Factors associated with psychotic relapse in patients with schizophrenia in a Pakistani cohort

Abstract

Despite a large body of research evaluating factors associated with the relapse of psychosis in schizophrenia, no studies in Pakistan have been undertaken to date to identify any such factors, including specific cultural factors pertinent to Pakistan. Semistructured interviews and psychometric measures were undertaken with 60 patients diagnosed with schizophrenia (49 male and 11 female) and their caregivers at four psychiatric hospitals in the Peshawar region in Pakistan. Factors significantly associated with psychotic relapse included treatment non-adherence, comorbid active psychiatric illnesses, poor social support, and high expressed emotion in living environments (P < 0.05). The attribution of symptoms to social and cultural values (97%) and a poor knowledge of psychosis by family members (88%) was also prevalent. In addition to many well-documented factors associated with psychotic relapse, beliefs in social and cultural myths and values were found to be an important, and perhaps treatable, factor associated with relapse of psychosis in Pakistan. The provision of evidence-based psychotherapeutic interventions, such as behaviour and family therapy and cognitive behaviour therapy for psychosis, could potentially ameliorate the relapse rate of psychosis in Pakistan.

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

“…This instrument was adapted and validated for the Brazilian context in 2013 and contains 20 items, divided into two domains -CC (10 items -2, 4,6,8,10,12,14,16,18,20) and EOI (10 items -1, 3,5,7,9,11,13,15,17,19). The items in the two domains reflect different situations that the family members use to cope with their daily problems.…”

“…The family may be classified as having high EE if the family member that spends most of the time with the patient presents one or more of these components (2)(3) . Studies show that EE is a strong predictor of psychiatric relapses in schizophrenic patients, in different social and cultural contexts (4)(5) . A meta-analysis identified 27 articles reporting EE and psychiatric relapses in schizophrenia patients.…”

Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future

“…This is a concern as there are medicines and other strategies available to help address mental health disorders. However, inaccessibility to mental healthcare, as well as beliefs that psychiatric illness may be due to evil spirits and the neglect of ritual obligations, can result in patients approaching local religious healers, faith healers, hakims, or practitioners of homeopathic medicine, and potentially ultimately finding only limited relief (63,64). Pakistani women face an even greater risk as they can be targets of domestic violence and there are continuing concerns with gender-inequality including management of diseases such as mental health disorders.…”

“…To date, there have been relatively few studies reporting on mental health conditions in Pakistan. Those that have been published include studies on common psychiatric disorders in outpatient care, general and major depressive disorders, factors associated with psychotic relapses and nonadherence of anti-psychotic medicines, gender differences in response to antipsychotics, cognitive disorders, and prescribing preferences of mental health professionals (7,13,64,(66)(67)(68)(69)(70)(71). However, we are not aware of any study that has comprehensively assessed utilization and expenditure patterns of antipsychotic medicines across Pakistan as a first step to improving treatment options if concerns.…”

A relação entre emoção expressa e variáveis sociodemográficas, estresse precoce e sintomas de estresse em cuidadores informais de pessoas com transtornos mentais

“…EE is a relevant measure because several studies showed that people with mental disorders from families with high EE have a worse prognosis of the disease and more episodes of psychiatric acute than those from families with low EE (AHMAD et al, 2017;ZANETTI et al, 2018b).…”