BackgroundTranscultural studies have found lack of insight to be an almost invariable
feature of acute and chronic schizophrenia, but its influence on prognosis is
unclear.AimsTo investigate the relationship between insight, psychopathology and
outcome of first-episode schizophrenia in Vellore, India.MethodPatients with a DSM–IV diagnosis of schizophrenia (n = 131)
were assessed prospectively at baseline and at 6-month and 12-month follow-up.
Demographic and clinical measures included insight, psychopathology, duration
of untreated psychosis (DUP) and social functioning. Linear and logistic
regression was used to measure predictors of outcome.ResultsFollow-up data were available for 115 patients at 1 year. All achieved
remission, half of them with and half without residual symptoms. Changes in
psychopathology and insight during the first 6 months and DUP strongly
predicted outcome (relapse or functional impairment), controlling for baseline
measures.ConclusionsOutcome of schizophrenia in this setting is driven by early symptomatic
improvement and is relatively favourable, in line with other studies from low-
and middle-income countries. Early improvement in insight might be a useful
clinical guide to future outcome. Reduction of DUP should be a target for
intervention.