▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response
▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai
▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years
▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, using the SAS system of statistical analysis
▪ 61 of 101 patients showed good outcome on the CGIS after ten years
▪ Predictors of good recovery were high baseline positive symptoms and low negative symptoms, higher anxiety-depressive symptoms, lower level of depressive symptoms, lower level of aggression, higher work performance and ability to live independently.
▪ Characteristics of non-recovered patients showed higher extra pyramidal symptoms, severe aggressive symptoms, higher frequency of disorganization symptoms at baseline and higher level of family burden at the end of the term
▪ Our study shows reasonably good outcome [61.7%] in first episode-hospitalized patients
▪ Good outcome correlated with severity of positive symptoms, level of work function and ability to live independently at baselin

Chinnasamy, Gurusamy

Johnston, Megan

Shah, Nilesh

Shrivastava, Amresh

Stitt, Larry

Thakar, Meghana

English

Scholarship@Western

Predictors and Characteristics of Response and Nonresponse: A Ten Year Follow-Up of First Episode Schizophrenia in Mumbai

Western UniversityScholarship@WesternPsychiatry Presentations Psychiatry Department1-19-2010Predictors and Characteristics of Response andNonresponse: A Ten Year Follow-Up of FirstEpisode Schizophrenia in MumbaiAmresh ShrivastavaUniversity of Western Ontario, amresh.srivastava@sjhc.london.on.caNilesh ShahUniversity of MumbaiMegan JohnstonUniversity of TorontoLarry StittUniversity of Western Ontario, larry.stitt@schulich.uwo.caMeghana ThakarSilver Mind Hospital, Mumbai, IndiaSee next page for additional authorsFollow this and additional works at: https://ir.lib.uwo.ca/psychiatrypresPart of the Psychiatry and Psychology CommonsCitation of this paper:Shrivastava, Amresh; Shah, Nilesh; Johnston, Megan; Stitt, Larry; Thakar, Meghana; and Chinnasamy, Gurusamy, "Predictors andCharacteristics of Response and Nonresponse: A Ten Year Follow-Up of First Episode Schizophrenia in Mumbai" (2010). PsychiatryPresentations. 33.https://ir.lib.uwo.ca/psychiatrypres/33AuthorsAmresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, and Gurusamy ChinnasamyThis presentation is available at Scholarship@Western: https://ir.lib.uwo.ca/psychiatrypres/33TEMPLATE DESIGN © 2008www.PosterPresentations.comPredictors and Characteristics of Response and Nonresponse: A Ten Year Follow-Up of  First Episode Schizophrenia in MumbaiAmresh Shrivastava1, Nilesh Shah2, Megan Johnston3, Larry Stitt4, Meghana Thakar5, and Gurusamy Chinnasamy6Abstract Results – Clinical OutcomeConclusionsAcknowledgementsDifferences on Continuous VariablesAffiliationsThe study was supported partly by Ashoka Innovators for Public, Washington, DC, USA and the PRERANA charitable Trust, Mumbai,India.▪It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, using the SAS system of  statistical analysis▪ 61 of 101 patients showed good outcome on the CGIS after ten years▪ Predictors of good recovery were high baseline positive symptoms and low negative symptoms, higher anxiety-depressive symptoms, lower level of depressive symptoms, lower level of aggression, higher work performance and ability to live independently. ▪ Characteristics of non-recovered patients showed higher extra pyramidal symptoms, severe aggressive symptoms, higher frequency of disorganization symptoms at baseline and higher level of family burden at the end of the term ▪ Our study shows reasonably good outcome [61.7%] in first episode-hospitalized patients▪ Good outcome correlated with severity of positive symptoms, level of work function and ability to live independently at baseline▪ Outcome of schizophrenia in developing countries, including India, has been ‘good’ due to a variety of reasons, such as the acute and florid nature of symptoms, less deterioration, family support, etc. However, the psychosocial situation of metro cities also contributes to poorer outcome and may jeopardize the benefits seen in the developing world.▪ Historically, poor outcome has often been considered to be an integral part of the concept of schizophrenia, though in recent times this has been challenged by many cross-cultural studies. The evidence arising from various studies across the globe largely supports the ‘favorable outcome hypothesis in developing countries’, i.e. developing countries have a larger proportion of patients with a good outcome and lesser percentage with a worse outcome as compared to developed countries▪ The pertinent question remains:  ‘Do patients in developing countries continue to have good outcome of schizophrenia?’ Furthermore, what characteristics predict good outcome?BackgroundMethodsMeasures▪ Recovered and non-recovered groups differed in repeat hospitalization, presence of positive symptoms and presence of negative symptoms▪ In a logistical regression analysis we found that recovery was statistically correlated with higher age at the baseline, higher scores on positive symptoms, lower scores on negative symptoms, lower scores on depression, and lower levels of aggression▪ The scores of total PANSS baseline, CGIS, gender, baseline interpersonal social functioning, the level of family burden, and level of suicidality did not predict either good or poor outcome 1 Silver Mind Hospital, Mumbai, India; and University of Western Ontario, London, Ontario, Canada; 2LTMG College, Mumbai University, India;3University of Toronto, Toronto, Ontario, Canada; 4University of Western Ontario, London, Ontario, Canada; 5Silver Mind Hospital, Mumbai, India; and NHS, United Kingdom6Centre for Applied Research and Technology Transfer, The Northern Alberta Institute of Technology, Edmonton, Alberta, Canada▪ Measures of outcome on multidimentional criteria were divided into clinical and social recovery ▪ Clinical parameters consisted of symptoms, psychopathology, side effects, depression, aggression, hospitalization , and suicidality▪ Social parameters were quality of life functioning, employability, return to education, interpersonal functioning, level of family burden cause, and the ability to live independently▪ Outcome was measured using the Clinical Global Impression Scale (CGIS).