Factors associated with relapse in schizophrenia
Authors: Kazadi N J B , Moosa M Y H , Jeenah F Y 
Published: June 2017

<div style="left: 80.9418px; top: 456.754px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.927184);" data-canvas-width="28.65"><strong>Aim.</strong></div><div style="left: 109.592px; top: 456.754px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.922792);" data-canvas-width="357.70500000000004">Early identification and prevention of relapse in patients</div><div style="left: 80.9418px; top: 480.083px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.927149);" data-canvas-width="381.63000000000005">with schizophrenia has significant therapeutic and socio-</div><div style="left: 80.9418px; top: 503.413px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.90105);" data-canvas-width="386.2799999999999">economic implications. The aim of this study was to determine</div><div style="left: 80.9418px; top: 526.742px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.955219);" data-canvas-width="386.37000000000006">the factors, if any, that may be associated with relapse in a</div><div style="left: 80.9418px; top: 550.072px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.889795);" data-canvas-width="211.875">group of patients in Johannesburg.</div><div style="left: 80.9418px; top: 550.072px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.889795);" data-canvas-width="211.875"> </div><div style="left: 80.9418px; top: 550.072px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.889795);" data-canvas-width="211.875"> </div><div style="left: 80.9418px; top: 587.585px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.945913);" data-canvas-width="52.845000000000006"><strong>Method.</strong></div><div style="left: 133.787px; top: 587.585px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.898222);" data-canvas-width="333.49499999999995">Patients were recruited from mental health outpatient</div><div style="left: 80.9418px; top: 610.914px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.874534);" data-canvas-width="386.3399999999999">clinics in a predominantly residential area during the period</div><div style="left: 80.9418px; top: 634.244px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.964537);" data-canvas-width="386.26500000000004">January 1995 - June 2005. They were included if a review</div><div style="left: 80.9418px; top: 657.573px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.944481);" data-canvas-width="386.34">of their records confirmed a diagnosis of schizophrenia</div><div style="left: 80.9418px; top: 680.903px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.93674);" data-canvas-width="107.085">according to the</div><div style="left: 188.417px; top: 680.903px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.929862);" data-canvas-width="278.8499999999999">Diagnostic and Statistical Manual of Mental</div><div style="left: 80.9418px; top: 704.232px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.864154);" data-canvas-width="57.135000000000005">Disorders</div><div style="left: 138.077px; top: 704.232px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.922967);" data-canvas-width="329.13">(4th edition) (DSM-IV); they had no other psychotic</div><div style="left: 80.9418px; top: 727.562px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.915005);" data-canvas-width="139.95">illness; and they were</div><div style="left: 221.222px; top: 730.327px; font-size: 15.45px; font-family: sans-serif;">≥</div><div style="left: 229.457px; top: 727.562px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.925571);" data-canvas-width="237.80999999999995">18 years old. Patients were excluded</div><div style="left: 80.9418px; top: 750.891px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.948122);" data-canvas-width="386.26500000000004">if the diagnosis of schizophrenia had first been made in the</div><div style="left: 80.9418px; top: 774.221px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910179);" data-canvas-width="386.295">preceding 6 months. Demographic and clinical characteristics</div><div style="left: 80.9418px; top: 797.55px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.899872);" data-canvas-width="316.3349999999999">of the patients were obtained from their case notes.</div><div style="left: 80.9418px; top: 835.063px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.789549);" data-canvas-width="44.06999999999999"><strong>Results.</strong></div><div style="left: 125.012px; top: 835.063px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.955789);" data-canvas-width="342.3">Of the 217 patients who were included in the study,</div><div style="left: 80.9418px; top: 858.392px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.935752);" data-canvas-width="49.86000000000001">61.8% (</div><div style="left: 123.602px; top: 858.392px; font-size: 15.45px; font-family: sans-serif;">N</div><div style="left: 136.247px; top: 858.392px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.906889);" data-canvas-width="323.83500000000004">=134) had a history of at least 1 relapse. There was</div><div style="left: 80.9418px; top: 881.722px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.878496);" data-canvas-width="150.75">no significant difference (</div><div style="left: 193.772px; top: 881.722px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 202.172px; top: 881.722px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.909853);" data-canvas-width="227.17500000000004">&gt;0.05) between those who relapsed</div><div style="left: 80.9418px; top: 905.051px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.884851);" data-canvas-width="386.37">and those who did not relapse in terms of gender, marital</div><div style="left: 80.9418px; top: 928.381px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.861113);" data-canvas-width="318.87000000000006">status or employment status. Approximately 46% (</div><div style="left: 399.857px; top: 928.381px; font-size: 15.45px; font-family: sans-serif;">N</div><div style="left: 412.502px; top: 928.381px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.957726);" data-canvas-width="54.75">=61) of</div><div style="left: 80.9418px; top: 951.71px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.927032);" data-canvas-width="386.325">those who relapsed had co-morbid psychiatric disorders,</div><div style="left: 80.9418px; top: 