outcome scale Methods In a Longitudinal , Naturalistic,  cohort study, patients with completed 10 years treatment were assessed on clinical and social parameter. These patients were re-assessed for the status and quality of recovery using Global outcome scale  on 7 outcome criteria Results were analyzed.  Screening  :  Patients diagnosed DSM IIIR : First Hospitalization Recruited Assessment Follow up for ten years Reassessment  Clinical Social Outcome ( Global outcome criteria.)  Methods Present study Good outcome : 67 1996 Phase I N=200 Follow up period for 10 years Phase II Drop outs : 93 2003 Phase III N= 107     Study parameters: •  Demography •  Clinical parameters •  Global Outcome criteria •  PANSS •  CGIS Multiple outcome criteria in schizophrenia Various parameter quantified based on clinical outcome and using popular scales for measurement Thirteen criteria • 1.Psychopathology (positive symptoms, negative symptoms and disorganization) • 2.Cognitive function (attention, executive function, working memory, recall memory, semantic memory, storage memory) • 3.Interpersonal social function • 4.Work–school function  • 5.Extra pyramidal function (parkinsonism, akathesia, tardive dyskinesia) Meltzer HY. Eur Psychiatry 1995;10(Suppl. 1):19S–25S 6.Independent living 7.Aggression 8.Quality of life 9.Compliance 10.Hospitalization 11.Family burden 12.Social burden 13.Suicidality Psychopathology: Total Positive Symptoms P<0.001 The residual features and persisting symptoms include positive symptoms, negative symptoms, suicidality, side effects like EPS, Interpersonal Social Functioning NS Cognition: Global  Work/ employment EPS Independent Living Aggression Quality of Life  Hospitalization Family Burden Suicidality Global assessment of functioning Hospitalization does not Correlate with any of the thirteen  outcome variables ( P < 0.01 to P< 0.5, NS) parameters  Hospitalized(25)  Non‐hospitalized (42)  P‐value  signiﬁcance Posi:ve symptoms  28  42  0.01  NS Nega:ve symptoms  15  21  0.05  NS Disorganiza:on  17  24  0.05  NS Interpersonal func:oning 12  30  0.01  NS Cogni:on not Declined  14  20  0.05  NS Independent living possible  12  17  0.5  NS Aggression not present  22  30  0.05  NS Improved QOL  16  30  0.5  NS Family Burden  15  25  0.01  NS Social burden  23  29  0.05  NS No Suicidality  23  29  0.01  NS Sustained work/school  15  17  0.01  NS Cross analysis of independent variables against hospitalized Vs non-hospitalized did not provide statistically significant parameter. The two groups do not differ significantly on several parameters assessed. Improvement with various Criterias Re-assessed outcome at 10 years Good outcome appears to have several variables Why does schizophrenia show ‘poor’ outcome in developing Countries as well. • Changing culture • Treatment response • Changing phenomenology: Needs studies • Changing families • Late intervention • Treatment design, Lack of continuity • Lack of support system, resource, accessibility • Stigma • Poor advocacy and awareness Conclusion  Schizophrenia is a complex neurobehavioral disorder with limited outcome.  Multidimensional Clinical and Social recovery is achieved in 32% subjects in ten years treatment. Half of the patients improve with no concomitant difficulty while another half improves varieties of disability Outcome measures in schizophrenia need to be re-structured to capture real-life situation.  

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Outcome in Schizophrenia: How Good Is Good Outcome Schizophrenia in Long-term in Developing Countries

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