Ashok Malla1, Srividya N Iyer2, Thara Rangaswamy3, Padmavati Ramachandran3, Greeshma Mohan3, Aarati Taksal4, Howard C Margolese5, Norbert Schmitz5, Ridha Joober5. 1. Department of Psychiatry, McGill University, Montreal; and Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada. 2. Department of Psychiatry, McGill University, Montreal, Canada. 3. Schizophrenia Research Foundation (SCARF), Chennai, India. 4. Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada. 5. Department of Psychiatry, McGill University, Canada.
Abstract
BACKGROUND: Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS). AIMS: To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences. METHOD: Patients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted. RESULTS: Four patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = -7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes. CONCLUSIONS: Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.
BACKGROUND: Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS). AIMS: To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences. METHOD:Patients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted. RESULTS: Four patientsdied in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = -7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes. CONCLUSIONS:Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.
Entities:
Keywords:
First-episode psychosis; clinical outcomes; early intervention service; family support; high-income low-income country comparison
Authors: Gil Grunfeld; Ann-Catherine Lemonde; Ian Gold; Srividya N Iyer; Ashok Malla; Martin Lepage; Ridha Joober; Patricia Boksa; Jai L Shah Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2022-07-30 Impact factor: 4.519
Authors: Srividya N Iyer; Megan Pope; Aarati Taksal; Greeshma Mohan; Thara Rangaswamy; Heleen Loohuis; Jai Shah; Ridha Joober; Norbert Schmitz; Howard C Margolese; Ramachandran Padmavati; Ashok Malla Journal: Int J Ment Health Syst Date: 2022-01-10
Authors: Srividya N Iyer; Ashok Malla; Megan Pope; Sally Mustafa; Greeshma Mohan; Thara Rangaswamy; Norbert Schmitz; Ridha Joober; Jai Shah; Howard C Margolese; Padmavati Ramachandran Journal: Int J Ment Health Syst Date: 2022-01-10