Is the outcome of schizophrenia really better in developing countries?

Patel, Vikram; Cohen, Alex; Rangaswamy, Thara; Gureje, Oye

doi:10.1590/s1516-44462006000200014

Cited by 85 publications

(46 citation statements)

References 20 publications

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“…We have seen that longitudinal studies of schizophrenia in LIM countries suggest a significant degree of social disintegration, alienation of the mentally ill, stigma and even abuse. 7,40 Within the last decade, major human rights enquiries have revealed appalling human rights abuses within psychiatric institutions in both India 41 and South Africa. 42 Furthermore, in these same countries, abuse of the mentally ill continues to occur within community settings.…”

Section: Non-who Data On Outcomementioning

confidence: 99%

Dispelling a myth: developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia

Burns

2009

Afr. J. Psych

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The WHO multi-site studies of schizophrenia concluded that course and outcome of the disorder was better in developing countries. This has become psychiatric lore. However, the reality is that significant political, social and economic ills that characterize many countries in Africa, Latin America and Asia constitute psychosocial stressors that mediate strongly against better outcome in individuals living with this disorder. Outcome studies of schizophrenia in developing countries are reviewed and concepts of poverty, inequality and violence in relation to the course of the illness in this context are debated. The generally poor state of mental health services and policies in these regions are discussed. The belief that community and family life in the developing world is widely intact and that it provides a nurturing environment that facilitates recovery and promotes social and economic empowerment of seriously mentally ill individuals is dispelled as a myth. Idealisation of the under-developed South as a haven for schizophrenia sufferers will only add to the already heavy burden experienced by these individuals, their families and these societies in coping with this disabling disease.

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Section: Non-who Data On Outcomementioning

confidence: 99%

Dispelling a myth: developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia

Burns

2009

Afr. J. Psych

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“…23 The initial impression of a better outcome was obtained from the analysis of the 2-year follow-up assessment of patients in the International Pilot Study of Schizophrenia. Compared to patients from developed countries, those from Nigeria, India, and Colombia had a better symptomatic and functional outcome at two years.…”

Section: Outcome Of Schizophreniamentioning

confidence: 99%

Psychiatry in Africa: the myths, the exotic, and the realities

Gureje

2007

Afr. J. Psych

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Information regarding the occurrence and nature of mental disorders in Africa is still grossly limited. For many years, anecdotal reports and personal views, many of them based on very limited data, prevailed. Subsequently, many early studies were based on clinical samples and thus limited in generalizability. These factors led to a number of myths about mental disorders among Africans. In this short review, some of these myths are examined in the light of current information. It is observed that sufficient information probably exists to discard some old myths while some other current views, even though suspect in regard to their validity, await further exploration. It is concluded that while some racial differences may have been mistaken, there nevertheless remains the possibility that some unique features of psychiatric and behavioural disorders in Africans offer the prospect of advancing our knowledge in regard to etiology and possible interventions.

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“…The latter is important in developing contexts, where up to 90 % of individuals with schizophrenia have been observed to live with their families [11], who play key roles in their care and complement the inadequacies of the existing mental health facilities [12,13].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Functioning among Nigerians with Schizophrenia in a Tertiary Health Facility: Influence of Psychopathology, Socio-demographic and Treatment Factors

Campbell

Olagunju

Aina

et al. 2015

J. Psychosoc. Rehabil. Ment. Health

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To investigate the profile of functional impairment and the influence of psychopathology with other determinants among individuals with schizophrenia in a Nigerian tertiary health facility. The study participants consisted of one hundred adults with schizophrenia. Eligible participants were recruited using systematic random sampling technique. All participants were interviewed with questionnaire to elicit socio-demographic and treatment related information. This was followed by interview with brief psychiatric rating scale (BPRS) and the global assessment of functioning (GAF) to assess for psychopathology and impairment in functioning respectively. Analyses of data were done using SPSS-16. The mean age of the participants was 33.87(±11.6) years and a little above half (52 %) of the participants were female. Sixty (60 %) subjects had active psychopathology using BPRS cut-off score of [10; while participants with duration of illness of more than 10 years (X 2 = 5.59, p = 0.018) and previous relapse (X 2 = 6.34, p = 0.012) were more likely to have psychopathology. Overall, a little over two-thirds (69 %) had impairment following administration of GAF. Mild impairment was observed in 23 % of the participants, moderate impairment in 19 and up to 18 % of participants had severe impairment due to psychopathology. Subjects with lesser education, duration of illness of more than 10 years, extrapyramidal side effects (EPSE), previous relapse and psychopathology had significant levels of impairment (p \ 0.05). However, it was education (Odds ratio [OR] = 0.060; 95 % Confidence interval [95 % CI] = 0.055, 0.770; p = 0.031), psychopathology (OR 5.265; 95 % CI 2.744, 13.626; p \ 0.001) and EPSE (OR 0.183; 95 % CI 0.049, 0.939; p = 0.043) that were independently associated with impairment in functioning following logistic regression to control for effects of confounders. In this study, varied degrees of impairment in functioning were prevalent among individuals with schizophrenia under treatment. However, those with lesser education, EPSE, active psychopathology and longer duration of illness were more likely to be impaired. Thus, better attention to the management of active psychopathology and prevention of extra-pyramidal side effects are indicated in order to promote improve functioning in schizophrenia. In addition, promotion of recovery oriented psychosocial services with need-based rehabilitation program for individuals with schizophrenia is advocated. There is need for more research on predictors of functioning towards promotion of evidence based rehabilitation.

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Is the outcome of schizophrenia really better in developing countries?

Cited by 85 publications

References 20 publications

Dispelling a myth: developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia

Dispelling a myth: developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia

Psychiatry in Africa: the myths, the exotic, and the realities

Assessment of Functioning among Nigerians with Schizophrenia in a Tertiary Health Facility: Influence of Psychopathology, Socio-demographic and Treatment Factors

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