Factors associated with relapse in schizophrenia

Abstract

Aim.Early identification and prevention of relapse in patientswith schizophrenia has significant therapeutic and socio-economic implications. The aim of this study was to determinethe factors, if any, that may be associated with relapse in agroup of patients in Johannesburg.  Method.Patients were recruited from mental health outpatientclinics in a predominantly residential area during the periodJanuary 1995 - June 2005. They were included if a reviewof their records confirmed a diagnosis of schizophreniaaccording to theDiagnostic and Statistical Manual of MentalDisorders(4th edition) (DSM-IV); they had no other psychoticillness; and they were≥18 years old. Patients were excludedif the diagnosis of schizophrenia had first been made in thepreceding 6 months. Demographic and clinical characteristicsof the patients were obtained from their case notes.Results.Of the 217 patients who were included in the study,61.8% (N=134) had a history of at least 1 relapse. There wasno significant difference (p>0.05) between those who relapsedand those who did not relapse in terms of gender, maritalstatus or employment status. Approximately 46% (N=61) ofthose who relapsed had co-morbid psychiatric disorders,compared with 10.8% (N=9) in those who did not relapse(p<0.0001), but there was no significant difference betweenthe two groups when comparing the presence of co-morbidmedical disorder (p=0.348). Nearly half (N=63) of patientswho relapsed had a history of substance abuse (p=0.0054);cannabis was significantly more abused (p=0.0014). Two-thirds (N=138) of the study population did not adhere to theirtreatment, of whom 80.4% (N=107) experienced a relapse(p<0.0001). Significant multiple logistic regression models forpatients who relapsed included poor adherence due to side-effects (odds ratio (OR)=3.032;p=0.023; 95% confidenceinterval (CI) 1.168 - 7.870); poor adherence due to lack ofinsight (OR=5.29;p<0.0001; 95% CI 2.28 - 12.20), andco-morbid depressed mood (OR=5.33;p<0.001; 95% CI

2.32 - 12.22)

 Conclusion.

Co-morbid depressed mood, poor adherenceowing to lack of insight, and medication side-effects were thefactors most likely to increase the risk of relapse in patientswith schizophrenia. Risk of relapse may be reduced when the

treating psychiatrist identifies and addresses these factors.