مداخله برای روان پریشی اپیزود اول در هند - تجربه اسکارف

Introduction There have been very few studies or programs in India on early intervention for first episode psychoses. This paper reports the findings of a pilot program, part of a collaboration with the Prevention and Early Intervention Program for Psychoses, Montreal. Methodology A sample of 47 patients with first episode psychosis were followed up for 2 years. Complete data was available on 39 subjects at 2 years. This data was analyzed for socio-demographic and clinical variables and its relationship with outcomes and DUP. Those who had a PANSS score <60 and GAF >80 were categorized to be in remission (N = 28) and others as continually ill (N = 10). Results There was significant improvement from baseline to 1st year with maximal improvement seen at 3 months after intake. However, improvement between 1 and 2 years was not significant. More women relapsed and more men dropped out. 25 out of 28 subjects with shorter DUP (<2 years) were in remission at 2 years as against 3 out of 10 with >2 years DUP. Three different patterns of course of the disorder were found. Single episode followed by total remission for 2 years (N = 20; 52.6%) was the commonest. The others were relapses followed by remissions (N = 8; 21.1%), and continuous illness (N = 10; 26.3%). Conclusion Early intervention is effective and more so if DUP is shorter. PANSS scores and GAF at baseline are not predictive of later outcomes. Medication adherence in therapeutic engagement and psychosocial needs should be considered in the implementation of early intervention programs in our cultural context.

A majority of individuals with schizophrenia and related psychotic disorders live in the developing world, about 7–8 million in India alone (Thara, 2005 and World Health Organization, 2001). The DOSMeD study found that acute psychosis is more prevalent in developing countries and among females (Sartorius et al., 1986). The last decade has witnessed an upsurge of research on early intervention for psychotic disorders. Early intervention can minimize relapses and maximize recovery, as outcome in the early years significantly predicts long-term illness course (Birchwood et al., 1998, Malla et al., 2005 and Penn et al., 2005). There have been very few studies or programs in India on early intervention for first episode psychoses. While there have been some studies reporting on chronic, untreated schizophrenia in India (McCreadie et al., 2002, McCreadie et al., 2003 and McCreadie et al., 2005), very little information is available on Duration of Untreated Psychosis (DUP). A first episode psychoses program was started at the Schizophrenia Research Foundation (SCARF) in collaboration with the Prevention and Early Intervention Program for Psychoses (PEPP), Montreal. This paper describes a pilot study of this program. The objectives are: 1. To study the course and outcome of persons with untreated first episode of psychosis. 2. To identify factors affecting outcome. 3. To assess DUP and its impact on outcome in psychosis.

This study has demonstrated that early intervention is possible even in settings which largely deal with chronic, sometimes never treated psychotic patients. Those with a shorter duration of illness who improve quickly need special measures to engage them and to maintain follow-up since they tend to drop out more easily. Those with a longer DUP, even if they are first episode require a different set of interventions aimed at maintaining clinical stability and optimizing functional recovery which is sometimes more important than clinical remission in many developing countries. Adherence to medication and involving the families are critical to the efforts of early intervention. In order to increase the numbers seeking help early, large scale awareness programmes in schools, colleges, software industry, and other youth oriented programmes are required. Intervention programmes should also be suitably tailored to their needs and capable of sustaining their long tern engagement.