Factors associated with relapse in schizophrenia
Aim. Early identification and prevention of relapse in patients with schizophrenia has significant therapeutic and socioeconomic implications. The aim of this study was to determine the factors, if any, that may be associated with relapse in a group of patients in Johannesburg. Method. Patients were recruited from mental health outpatient clinics in a predominantly residential area during the period January 1995 - June 2005. They were included if a review of their records confirmed a diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV); they had no other psychotic illness; and they were ≥18 years old. Patients were excluded if the diagnosis of schizophrenia had first been made in the preceding 6 months. Demographic and clinical characteristics of the patients were obtained from their case notes. Results. Of the 217 patients who were included in the study, 61.8% (N=134) had a history of at least 1 relapse. There was no significant difference (p>0.05) between those who relapsed and those who did not relapse in terms of gender, marital status or employment status. Approximately 46% (N=61) of those who relapsed had co-morbid psychiatric disorders, compared with 10.8% (N=9) in those who did not relapse (p<0.0001), but there was no significant difference between the two groups when comparing the presence of co-morbid medical disorder (p=0.348). Nearly half (N=63) of patients who relapsed had a history of substance abuse (p=0.0054); cannabis was significantly more abused (p=0.0014). Twothirds (N=138) of the study population did not adhere to their treatment, of whom 80.4% (N=107) experienced a relapse (p<0.0001). Significant multiple logistic regression models for patients who relapsed included poor adherence due to sideeffects (odds ratio (OR)=3.032; p=0.023; 95% confidence interval (CI) 1.168 - 7.870); poor adherence due to lack of insight (OR=5.29; p<0.0001; 95% CI 2.28 - 12.20), and co-morbid depressed mood (OR=5.33; p<0.001; 95% CI 2.32 - 12.22). Conclusion. Co-morbid depressed mood, poor adherence owing to lack of insight, and medication side-effects were the factors most likely to increase the risk of relapse in patients with schizophrenia. Risk of relapse may be reduced when the treating psychiatrist identifies and addresses these factors.
South African Journal of Psychiatry Vol. 14 (2) 2008: pp. 52-62
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