Predictors of clinical outcome among adolescents with first episode schizophrenia in Alexandria.

ABSTRACT

Evidence was emerging that the early phase following the onset of a first psychotic illness could be conceived of as a critical period, influencing the long-term course of the illness. Effective intervention at this stage might alter the subsequent course of the illness. Psychosis may be developed as the action of social or psychological stressors acting on the vulnerable individuals. The present study aimed at providing data about potential sociodemographic and family risk factors related to development of first episode schizophrenia [FES], identifying clinical profile of FES among adolescents, providing baseline assessment of patients with FES as well as changes in assessment domains during five months follow up period, and finally identifying significant contributing factors related to clinical outcome of FES among adolescents. A clinic-based case control study was carried out. Cases were recruited from Psychiatric Consultation Clinic for school children in Alexandria. The trained investigators themselves collected the data using precoded structured questionnaire. A structured clinical interview format was used for assessing five domains. The majority of cases [88.7%] claimed that illness was precipitated by stressful life events. Source of referral was the physician in 66.2% of instances. The most commonly cited reason for referral was aggression and violence [39.4%]. More than one-fifth of cases [21.1%] visited faith healer before referral and 19.7% did not seek any medical care. Just less than two-thirds of family members [60.6%] had negative attitude towards the illness. Nearly three-quarter of cases [73.2%] reported progressive course of illness. Significant risk factors for FES in logistic regression model were positive family history of mental disorders [Adjusted OR=6.47, 95% Cl=1.29-9.61], unskilled fathers' occupation [Adjusted OR=1.34, 95% Cl=1.22-3.03], low mothers' educational level [Adjusted OR=4.92, 95% Cl=2.42-9.71], and negative parental rearing style [Adjusted OR=2.51, 95% Cl=1.67-4.471. The estimated remission rate following the follow up period was 86.3%. Positive symptoms improved in 87.3% of cases while negative symptoms improved in 83.1% of cases. Moreover, 73.2% of cases experienced improvement in psychopathological symptoms. Social functioning had improved in 76.1% of cases. Compliance to medication and family support were the only significant predictors for clinical improvement in patients with FES [Adjusted OR=3.15, 95% Cl=2.64-6.83, P<0.001, and 2.63, 95% Cl=1.89-5.72, P=0.0081. The present work concluded that the best strategy is to early diagnose and treat patients suffering from first episode psychosis. This includes appropriate medical diagnosis, neurocognitive and psychological assessment, and appropriate medication. The support and necessary education were needed for family members to be helpful