Outcome of first-episode schizophrenia in India: longitudinal study of effect of insight and psychopathology.
BACKGROUND
Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia, but its influence on prognosis is unclear.


OBJECTIVE
To investigate the relationship between insight, psychopathology and outcome of first-episode schizophrenia in Vellore, India.


METHODS
Patients with a DSM-IV diagnosis of schizophrenia (n = 131) were assessed prospectively at baseline and at 6-month and 12-month follow-up. Demographic and clinical measures included insight, psychopathology, duration of untreated psychosis (DUP) and social functioning. Linear and logistic regression was used to measure predictors of outcome.


RESULTS
Follow-up data were available for 115 patients at 1 year. All achieved remission, half of them with and half without residual symptoms. Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome (relapse or functional impairment), controlling for baseline measures.


CONCLUSIONS
Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable, in line with other studies from low- and middle-income countries. Early improvement in insight might be a useful clinical guide to future outcome. Reduction of DUP should be a target for intervention.
Saravanan
Balasubramanian
B
Section of Cognitive Neuropsychiatry, PO Box 68, Institute of Psychiatry, King's College London, Denmark Hill, London SE58AF, UK.
Jacob
K S
KS
Johnson
Shanthi
S
Prince
Martin
M
Bhugra
Dinesh
D
David
Anthony S
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001364:Awareness; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology*; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents