Persisting symptoms in recovered first episode schizophrenia patients

Amresh Shrivastavaa,*, Nilesh Shahb, Meghana Thakara, Larry Stittc, Gurusamy Chinnasamyd

aMental Health Foundation of India (PRERANA Charitable trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602 bLTMG Hospital, University of Mumbai, Sion, Mumbai, Maharashtra, India 400 022 cDepartment of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5C1 dResearch Office, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5C1

*Corresponding author. Tel.: +1-519-631-8510; Fax: +1-519-631-2512. E-mail address: dr.amresh@gmail.com (A. Shrivastava). Present address: Regional Mental Health Care, 467 Sunset Drive, St. Thomas, Ontario, Canada N5H 3V9.

Abstract Our goal was to determine level of remission in clinical symptoms amongst the recovered patients of first episode schizophrenia in a long-term follow up study. We assessed recovered subjects categorized by Clinical Global Impression Scale (CGIS), in a cohort of long-term follow up study, on parameters of positive, negative and disorganized symptoms as well as on parameters of social functioning, in a naturalistic setting using cross sectional design. Subjects were drawn from a prospective outcome study of schizophrenia. Among the patients who showed ‘improved’ and ‘much improved’ state on CGIS, 40 patients (65.6%) had persistent psychopathology scoring >7 on either positive or negative sub scales of positive and negative symptoms scale. 39% showed presence of one or more positive symptoms, 42% showed one or more negative symptoms, and 49% had disorganization symptoms. There was no significant difference on any parameter of social functioning, cognition and other clinical symptoms between those who had persisting symptoms and those who did not. There were only 10 patients (16.4%) who had both persistent positive and negative symptoms. None of the baseline characteristics were found to have any predictive significance for persisting symptoms in long-term, despite adequate treatment with atypical antipsychotic drugs. This study concludes that clinical symptoms do persist despite treatment in low severity and interfere with patients’ socioeconomic status and independence. The findings suggest the need for continued, comprehensive, multidisciplinary treatment for patients of schizophrenia.

Keywords: Persisting symptoms, Clinical outcome, Schizophrenia, Social outcome