DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20180296

Clinical correlates of first episode schizophrenia-a comparative study

Kathir M., Pugazhendhi K., Ravishankar J.

Abstract


Background: Schizophrenia is a major mental disorder which has to be assessed early and managed actively even though long term functional outcome remains relatively poor. The aim of the study is to analyze negative symptoms, suicidal risk and substance use in first episode schizophrenics in comparison with multi-episode schizophrenics.

Methods: 30 patients with drug naive first episode schizophrenia and 30 patients with multi episode schizophrenia, who attended the outpatient department of Psychiatry, Government Stanley Medical College, Chennai, Tamilnadu, India were studied to compare predisposing factors and spectrum of symptoms for Schizophrenia for a period of one year (January 2010-December 2010). Psychiatric questionnaire by Michael C. Hilton, DAST by Harvey A. Skinner, AUDIT by WHO, Suicide risk scale by National Health and Medical Research Council, PANSS by SR Kay were used to assess patients.

Results: Unemployment and family history of suicide attempts were observed more in drug naive first episode schizophrenics. 90% of these patients had completed their primary education while 47% of multi-episode schizophrenics were illiterates. Positive symptoms (delusions, hallucinatory behaviour and suspiciousness) and negative symptoms (blunted affect, emotional withdrawal and social withdrawal) were observed more in first episode schizophrenics while PANSS, DAST, AUDIT scores did not find any differences between both the groups.

Conclusions: In our study, the first episode schizophrenia patients were more educated, more unemployed and had more family history of suicide, elevated sub score of positive symptoms as measured by PANSS. Relative assessment of violence and serious behavior problems that are related to positive symptoms must be done and managed with anti psychotics.


Keywords


First episode, Negative symptoms, Positive symptoms, Schizophrenia

Full Text:

PDF

References


Ayuso-Mateos JL. Global Burden of schizophrenia in the year 2000-Version 1 Estimates. World health organization. 2002.Malla A, Payne J. First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia bulletin. 2005;31(3):650-71.

Edwards J, Maude D, Herrmann-Doig T, Wong L, Cocks J, Burnett P, et al. Rehab rounds: a service response to prolonged recovery in early psychosis. Psychiatric Services. 2002;53(9):1067-9.

Melle I, Haahr U, Friis S, Hustoft K, Johannessen JO, Larsen TK, et al. Reducing the duration of untreated first-episode psychosis-effects on baseline social functioning and quality of life. Acta Psychiatr Scand. 2005;112(6):469-73.

Monte RC, Goulding SM, Compton MT. Premorbid functioning of patients with first-episode nonaffective psychosis: a comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores. Schizophrenia research. 2008;104(1):206-13.

Strous RD, Alvir JM, Robinson D, Gal G, Sheitman B, Chakos M, Lieberman JA. Premorbid functioning in schizophrenia: relation to baseline symptoms, treatment response and medication side effects. Schizophr Bull. 2004;30(2):265-78.

Wunderink L, Sytema S, Nienhuis FJ, Wiersma D. Clinical Recovery in First-Episode Psychosis. Schizophrenia Bulletin. 2009;35(2):362-9.

E Pek, S Mythily, SA Chong. Clinical and Social correlate of duration of untreated psychosis in First-episode psychosis patients. Ann Acad Med Singapore. 2006;35:24-6.

Choi JS, Chon MW, Kang DH, Jung MH, Kwon JS. Gender difference in the prodromal symptoms of first-episode schizophrenia. J Kor Med Sci. 2009;24(6):1083-8.

Miller DD, McEvoy JP, Davis SM, Caroff SN, Saltz BL, Chakos MH, Swartz MS, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005;80(1):33-43.

Phillips MR, Zhao ZA, Xiong XZ, Cheng XF, Sun GR, Wu NS. Changes in the positive and negative symptoms of schizophrenic in-patients in China. Brit J Psych. 1991;159(2):226-31.

Aich TK, Sinha VK, Khess CRJ, Singh S. Substance abuse co-morbidity in schizophrenia: An inpatient study of course and outcome. Ind J Psych. 2005;47(1):33-38.

Crebbin K, Mitford E, Paxton R, Turkington D. First-episode psychosis: an epidemiological survey comparing psychotic depression with schizophrenia. J Affect Disord. 2008;105(1-3):117-24.

Segarra R, Zabala A, Eguíluz JI, Ojeda N, Elizagarate E, Sánchez P, Ballesteros J, Gutiérrez M. Cognitive performance and smoking in first-episode psychosis: the self-medication hypothesis. Euro Arch Psychiatry Clin Neurosci. 2011;261(4):241-50.

Barrett EA, Sundet K, Faerden A, Nesvåg R, Agartz I, Fosse R, et al. Suicidality before and in the early phases of first episode psychosis. Schizophrenia research. 2010;119(1):11-7.

Eóin Killackey, Henry J. Jackson, Patrick D. McGorry. Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. Brit J Psychiatry. 2008;193(2):114-120.

Srivastava AK, Stitt L, Thakar M, Shah N, Chinnasamy G. The abilities of improved schizophrenia patients to work and live independently in the community: a 10-year long-term outcome study from Mumbai, India. Annals General Psych. 2009;8:24.

World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. World Health Organization; 1993.

Michael C. Hilton. Online new patient psychiatric questionnaire. Available at www.michaelhiltonmd .com/psych_questionnaire.pdf. Accessed on 20 Dec 2010.

Skinner HA. The drug abuse screening test. Addictive behaviors. 1982;7(4):363-71.

Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. J substance abuse treatment. 2007;32(2):189-98.

Babor TF, Higgins-Biddle J, Saunders J, Monteiro M. The Alcohol Use Disorders Identification Test–Guidelines for use in. Primary Care (2nd Ed.). Geneva, Switzerland: World Health Organization. 2001.

National Health and Medical Research Council. Depression in young people: A guide for general practitioners. Canberra, Australian Government Publishing Service. 1997.

Kay SR, Fiszbein A, Opler LA. The PANSS for Schizophrenia. Schizophrenia Bulletin. 1987;13,261-276.

Shrivastava A, Shah N, Johnston M, Stitt L, Thakar M. Predictors of long-term outcome of first-episode schizophrenia: A ten-year follow-up study. Indian J Psychiatry. 2010;52:320-6.

Miles CP. Conditions predisposing to suicide: a review. J Nerv Ment Dis. 1977;164:231-46.

Jäger M, Riedel M, Messer T, Laux G, Pfeiffer H, Naber D, et al. Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders. Euro Archives Psych Clin Neurosci. 2007;257(1):47-53.

Melle I, Larsen TK, Haahr U, Friis S, Johannesen JO, Opjordsmoen S, et al. Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. Archives of general psychiatry. 2008;65(6):634-40.

Češková E, Drybčák P, Lorenc M. Biological markers and possibilities for predicting therapeutic results in schizophrenia: a methodological contribution. Progress in Neuro-Psychopharm Biol Psych. 2002 ;26(4):683-91.