Five-year clinical course and outcome of schizophrenia in Ethiopia

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• 作者：Solomon Teferra^a ; ^d ; ^{soloteferra@yahoo.com} ; Teshome Shibre^a ; Abebaw Fekadu^a ; Girmay Medhin^b ; Asfaw Wakwoya^c ; Atalay Alem^a ; Lars Jacobsson^d
• 关键词：Schizophrenia ; Longitudinal study ; Course and outcome ; Ethiopia ; Sub-Saharan Africa
• 刊名：Schizophrenia Research
• 出版年：2012
• 期刊代码：240_09209964
• 类别：med
• 出版时间：April, 2012
• 卷：136
• 期：1-3
• 页码：137-142
• 文件大小：181 K

摘要

Background

Findings from the WHO sponsored multicenter studies done a few decades ago, which reported favorable outcome of schizophrenia in developing countries both in 2 and 5 year follow-up studies, dominated the world view until recently. Emerging evidence from Low and Middle Income countries (LAMIC) started to challenge this long held view, also called 鈥榙ogma鈥?by some authors. We reported the short-term follow-up which showed unfavorable outcome. We followed-up the cohort further to determine the 5-year outcome of schizophrenia and to compare the results with the WHO reports.

Methods

Patients with schizophrenia (n = 321) were identified systematically after screening 68 378 adults, ages 15-49 years, in rural Ethiopia. The majority (74.9%) had chronic illness at entry and were treatment na茂ve (89.6%).

Results

During 5-year follow-up, 96%had received treatment at least once although only about 6%had received antipsychotic treatments continuously. Forty five percent of participants were continuously symptomatic with 30.3%having had continuous psychotic episode. About 20%had experienced continuous remission. Being single (OR = 3.41, 95%CI = 1.08-10.82, P = 0.037), on antipsychotic treatment for at least 50%of follow up time (OR = 2.28, 95%CI = 1.12-4.62, P = 0.023), and having a diagnosis of paranoid subtype of schizophrenia (OR = 3.68, 95%CI = 1.30-10.44, P = 0.014) were associated with longer period of remission

Conclusion

The findings from this 5-year outcome were consistent with our previous short term report which was unfavorable. Treatment has been a consistent predictor of a favorable outcome. Therefore, ensuring availability of treatment and adherence is an essential pragmatic step to improve outcome in this setting.