Predictors of disability: A 5-year cohort study of first-episode schizophrenia

• Published in: Asian journal of psychiatry Vol. 9; pp. 45 - 50
• Main Authors: Johnson, Shanthi, Sathyaseelan, Manoranjitham, Charles, Helen, Jacob, K.S
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2014
• Subjects: Adult; Cohort Studies; Cross-Sectional Studies; Disability; Disability Evaluation; Employment; Explanatory models; Female; Humans; Insight; Internal Medicine; Longitudinal Studies; Male; Mentally Disabled Persons - psychology; Outcome; Predictive Value of Tests; Predictors; Psychiatry; Schizophrenia; Schizophrenia - diagnosis; Schizophrenic Psychology; Young Adult; Disability; Schizophrenia; Insight; Outcome; Explanatory models; Predictors
• ISSN: 1876-2018; 1876-2026
• DOI: 10.1016/j.ajp.2014.01.003

Abstract Background There is a dearth of information about the predictors of disability in schizophrenia from low and middle-income countries. This study attempted to investigate the impact of socio-demographic and clinical variables on disability in a cohort of first episode schizophrenia. Method Patients diagnosed to have DSM IV schizophrenia ( n = 131) were assessed prospectively for psychopathology, functioning, insight and explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Disability was assessed at 5 years. Multiple linear regression was employed to adjust for common confounders. Results We could follow-up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. Disability scores at 5 years were associated negatively with episodic nature of illness at baseline, functional assessments at 6 and 12 months and return to pre-morbid level function. Disability correlated positively with psychopathology at 6 and 12 months and time spent in psychotic episodes. It was also associated with psychopathology, remission, insight and patient perspectives at the 5th year cross-sectional evaluation. While employment status at recruitment was not associated with disability, it was associated with unemployment at follow-up. Conclusions Disability at 5 years was associated with illness variables – episodic nature of illness at baseline, psychopathology and functioning, duration in psychotic episode and return to pre-morbid function. Patient perspectives about their illness (insight and patient explanatory models) were only associated cross-sectionally at 60 months but not earlier and are more suggestive of a coping response rather than being predictive of outcome. The relationship between unemployment and disability suggests that they are products of the same disease process.