Bangladesh Journal Psychiatry, December, 2012;26(2) An Original Article ________________________ Short-term treatment outcome of Schizophrenia in a tertiary hospital of Bangladesh *Shahidullah M1, Mullick MSI2, Nahar JS3, Rahman W4, Ahmed HU5, Siddike MA6, Khaled MS7, Miah MZ8 Summary Schizophrenia may have a better outcome in low- and middle-income countries. It is required to see outcome of schizophrenia in Bangladesh. Specific objective of this study is to assess the outcome of short-term follow-up of patients with schizophrenia. Patients with a SCID-l/p diagnosis of schizophrenia (n=42) were assessed prospectively at baseline, at 6-week and at 6-month follow-up. Socio-demographic and relevant variables and questionnaire for family support and previous work record for the study were read in front of the patients and guardians and were filled up by the researchers. Psychopathological measurements was applied at base line by researchers and at 6-week and at 6-month by research assistant for the study population Follow-up data were available for 38 patients at 6-month and among them 86.85% achieved partial remission, 7.89% had not responded and 5.26% had relapsed. Drug treatment outcome of schizophrenia in Bangladesh is better in short-term follow-up. Increasedfamily support and early management by drugs should be a target for intervention. Bang J Psychiatry 2012; 26(2); 44-56 1. *Dr. Mohammad Shahid Ullah, Assistant Professor, Department of Psychiatry, Eastern Medical College, Comilla, Cell-01711316822, e-mail: [email protected] 2. Professor MSI Mullick, Chairman and Professor, Department of Psychiatry, Bangbandhu Sheikh Mujib Medical University (BSMMU), Dhaka. 3. Dr. Jhunu Shamsun Nahar, Professor, Department of Psychiatry, BSMMU, Dhaka. 4. Dr. Wasima Rahman, Medical Officer, BSMMU, Dhaka. 5. Dr. Helal Uddin Ahmed, Assistant Professor, Child Adolescent & Family Psychiatry, NIMH. 6. Dr. Mohammmad Asraful Siddike Pathan, Assistant Professor, Department of Psychiatry, Community based Medical College, Mymensingh. 7. Dr. M. S. Khaled, Assistant Professor (Ped.pul), National Institute of Diseases of the Chest & Hospital (NIDCH), Mohakhali, Dhaka. 8. Dr. Mohammmad Zubayer Miah, Assistant Professor, Department of Psychiatry, Pabna Medical College, Pabna. *For Correspondence Date of Submission of the article: 04.01.2014 Date of acceptance of the article: 24.03.2014 Page no. 46 Bangladesh Journal Psychiatry, December, 2012;26(2) Introduction reported that in the long-term, 17 percent of Schizophrenia is a chronic relapsing his patients were socially well-adjusted. psychotic disorder that primarily affects Although it remains generally agreed that the thought and behaviour1. The world wide outcome of schizophrenia is worse than that prevalence of schizophrenia is about 1% 2. In of most psychiatric disorders, it is difficult to Bangladesh, a recent study was done in draw clear conclusions 3. An important collaboration with WHO, the prevalence rate long-term study was carried out by Manfred of schizophrenia was to be found 0.6 % 3. Bleuler (1974), son of Eugen Bleuler, who Schizophrenia is often a chronically personally followed up 208 patients who had disabling condition; it is therefore been admitted to hospital in Switzerland responsible for a great deal of population's between 1942 and 1943, Twenty years after morbidity. In social terms chronic illness admission, 20% had a complete remission of generally consume much of the total health symptoms, 35% had a good outcome in terms budget. The outcome of a case of of social adjustment and 24% were severely schizophrenia is remarkably heterogeneous disturbed. When full recovery had occurred, and unpredictable4’ 6. For example, in the it was usually in the first 2 years. International Pilot Study of Schizophrenia 5, Nevertheless, 10% of his patients suffered an 6, tests were made of the predictive value of illness of such severity that they required several sets of criteria based on symptoms. long-term sheltered care6. Bleuler's All proved largely unsuccessful at predicting conclusions are broadly supported by outcome at 2 years or 5 years6. Ciompi's larger but less detailed study of Poor outcome in schizophrenia is associated long-term outcome in Lausanne 9. The study with younger age of onset, male sex, poor was based on the well-kept records of 1642 pre-morbid functioning and persistence of patients diagnosed as having schizophrenia negative symptoms. There is also evidence from the beginning of the century to 1962. that the duration of psychotic symptoms prior The average follow up was 37 years. A third to treatment correlates with time to remission of the patients were found to have a good or and level of remission 7>6- Whilst reluctance fair social outcome. Symptoms