975.04px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.901579);" data-canvas-width="154.17000000000002">compared with 10.8% (</div><div style="left: 235.127px; top: 975.04px; font-size: 15.45px; font-family: sans-serif;">N</div><div style="left: 247.772px; top: 975.04px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.878855);" data-canvas-width="219.45000000000002">=9) in those who did not relapse</div><div style="left: 80.9418px; top: 998.369px; font-size: 15.45px; font-family: sans-serif;">(</div><div style="left: 84.5418px; top: 998.369px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 92.9418px; top: 998.369px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.944237);" data-canvas-width="374.28000000000014">&lt;0.0001), but there was no significant difference between</div><div style="left: 80.9418px; top: 1021.7px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.874532);" data-canvas-width="386.31">the two groups when comparing the presence of co-morbid</div><div style="left: 80.9418px; top: 1045.03px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.92735);" data-canvas-width="113.92499999999997">medical disorder (</div><div style="left: 194.882px; top: 1045.03px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 203.282px; top: 1045.03px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(1.00079);" data-canvas-width="144.915">=0.348). Nearly half (</div><div style="left: 348.212px; top: 1045.03px; font-size: 15.45px; font-family: sans-serif;">N</div><div style="left: 360.857px; top: 1045.03px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.955652);" data-canvas-width="106.38000000000001">=63) of patients</div><div style="left: 80.9418px; top: 1068.36px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.915876);" data-canvas-width="304.605">who relapsed had a history of substance abuse (</div><div style="left: 385.502px; top: 1068.36px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 393.902px; top: 1068.36px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(1.04686);" data-canvas-width="73.35000000000002">=0.0054);</div><div style="left: 80.9418px; top: 1091.69px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.88818);" data-canvas-width="269.38500000000005">cannabis was significantly more abused (</div><div style="left: 350.357px; top: 1091.69px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 358.757px; top: 1091.69px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.962865);" data-canvas-width="103.84500000000001">=0.0014). Two-</div><div style="left: 80.9418px; top: 1115.02px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.854603);" data-canvas-width="40.379999999999995">thirds (</div><div style="left: 120.842px; top: 1115.02px; font-size: 15.45px; font-family: sans-serif;">N</div><div style="left: 133.487px; top: 1115.02px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.928543);" data-canvas-width="333.28499999999997">=138) of the study population did not adhere to their</div><div style="left: 80.9418px; top: 1138.35px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.870596);" data-canvas-width="180.315">treatment, of whom 80.4% (</div><div style="left: 308.777px; top: 1138.35px; font-size: 15.45px; font-family: sans-serif;">N</div><div style="left: 321.422px; top: 1138.35px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.905338);" data-canvas-width="193.36500000000004">=107) experienced a relapse</div><div style="left: 80.9418px; top: 1161.68px; font-size: 15.45px; font-family: sans-serif;">(</div><div style="left: 84.5418px; top: 1161.68px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 92.9418px; top: 1161.68px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.918138);" data-canvas-width="374.3399999999999">&lt;0.0001). Significant multiple logistic regression models for</div><div style="left: 80.9418px; top: 1185.01px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.930805);" data-canvas-width="381.63000000000005">patients who relapsed included poor adherence due to side-</div><div style="left: 80.9418px; top: 1208.33px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.900849);" data-canvas-width="206.82">effects (odds ratio (OR)=3.032;</div><div style="left: 289.367px; top: 1208.33px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 297.767px; top: 1208.33px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.945699);" data-canvas-width="169.485">=0.023; 95% confidence</div><div style="left: 80.9418px; top: 1231.66px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.970823);" data-canvas-width="386.35499999999996">interval (CI) 1.168 - 7.870); poor adherence due to lack of</div><div style="left: 80.9418px; top: 1254.99px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.957232);" data-canvas-width="119.67000000000003">insight (OR=5.29;</div><div style="left: 201.782px; top: 1254.99px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 210.182px; top: 1254.99px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(1.04379);" data-canvas-width="257.08500000000004">&lt;0.0001; 95% CI 2.28 - 12.20), and</div><div style="left: 80.9418px; top: 1278.32px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.915405);" data-canvas-width="257.595">co-morbid depressed mood (OR=5.33;</div><div style="left: 341.147px; top: 1278.32px; font-size: 15.45px; font-family: sans-serif;">p</div><div style="left: 349.547px; top: 1278.32px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.981693);" data-canvas-width="117.70500000000003">&lt;0.001; 95% CI</div><p>2.32 - 12.22)</p><p> <strong>Conclusion.</strong></p><div style="left: 604.536px; top: 321.242px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.924674);" data-canvas-width="313.11">Co-morbid depressed mood, poor adherence</div><div style="left: 531.336px; top: 344.572px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.919825);" data-canvas-width="386.265">owing to lack of insight, and medication side-effects were the</div><div style="left: 531.336px; top: 367.901px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.856342);" data-canvas-width="386.31">factors most likely to increase the risk of relapse in patients</div><div style="left: 531.336px; top: 391.231px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910177);" data-canvas-width="386.3399999999999">with schizophrenia. Risk of relapse may be reduced when the</div><p>treating psychiatrist identifies and addresses these factors.</p>