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The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied.
To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course.
The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups.
Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died – a nine times higher mortality rate than among patients with other 2-year course types.
In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.
The acute and transient psychotic disorders (ATPD) in ICD–10 advanced the nosology of remitting psychoses with acute onset. But the proposed criteria for ATPD – especially in regard to duration – are tentative and need to be validated.
To evaluate: (a) the duration of remitting psychoses with acute onset; (b) the applicability of the ATPD criteria for these cases; and (c) differences in duration and ATPD diagnoses across sociocultural settings.
Data from the World Health Organization Determinants of Outcome study were used.
The 98 cases of remitting psychoses with acute onset had a modal duration of 2–4 months, with 43% falling in this range. Mainly because of this, few met the ATPD criteria. Duration and diagnostic findings were similar across settings.
ATPD criteria need refinement, especially in regard to duration. Further studies aimed at early detection and assessment of onset and duration of these disorders are needed.
This case-control study used data from Chandigarh, North India to investigate the association between antecedent fever and acute brief psychosis.
To assess whether antecedent fever may be a biological correlate of acute brief psychosis, and contribute to the nosology of acute brief psychosis.
The study was based in an incidence cohort from two catchment areas, an urban and a rural site, that were part of the World Hearth Organization Determinants of Outcome study. The cases (n=17) met criteria for acute brief psychosis; controls (n=40) were patients with other acute and subacute psychoses. The Life Events Schedule was used to determine the presence of antecedent fever.
The crude odds ratio for fever as a risk factor for acute brief psychosis was 6.2 (P=0.004). The odds ratio in a logistic regression analysis – adjusted for site, gender and CATEGO classification – was 11.2 (P=0.003).
Antecedent fever may be a biological correlate of acute brief psychosis. This finding supports the validity of this entity, and has implications for its aetiology and diagnosis.
This study in North India compared acute brief psychosis – defined by acute onset, brief duration and no early relapse – with other remitting psychoses, over a 12-year course and outcome.
In a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD–10 criteria.
At 12-year follow-up, the proportion with remaining signs of illness was 6% (n=1) for acute brief psychosis versus 50% (n=18) for the comparison group (P=0.002). Using ICD–10 criteria, the majority in both groups were diagnosed as having schizophrenia.
Acute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD– 10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD–10 criteria need modification.
This study explored the relation of level of socio-economic development to the course of non-affective psychosis, by extending the analysis of urban/rural differences in course in Chandigarh, India.
The proportion of ‘best outcome cases between urban (n=110) and rural (n=50) catchment areas were compared at two-year follow-up, separately for CATEGO S+ and non-S+ schizophrenia.
The proportion of subjects with ‘best outcome’ ratings at the urban and rural sites, respectively, was similar for CATEGO S+ schizophrenia (29 v. 29%), but significantly different for non-S+ psychosis (26 v. 47%)
The fact that in rural Chandigarh, psychoses have a more favourable course than in the urban area may be explained in large part by psychoses distinct from ‘nuclear’ schizophrenia.
We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders.
We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia, we examined the distribution of duration of the episode. With respect to separation from affective disorders, we assessed the frequency of affective symptoms.
Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes.
Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD–10.
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