A Study on the Characteristics of Patients Who do not Recover in the Long-term Treatment of First Episode Schizophrenia

Background: Despite revolutionary advances in treatment of Schizophrenia, about 30-40% patient do not achieve a state of recovery. This limited outcome interferes achieving a positive outcome and wellness. Long term outcome in schizophrenia has been poorly studied. There is a dearth of longitudinal studies that determine factors affecting outcome in patients with first episode of schizophrenia. While short term studies have yielded some findings, long term studies in this domain are rare. The present study looks at the characteristics and factors that affect non recovery in patients with first episode schizophrenia over a ten year duration. Methodology: 101 patients attending a non government private psychiatric hospital were followed up over a 10 year period and assessed for recovery and outcome parameters using the Clinical Global Impression Scale (CGIS ≤ 2), the Positive and Negative Symptoms Scale for Schizophrenia (PANSS) based on RSWG criteria, Hamilton Depression Rating Scale (HDRS), Quality of Life Scale (QOLS), Global Assessment of Functioning (GAF) and the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms. Independent living and family burden were studied on a 1 to 5 point likert scale with 1 being worst and 5 being good. Non recovery was defined as Good outcome was defined as a score of 2 or less on CGIS. The results were analyzed statistically and presented. Results: When non recovered subjects were assessed on various parameters, significant reductions in total PANSS scores, positive and negative symptom scores, depression scores on the HDRS (p<0.0001 in all cases). The non recovered group had significantly greater number of hospitalizations (p<0.0001), more disorganized behavior (p<0.0002), greater interpersonal issues (p=0.0013) and poor outcome on independent living (p<0.0001). Assessment of the baseline characteristics of both groups revealed that age at the time of entry into the study was lower in the non-recovery group (p<0.0001) while greater negative symptom scores (p<0.0001), greater depression scores (p<0.0001) and greater aggression was present. Conclusion: The present study shows that early age of onset of psychosis and presence of severe negative symptoms are significantly related to future non-response in long term outcome of first episode schizophrenia. It is also important mentioning that symptom reduction alone is insufficient when looked as an outcome measure in schizophrenia.