Pathways to Care: Duration of Untreated Psychosis from Karachi, Pakistan

Abstract

BackgroundSubstantial amount of time is lost before initiation of treatment in Schizophrenia. The delay in treatment is labelled as Duration of Untreated Psychosis (DUP). Most of these estimates come from western countries, where health systems are relatively better developed. There is dearth of information on pathway to care from developing countries.Methods and ResultsPatients with ICD-10 based diagnosis of Schizophrenia were enrolled by convenient method of sampling. The pathway to care was explored through a semi-structured questionnaire. Onset, course and symptoms of psychosis were assessed using Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Ethical approval of the project was taken from The Aga Khan University, Ethics Review Committee. Of the enrolled 93 subjects, 55 (59%) were males and 38 (41%) were females. In our sample, 1.56 mean (median, 2) attempts were made prior to successful help seeking. The duration of untreated psychosis was 14.8 months (St. Deviation; 29.4). DUP was 16.8 months (St. Deviation; 34.9) for males and 11.8 months (St. Deviation; 18.9) for females. In the pathway to care, psychiatrists featured prominently as initial care providers. In the first attempt at help-seeking, 43% patients were initially taken to psychiatrists. After the initial consultation, 45% were prescribed psychotropic medication while 7% were hospitalized. Only 9% subjects were given the diagnosis of schizophrenia initially. When participants were inquired about the reasons for delay, 29% reported financial difficulties as the barrier to care. Positive symptoms of psychosis were present in 57% subjects while negative symptoms were present in 30% subjects. There was a statistically significant difference (Chi-square; 7.928, df: 1, Sig 0.005) between DUP and the positive and negative symptoms category.ConclusionIn the absence of well developed primary care health system in Pakistan, majority of patients present to psychiatrists as a first contact. DUP, as a measurement of help seeking behaviour, tends to be shorter with positive symptoms of Schizophrenia. Substantial amount of time is lost due to non recognition of disease and subsequently, inadequate treatment. Secondary prevention strategies should focus on families, which play an important role in the treatment-seeking process of psychotic patients.

Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia

“…36 However, other studies did not show any association between marital status and DUP. 10,16 Our result might be understood by considering the impact of culture on decision making to seek treatment. This might be influenced by lack of awareness of mental illness and stigma.…”

“…9 Another study was conducted in Karachi, Pakistan, and showed that because of the lack of a primary care system, most of the psychotic patients contacted psychiatrists directly. 10 Understanding the importance of early diagnosis and treatment is an important step to eliminate this delay and mitigate its impact on the prognosis of the disease. The first stage of help seeking is the decision to seek help and this is what seems to be prone to most delay.…”

Duration of Untreated Psychosis in Chinese and Mauritian: Impact of Clinical Characteristics and Patients’ and Families’ Perspectives on Psychosis

“…Second, economic factors may impair access to mental health services. For a low-income population, it may simply be too expensive to afford psychiatric treatment [ 9 – 10 , 12 – 13 ]. Third, the fear of stigmatization and discrimination associated with psychosis can prevent patients, or their family members, from acknowledging the presence of mental disorder and therefore seeking help [ 8 – 10 , 14 – 15 ].…”

“…To our knowledge, much of the research concerning DUP has focused on one site only [ 2 , 12 , 16 ], without direct comparison in different cultures and religions. In addition, previous studies focused on patients’ [ 8 – 9 , 11 , 14 , 17 – 20 ] or caretakers’ perspectives [ 21 – 22 ], but research on DUP with diverse population or perspectives from both patients and their family members are especially scarce. In this research, both respects were taken into consideration, and the above barriers were assessed in Changsha, China and Mauritius, which are geographically, socially and culturally different.…”

Combining depot antipsychotic with an assertive monitoring programme for treating first‐episode schizophrenia in a resource‐constrained setting

“…[51][52][53] Given the enormous risks associated with relapse and the absence of reliable relapse predictors, longer periods of treatment are increasingly advocated. 5 Clinicians may however sometimes decide to discontinue antipsychotic treatment in a particular patient, for example, due to uncertain or changed diagnosis. In such a situation, as with oral antipsychotics, depot antipsychotics may be discontinued at any stage of treatment.…”