Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, India.
Department of Psychiatry & Sleep Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA, USA.
Indian J Med Res. 2017 Jul;146(1):34-41. doi: 10.4103/ijmr.IJMR_838_15.
BACKGROUND & OBJECTIVES: In low- and middle-income countries such as India, a feasible public health strategy could be to ensure continuous antipsychotics and psychoeducation for those with schizophrenia. Whether such a strategy favourably influences its course and outcome is not well-studied. The objectives of this study were to examine these issues in a cohort of patients with schizophrenia in a rural south Indian taluk (an administrative block). This cohort was part of a community intervention programme running in the place since the past one decade.
A total of 201 patients were assessed after an average of four years of follow up. Psychopathology, disability and course of illness were assessed using Positive and Negative Syndrome Scale (PANSS), Indian Disability Evaluation and Assessment Scale (IDEAS) and Psychiatric and Personal History Schedule (PPHS), respectively. Interventions included ensuring continuous antipsychotic treatment and low-intensity psychoeducation.
One hundred and forty two [70.6%; 95% confidence interval (CI): 64.35-76.95] of the 201 patients achieved clinical remission by the end of follow up period (four years); 140 (69.6%; 95% CI: 63.29-76.07) had satisfactory outcome (42.3% best outcome and 27.4% intermediate outcome). There was a significant reduction in the proportion of patients with disability [134/201 (66.7%) at baseline; 55/201 (27.3%) at follow up; PInterpretation & conclusions: Treatment with antipsychotics and psychoeducation can favourably influence the course of schizophrenia and reduce disability in a substantial proportion of patients. Structured psychosocial interventions may be indicated in the significant minority who show suboptimal outcome with this strategy.
在印度等中低收入国家，可以采取一种可行的公共卫生策略，即为精神分裂症患者持续提供抗精神病药物和心理教育。但这种策略是否会对疾病进程和结局产生有利影响，目前还没有得到充分研究。本研究旨在考察印度南部一个农村地区的精神分裂症患者队列中是否存在这些问题。该队列是过去十年在该地区开展的一项社区干预项目的一部分。
对 201 例患者进行评估，平均随访 4 年后。使用阳性与阴性症状量表（PANSS）、印度残疾评估与评估量表（IDEAS）和精神病史和个人史问卷（PPHS）评估精神病理学、残疾和疾病进程。干预措施包括确保持续的抗精神病药物治疗和低强度心理教育。
在随访结束时（4 年），142 例（70.6%；95%置信区间：64.35-76.95）患者达到临床缓解；140 例（69.6%；95%置信区间：63.29-76.07）患者有满意的结局（42.3%为最佳结局，27.4%为中等结局）。残疾患者的比例显著下降[基线时 201 例中有 134 例（66.7%）；随访时 201 例中有 55 例（27.3%）；P
