American Journal of Psychiatry and Neuroscience
Volume 8, Issue 3, September 2020, Pages: 60-64
Received: Aug. 21, 2020;
Accepted: Sep. 1, 2020;
Published: Sep. 10, 2020
Views 252 Downloads 152
Md Kamrul Hassan, Department of Psychiatry, Combined Military Hospital, Sylhet, Bangladesh
Md Inamul Islam, Department of Psychiatry, Combined Military Hospital, Rangpur, Bangladesh
Abul Hossain Muhammad Kazi Mostofa Kamal, Department of Psychiatry, Combined Military Hospital, Dhaka, Bangladesh
Md Julfikkar Alam, Combined Military Hospital (CMH), Sylhet, Bangladesh
Context: In the face of increasing number of relapse cases of schizophrenia, sufficient work is not available in Bangladesh. Aims: To find out the common factors of relapse of schizophrenia in Bangladesh and to find out the relationship of relapse of schizophrenia with sociodemographic characteristics. Settings and Design: Cross-sectional descriptive study; Department of Psychiatry, Combined Military Hospital, Dhaka, National Institute of Mental Health (NIMH), Dhaka and Psychiatry department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Materials and Methods: Data from 50 relapse patients receiving treatment of schizophrenia were collected, from April 2018 to September 2018. Statistical Analysis Used: The data were processed and analyzed with the help of computer program SPSS (Statistical Package for Social Sciences) win version 16. Results: The mean age was 31.16 (±10.59) years ranging from 14 to 55 years. Majority of the respondents 70% (n=35) were under 35 years. 62% (n=31) of the respondents were male and 38% (n=19) were female. 96% (n=48) of the respondents were Muslims. 52% (n=26) of the respondents were married and 46% (n=23) were unmarried. 46% (n=23) were from rural background and 54% (n=27) of the respondents were from urban background. 40% (n=20) of the respondents were from lower class, 52% (n=26) were from middle class, and only 8% (n=4) were from higher class. 56% (n=28) of the respondents had perceived stressful life events and 44% (n=22) of the respondents had no such history. 52% (n=26) of the patients had experienced high expressed emotion and 48% (n=24) had low expressed emotion. Among the 50 relapsed schizophrenia patients, only 26% (n=13) had full compliance, 30% (n=15) had full noncompliance and rest had partial compliance. There was no significant relationship between educational status and medication compliance in the current study. The study revealed significant association with lower social class and presumptive stressful life events. Conclusions: This study highlighted the perceptions of schizophrenic patients and their caregivers about factors that influence relapse. It indicated that stressful life events, high expressed emotion, and non-compliance to medication had a role in relapse. This study provides information about socio-demographic and other related factors which can offer important guideline for future study. Adherence to antipsychotic medication, reducing high expressed emotion and stressful life events protect patients from relapse.
Md Kamrul Hassan,
Md Inamul Islam,
Abul Hossain Muhammad Kazi Mostofa Kamal,
Md Julfikkar Alam,
Factors Associated with Relapse of Schizophrenia in Bangladesh, American Journal of Psychiatry and Neuroscience.
Vol. 8, No. 3,
2020, pp. 60-64.
Davis LM, Drummed MF. The economic burden of schizophrenia. Psychiatry Bulletin. 1990; 14: 522-525.
Chowdhury AKMN, Alam MN, Ali SMK. Dasher kandi Project Study: Demography, Morbidity and mortality in a rural area of Bangladesh. Bangladesh Medical Research Council Bulletin. 1981; 7 (1): 22-39.
Leff J, Wig N, Ghosh A et al. The influence of relatives’ expressed emotion on the course of schizophrenia at Chandigarh in India. Br J Psychiatry. 1987; 151: 166-173.
Suzuki Y, Yasumura S, Fukao S, et al. Associated factors of rehospitalization among schizophrenic patients. Psychiatry Clin Neurosci. 2003; 57: 555-561.
Harris MG, Henry LP, Harrigan SM, et al. The relationship between duration of untreated psychosis and outcome: an eight-year prospective study. Schizophr Res. 2005; 79: 85-93.