often became to seek treatment could be associated with less severe in the later years of life6. other predictor of poor outcome, it is also Schizophrenia in western world societies as a possible that early treatment either with "chronic debilitating illness" with a poor drugs or psychological therapies, may prognosis and a poor functional outcome. improve prognosis. There is growing interest This statement is not true in worldwide. At in the idea that early treatment of least two major international studies, the schizophrenia may improve the long-term International Pilot Study of Schizophrenia 10 prognosis, particularly from the work of and the Determinants of Outcome of Severe McGorry in Australia 8. Kraepelin initially Mental Disorders11 have provided believed that dementia praecox had an convincing evidence for a better outcome in invariably poor outcome, although he later India and other "less developed" countries Page no. 47 Bangladesh Journal Psychiatry, December, 2012;26(2) than in the west. The multi-site study of study on 'Effect of Clozapine on Drug factors affecting the course and outcomes of Resistant Schizophrenia' was found that schizophrenia in India found that 64% of the improvement of resistant schizophrenia in participants were in remission at a 2-year terms of both positive and negative follow-up and only 11% continued to be ill12. symptoms is indicated by the fact that the Such numbers are likely to be reversed inmean BPRS score at baseline was 28.33 (SD United States. Outcome of schizophrenia ±8.31) decline to 13.87 (SD ±6.22) at 6-week appears to be better in low- and and 9.2 (SD ±5.79) at 12-week of starting middle-incom e countries. A host of treatment with clozapine which was found sociocultural factors have been cited as statistically significant at 5% level 14. A contributing to this but future research should study was carried out on 102 cases of aim to understand this better outcome. schizophrenic patients at National Institute of Established factors apparently contributing to Mental Health (NIMH), Dhaka and was good prognosis of schizophrenia in low- and found that 66 were male and 36 were female. middle-income countries are low expressed Mean age of the patients was 29.20 emotion, good social support, tolerance of (SD±8.30) years. Most of them were odd behaviour by society and family,unmarried (59.80%) and unemployed marriage. Doubtful factors apparently (60.80%). They were least satisfied in the contributing to good prognosis of domains psychological health and social schizophrenia in low- and middle-income relationship. Women reported less countries are less industrialization and satisfaction in most of the domains than male urbanization, early death of those with bad except social relationship which was better outcome, increased prevalence of acute among females. Unemployed were less psychosis 12. Patients with schizophrenic satisfied in all domains QOL scale than illness had the most severe and disruptive employed. The overall QOL was positively psychopathology. The families with and significantly correlated with good schizophrenic patients were most distressed physical and psychological health 21. So from and socially isolated. They had difficulties in the clinical observation and previous study the areas of household functioning, financial findings, researcher intended to look at this and community problems. The distress felt area and decided to conduct a research in this by the family and the burden and problems field in Bangladesh. From the above finding, due to the patient's illness were significantly like non-western countries, it can be assumed correlated with the severity of the patient's that similar scenario will be found in psychopatholog y. Psychopatholog y in Bangladesh regarding outcome of children was influenced by the subjective schizophrenia. Hopefully this study will help distress of family members and the social the psychiatrists to treat their schizophrenic isolation of the family. High scored rater patients confidently and give valuable judgments reflected both subjective distress informatio n to the family of the and objective burden of the family 13. A schizophrenic patients about prognosis in our Page no. 48 Bangladesh Journal Psychiatry, December, 2012;26(2) perspective, encourage them to treat their psychiatry unit) in-patient department patients regularly and thus help to reduce the provides short-term care for the psychiatric disease burden to the family and also to the patients ^pith liaison psychiatric services. The state and improve the mental health of the Department of Psychiatry has a daily country. The general objective of this study out-patient clinic serving 50-60 patients. was to assess the short-term pharmacological Researcher used NICE