Using data from schizophrenia outcome study to estimate the time to treatment outcome and the early-response cut-off score that predicts outcome at week 16

Abstract Background Being able to make an estimation of the time to clinical outcome, and making predictions early during treatment about the possibility of later response/non-response to treatment, is an important asset that can help to guide treatment strategies and counsel patients and caregivers about treatment expectations. Objectives The study aimed to determine the time course to treatment outcome and the psychopathological cut-off score at week 4 that predicts outcome at week 16. Methods This was a naturalistic follow-up study of 160 incident cases of schizophrenia over 16 weeks. Four intervals of follow-up clinical assessments were done. Standard criteria for response and remission were applied. Results The mean (median) times, in weeks, to response and remission using Brief Psychiatric Rating Scale (BPRS) data were 8.1(8.0); 8.4(8.0); and 10.9 (12.0), respectively. The Areas Under the Curves were high, for response (0.909; 95% C.I., 0.85-0.97) and remission (0.86; 95% C.I., 0.81 -0.94) at week 16. A cut-off score of 20.7% reduction in the total BPRS score at week 4, predicted response status (79.5% sensitivity, 84.2% specificity) and remission status (77.6% sensitivity, 73.3% specificity) at week 16. In addition, a cut-off of 10.21% reduction in the total Scale for Assessment of Negative Symptoms (SANS) score at week 4, predicted response (70.8% sensitivity, 95.5% specificity) at week 16. Discussion The results are in line with the general clinical impression that, by 2 months, most acutely ill inpatients are fit for discharge; and introduced for further investigation 10.21% reduction in SANS Score as a marker of treatment resistance in schizophrenia.

Psychological Morbidity among Psychoactive Substance Users in a Rehabilitation Centre in Nigeria

Aim:The aim of this study was to determine the prevalence and correlates of anxiety and depression among psychoactive substance users in a rehabilitation centre.Place and Duration of Study: The study was carried out in a rehabilitation centre in Lagos state, Nigeria.Methodology: All the inhabitants of the centre who agreed to participate in the study were included in the study. However, individuals who had stayed at the centre for less than a week were excluded from the study because the effect of use or withdrawal effects of some of the drugs may mimic depressive or anxiety symptoms. The 9-item Patient Health Questionnaire (PHQ-9) and the Mini International Neuropsychiatric Interview (M.I.N.I) (anxiety modules) were used to asses for depression and anxiety disorder respectively.Results:A total of seventy six people participated in this study. Their ages ranged from 17 to 52 years (mean= 25.9 years SD= 8.4). A high number of the subjects were males (72.4%), single (78.7%) and unemployed (64.5%). Almost all the subjects (92.1%) were introduced to the use of psychoactive substances by friends/peers. Only 4 (5.3%) subjects reported injection drug use (IDU). 53.9% of the subjects had an anxiety disorder. While68.4% had depression. The factors associated with having anxiety disorder were female sex, older age, being divorced/ separated/widowed, unemployment, multiple substance use, long duration of use of alcohol, cocaine and heroin.Factors associated with depression included; young age of onset of substance use, female sex, being separated or divorced or widowed, unemployment, long duration/ frequency of use of substances and multiple substance use.Conclusion:This study has shown that there is a high rate ofanxiety and depression among psychoactive substance users

Morbid risk of schizophrenia amongst relatives of schizophrenia probands: a family-controlled study

Introduction: There is a dearth of data on heritability of schizophrenia in Africa. The few African studies that addressed familial psychiatric morbidity in schizophrenia involved relatively small sample sizes and addressed psychiatric morbidity only in first-degree relatives. The present study sought to improve upon the methodology of previous African studies, and widen the scope to second- and third-degree relatives with a view to enriching the field of genetic epidemiology in Africa. Methods: This study elicited information on the morbid risk of schizophrenia amongst 5259 relatives of schizophrenia probands (n = 138) and 6734 relatives of healthy controls (n = 138) through direct interview of patients, available relatives of patients and controls. Diagnosis of probands was confirmed using Mini International Neuropsychiatric Interview. Through a direct interview of 138 patients and their available relatives, a family history approach using the Family Interview for Genetic Studies was utilised to obtain information on the morbid risk for all relatives that could be recalled. The same approach was utilised for the interview of the controls (aged 45 years and above) and their relatives. Morbid risk estimates were calculated using the Weinberg shorter method. Results: Morbid risk for schizophrenia in the first-, second- and third-degree relatives of schizophrenia probands was 10.9% (95% confidence interval [CI] = 10.6­11.2), 4.2% (95%CI = 4.1­4.3) and 3.9% (95%CI = 3.6­4.2), respectively, compared with 2.6% (95%CI = 2.5­2.7), 1.6% (95%CI = 1.5­1.7) and 1.5% (95%CI = 1.4­1.6), respectively, of the healthy control group. Conclusion: The findings support the widely noted impression that schizophrenia significantly aggregates in families of schizophrenia probands more than healthy controls