Alvarez-Jimenez M, Priede A, Hetrick SE, Bendall S, Killackey E, Parker AG, et al. Risk factors for relapse following treatment for first episode psychosis:a systematic review and meta-analysis of longitudinal studies. Schizophr Res. 2012; 139: 116–128.
Castle DJ & Murray RM. The neurodevelopmental basis of sex differences in schizophrenia. Psychol Med. 1991; 21: 565–575.
Castle D, Sham P & Murray R. Differences in distribution of ages of onset in males and females with schizophrenia. Schizophr Res. 1998; 33: 179–183.
Eranti SV, MacCabe JH, Bundy H & Murray RM. Gender difference in age at onset of schizophrenia: a meta-analysis. Psychol Med. 2013; 43: 155–167.
Aleman A, Kahn RS & Selten JP. Sex differences in the risk of schizophrenia: evidence from meta-analysis. Arch Gen Psych. 2003; 60: 565–571.
Kirkbride JB et al. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP study. Arch Gen Psych. 2006; 63: 250–258.
Kirkbride JB et al. Neighbourhood variation in the incidence of psychotic disorders in Southeast London. Soc Psych Epidemiol. 2007; 42: 438–445.
EtichaT, Teklu A, Ali D, Solomon G, Alemayehu A. Factors associated with medication adherence among patients with schizophrenia in Mekelle, Northern Ethiopia. PLoS One. 2015; 10, e0120560.
Arafat SMY, Mali B, Akter H. Proportion and reasons for medication non-compliance among schizophrenics: a cross-sectional observation in a tertiary care hospital of Bangladesh. Asian J Psychiatr. 2018; 35: 52-54.
Nuechterlein KH et al. The early course of schizophrenia and long-term maintenance neuroleptic therapy. Arch Gen Psychiatry. 1995; 52: 203–205.
Robinson D et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999; 56: 241–247.
Wunderink L et al. Guided discontinuation versus maintenance treatment in remitted first-episode psychosis: relapse rates and functional outcome. J Clin Psychiatry. 2007; 68: 654–661.
Chen EY et al. Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomized controlled trial. BMJ. 2010; 341: c4024.
Gaebel W et al. Relapse prevention in first-episode schizophrenia-maintenance vs intermittent drug treatment with prodrome-based early intervention: results of a randomized controlled trial within the German Research Network on Schizophrenia. J Clin Psychiatry. 2011; 72: 205–218.
Caseiro O et al. Predicting relapse after a first episode of non-affective psychosis: a three-year follow-up study. J Psychiatr Res. 2012; 46: 1099–1105.
Kane JM, Kishimoto T, Correll CU. Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. World Psychiatry. 2013; 12: 216–226.
Birnbaum M, Sharif Z. Medication adherence in schizophrenia: patient perspectives and the clinical utility of paliperidone ER. Patient Prefer Adherence. 2008; 2: 233–240.
Teferra S, Hanlon C, Beyero T, Jacobsson L, Shibre T. Perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry 2013; 13: 168.
McCreadie R, Robinson ADG. The Nithsdale schizophrenia survey. VI. Relatives’ expressed emotion: prevalence, patterns, and clinical assessment. Br J Psychiatry 1987; 150: 640-644.
Butzlaff RL, Hooley JM. Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry. 1998; 55: 547-52.
Beards S et al. Life events and psychosis: a review and meta-analysis. Schizophr Bull. 2013; 39: 740–747.
Norman RM, Malla AK. Stressful life events and schizophrenia:a review of the research. Br J Psychiatry. 1993; 162: 161-166.
Xu B, Roos JL, Dexheimer P, Boone B, Plummer B, Levy S et al. Exome sequencing supports a denovo mutational paradigm for schizophrenia. Nature Genetics. 2011 Aug 7; 43 (9): 864-868.
Neuchterlein KH, Dawson ME. Aheuristic vulnerability/ stress model of schizophrenic episodes. Schizophr Bull. 1984, 10 (2): 300-312.
Cotter D, Pariante CM. Stress and the progression of the developmental hypothesis of schizophrenia. Br J Psychiatry. 2002 Nov; 181: 363-365.