Insight, psychopathology, explanatory models and outcome of schizophrenia in India: a prospective 5-year cohort study

Abstract

BackgroundThe sole focus of models of insight on bio-medical perspectives to the complete exclusion of local, non-medical and cultural constructs mandates review. This study attempted to investigate the impact of insight, psychopathology, explanatory models of illness on outcome of first episode schizophrenia.MethodPatients diagnosed to have DSM IV schizophrenia (n = 131) were assessed prospectively for insight, psychopathology, explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Multiple linear and logistic regression and generalized estimating equations (GEE) were employed to assess predictors of outcome.ResultsWe could follow up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. There was a negative relationship between psychosis rating and insight scores. Urban residence, fluctuating course of the initial illness, and improvement in global functioning at 6 months and lower psychosis rating at 12 months were significantly related to remission at 5 years. Insight scores, number of non-medical explanatory models and individual explanatory models held during the later course of the illness were significantly associated with outcome. Analysis of longitudinal data using GEE showed that women, rural residence, insight scores and number of non-medical explanatory models of illness held were significantly associated with BPRS scores during the study period.ConclusionsInsight, the disease model and the number of non-medical model positively correlated with improvement in psychosis arguing for a complex interaction between the culture, context and illness variables. These finding argue that insight and explanatory models are secondary to psychopathology, course and outcome of the illness. The awareness of mental illness is a narrative act in which people make personal sense of the many challenges they face. The course and outcome of the illness, cultural context, acceptable cultural explanations and the prevalent social stigma interact to produce a complex and multifaceted understanding of the issues. This complexity calls for a nuanced framing of insight.

Assessment of Functioning among Nigerians with Schizophrenia in a Tertiary Health Facility: Influence of Psychopathology, Socio-demographic and Treatment Factors

“…Similar age range has been reported in this environment [29,30], however, reported data on age are usually interpreted cautiously considering the widespread of illiteracy among majority of patients and their caregivers in this setting. In contrast to findings of some other studies [26,27,29], preponderance of females was noted in this study. However, Yusuf et al [31] reported a preponderance of female patients.…”

“…In this study, majority of the subjects were young and the illness also began at a relatively young age. This is consistent with the findings in previous studies [26,27] and confirms the fact that schizophrenia usually begins at an early age [28]. Similar age range has been reported in this environment [29,30], however, reported data on age are usually interpreted cautiously considering the widespread of illiteracy among majority of patients and their caregivers in this setting.…”

Insight in psychosis: An independent predictor of outcome or an explanatory model of illness?

“…Many reports, which have systematically elicited EMs, have documented the presence of multiple and contradictory beliefs about illness across cultures (Kapoor, 1975;Gater et al, 1991;Lloyd et al, 1998;Joel et al, 2003;McCabe and Priebe, 2004;Saravanan et al, 2007aSaravanan et al, ,b, 2010Johnson et al, 2012Johnson et al, , 2013Johnson et al, , 2014. EMs are usually a conglomeration of emic and etic approaches involving ethnocultural, personal and idiosyncratic beliefs and components from both within and outside culture.…”

“…Pluralistic societies employ multiple approaches to health and illness (Jacob, 1999). The fact that people with non-medical beliefs regularly take psychotropic medication (Saravanan et al, 2007a(Saravanan et al, ,b, 2010Johnson et al, 2012Johnson et al, , 2013Johnson et al, , 2014 argues for the complexity of the response to chronic and disabling illness. Research has documented a complex list of reasons and circumstances, which facilitate medication compliance and which are not necessarily voluntary or rational (Tranulis et al, 2011).…”

Schizophrenia: Indian Research: II—Treatment Issues

“…In a 10-year longitudinal follow-up study, Shrivastava et al (2010) showed that compared to non-recovered group, mean duration of untreated psychosis was longer for a group, which showed clinical recovery as assessed on the Clinical Global Impression Scale. A recent study evaluated the predictors of 5-year outcome of patients with schizophrenia and reported that level of insight, number of non-medical explanatory models and individual explanatory models held during the later course of the illness have a significant impact on the outcome (Johnson et al 2012).…”