▪ The study was carried out in a non-governmental, psychiatric hospital certified as a psychiatric facility by the State Government as per the Indian Mental Health Act 1987. The study period spanned from 1993 to 2007. ▪ The current sample of 101 patients diagnosed with schizophrenia were admitted in their first episode ten years back. These patients were assessed at the time of admission and then ten years post-treatment the available patients were reassessed ▪ Good outcome was defined as those showing ‘improvement’ and ‘much improvement’ on the CGIS. Clinical assessment was administered by two experienced clinicians. Also at the follow-up, diagnosis was reconfirmed using the DSM-IV-TRDifferences between Recovered & Non-recovered subjects at 10 years (Continuous Variables)Outcome Non-recovered (n=40) {Mean (sd)}Recovered (n=61){Mean (sd)}Difference{Mean (sd)}95% CI about differenceP ValueγAge at End of Study 33.4 (7.2) 41.8 (7.3) -6.5 (7.3) -9.4 - -3.5 <.001PANNS 54.9 (9.0) 49.4 (8.2) 5.5 (8.5) 2.1 - 9.0 .002Positive Symptoms 9.8 (3.8) 8.0 (3.9) 1.9 (3.8) 0.3 - 3.4 .019Negative Symptoms 15.4 (6.0) 10.1 (7.5) 5.4 (6.9) 2.6 - 8.2 <.001GP 26.3 (10.0) 31.0 (12.7) -4.7 (11.7) -9.4 - 0.1 .053HDRS 14.1 (4.9) 12.5 (5.3) 1.6 (5.2) -0.5 - 3.7 .141GAF 79.9 (10.7) 78.3 (12.2) 1.6 (11.7) -3.3 - 6.5 .523QOL 54.5 (7.5) 76.2 (11.5) -21.7 (10.1) -25.8 - -17.6 <.001γ Statistical comparisons obtained using unpaired t-tests.  For QOL there was evidence that the variances are not equal.  However, via a non-parametric test (Wilcoxon two-sample test) a between-group statistically significant difference was observed (p<.001)▪ The present study shows that out of 101 patients available at 10 years of follow up 61 showed much improvement and 40 patients showed poor outcome ▪ There was statistically significant difference on the scale of total PANSS and both positive and negative symptoms in the recovered and non-recovered group ▪ The characteristic features of the group not showing recovery were lower age at intake, lower positive symptoms, higher negative symptoms, lower anxiety-depressive symptoms, higher scores of depression, higher score of aggression▪ Thus, our study shows reasonably good recovery [61.7%] in first episode-hospitalized patients. The good outcome correlated with severity of positive symptoms, level of work function and ability to live independently at baseline.Differences on Dichotomous VariablesDifferences between Recovered & Non-recovered subjects at 10 years (Dichotomous Variables)Outcome Non-recovered (n=40){frequency (%)}Recovered (n=61){frequency (%)}P Valueγ>1 Hospitalization in 10 years 37 (92.5%) 24 (40.7%) <.001>7 Positive Symptoms 30 (75.0%) 24 (39.3%) <.001>7 Negative Symptoms 35 (87.5%) 26 (42.6%) <.001Disorganization >3 27 (67.5%) 17 (27.9%) <.001IP Social ≤3 36 (90.0%) 37 (60.7%) .001Work ≤3 39 (97.5%) 36 (60.0%) <.001AIMS ≤2 25 (62.5%) 39 (66.1%) .713Disturbed Independent Living  ≤3 35 (87.5%) 16 (27.1%) <.001Aggression>2 17 (42.5%) 22 (36.7%) .558Family Burden >3 22 (61.1%) 32 (53.3%) .457Suicidality - Occasional or Occasional with plan20 (55.6%) 31 (51.7%) .712GAF≤80 20 (55.6%) 35 (58.3%) .790QOL<80 40 (100.0%) 32 (53.3%) <.001γ Statistical comparisons obtained using chi-square tests for comparing proportions.Results – Social Outcome▪ Poor work performance and poor interpersonal socialization did not significantly change during 10 years. Ability to live independently improved significantly. Those who did not recover had poor baseline work functioning, poor independent living ability, high scores on aggression 

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response  ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai  ▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years  ▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, using the SAS system of statistical analysis  ▪ 61 of 101 patients showed good outcome on the CGIS after ten years  ▪ Predictors of good recovery were high baseline positive symptoms and low negative symptoms, higher anxiety-depressive symptoms, lower level of depressive symptoms, lower level of aggression, higher work performance and ability to live independently.  ▪ Characteristics of non-recovered patients showed higher extra pyramidal symptoms, severe aggressive symptoms, higher frequency of disorganization symptoms at baseline and higher level of family burden at the end of the term  ▪ Our study shows reasonably good outcome [61.7%] in first episode-hospitalized patients  ▪ Good outcome correlated with severity of positive symptoms, level of work function and ability to live independently at baselin

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Predictors and Characteristics of Response and Nonresponse: A Ten Year Follow-Up of First Episode Schizophrenia in Mumbai

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