Factors contributing the outcome of Schizophrenia in developing and developed countries: A brief review

Abstract

INTRODUCTIONSchizophrenia is a heterogeneous syndrome characterized by perturbations of language, perception, thinking, social activity, affect, and volition. There are no pathognomonic features. The syndrome commonly begins in late adolescence, has an insidious (and less commonly acute) onset, and, classically, a poor outcome, progressing from social withdrawal and perceptual distortions to a state of chronic delusions and hallucinations (Harrison et al., 2005). In this article we reviewed the factors that influence the outcome of schizophrenia in developing and developed countries. EPIDEMIOLOGY AND PATHOPHYSIOLOGYEpidemiologic surveys identify several risk factors for schizophrenia including genetic susceptibility, early developmental insults, winter birth, and increasing parental age. Genetic factors are involved in at least a subset of individuals who develop schizophrenia. Schizophrenia is observed in near about 6.6% of all first-degree relatives of an affected proband. If both parents are affected, the risk for offspring is 40%. The concordance rate for monozygotic twins is 50%, compared to 10% for dizygotic twins. Schizophrenia-prone families are also at risk for other psychiatric disorders (Harrison et al., 2005).Schizophrenia is also associated with gestational and perinatal complications, including Rh factor incompatibility, fetal hypoxia, and prenatal exposure to influenza during the second trimester, and prenatal nutritional deficiency. Studies of monozygotic twins discordant for schizophrenia have reported neuroanatomic differences between affected and unaffected siblings, supporting a "twostrike" etiology involving both genetic susceptibility and an environmental insult. The latter might involve localized hypoxia during critical stages of brain development. DIAGNOSIS AND TREATMENTPatients may present with positive symptoms (such as conceptual disorganization, delusions, or hallucinations) or negative symptoms (loss of function, anhedonia, decreased emotional expression, impaired concentration, and diminished social engagement) and must have at least two of these for REVIEW ARTICLE OPEN ACCESS International Current Pharmaceutical Journal ABSTRACTAccording to WHO, schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years. Though the incidence is low (3-10,000), the prevalence is high due to chronicity. Schizophrenia is occurring in both developing and developed countries. The remission rate is higher in developing countries compared to the developed ones. There are some compelling factors that may influence the outcome of schizophrenia includes gender, employment, marital status, family support, illness myths, family burden, duration of untreated psychosis etc. In this review we have discussed the epidemiology, pathophysiology, diagnosis, treatment and finally the factors that influence the outcome of schizophrenia in developing and developed countries.

Evaluation of Psychiatric Disability Among Patients With Schizophrenia in Relation to Duration of Untreated Illness- A Cross-Sectional Study

“…In the current era of rapid globalisation, the effects of diminishing social support and the increasing prevalence of nuclear family warrant close examination of the effects of these social changes on outcome. 16 An Indian study did not find significant correlation of DUI with the educational level, marital status and socioeconomic status at baseline assessment, a finding which is like most other studies. 24 According to the present study, DUI is more in unmarried group but not statistically significant.…”

“…Absence of state social security benefits and pressure to find work as primary wage earners would also have contributed to the high rate of employment. 26 In metaanalysis study, DUI and employment found no significant association. 28 Current study found no significant association between DUI and employment, but most of the schizophrenia patients are unemployed or in unskilled work or are involved in domestic works.…”

“…25 It is observed that in low-and middle-income countries a large population with schizophrenia remains untreated and engaged in job. 26 Moreover, among untreated Indian people with schizophrenia almost one-third was employed. Generally, high employment rates (Upto 75%) have been found in India in contrary to western population.…”

“…15 There are several factors that may influence the outcome like employment, marital status, family support etc. 16…”

Pharmacoepidemiological survey of schizophrenia in a tertiary care teaching hospital

“…16 Although sex difference is not a significant factor in schizophrenia, it has been observed that the clinical remission and recovery is higher in female rather than male. 17 The risk for schizophrenia at the most urban environment was estimated to be 2.37 times higher than in the most rural environment. 18 Present study shows that there is an increase preponderance of schizophrenic illness in urban area.…”