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ABSTRACT: Transcultural studies suggest that the social outcome of schizophrenia might be better in developing countries than in industrialized ones. This study aims to check this hypothesis and attempted to identify prognostic indicators of schizophrenia among Tunisian patients.
This study included all the outpatients responding to DSM IV criteria of schizophrenia for at least five years, during the study period. The assessment tools were: an interview with the patients and their families, data from medical records and the Global Assessment of Functioning scale (GAF) applied for the premorbid period, at two years after onset, at five years, and during the interview (current assessment). The social outcome was assessed by marital and labour market status, social network, sexuality and the GAF score. The outcome was considered to be good, if the current GAF >60, intermediate if GAF was between 31 and 60 and severe if GAF <or=30. The three prognostic subgroups were compared in order to look for prognostic indicators.
Informed consent was obtained from 60 patients (85.7% of outpatients) and from 56 families. The sex-ratio was 4 (48 men/12 women), the mean age of patients was 39.3 years; the mean follow-up was 14.7 years ([5-45]). School level was six years primary school in the majority of cases, and the living conditions were poor in 48.3% of cases (n=29). During the interview, only 21.6% (n=13) of patients were married. The majority of patients, who were working before the first episode, had lost their job. 76.6% (n=46) did not have any social contacts and only 23.3% (n=14) had any sexual activity. Thus, the social outcome was good in 21% of patients, intermediate in 11.1% and severe in 67.9%. Most social indicators (GAF score, labour market status, social network) revealed a fairly similar progress: a significant decline between the premorbid period and two years after the onset. The course reached a plateau after two years. According to current GAF scores, outcome was good in 25% (n=15) of cases, intermediate in 55% (n=33) of them and severe in 20% (n=12). Some indicators were found to be correlated with this outcome: patient related factors; late language development (correlated with intermediate prognosis [p=0.03]); a comorbid axis II diagnosis (correlated with poorer outcome p=0.04); a poor premorbid global functioning (higher premorbid GAF scores were correlated with a better outcome [p<0.03]); family history related factors; consanguinity in parents (correlated with intermediate-severe prognosis [p=0.04]); elderly father at birth (correlated with severe prognosis [p=0.04]).
Even if these results are limited in their generalisation, this Tunisian sample argues that schizophrenia's prognosis is not better in such a developing country.
L Encéphale 06/2009; 35(3):234-40. · 0.63 Impact Factor
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ABSTRACT: Epidemiological research concerning the seasons of births of schizophrenics show for the greatest part that there's an excess of births in winter and in the beginning of spring. Research about the environmental theories of schizophrenia suggest that there would exist one or many seasonal environmental factors affecting the foetus and the neonate, and which would be likely to increase the risk of a subsequent development of schizophrenia. As no research concerning this subject have been published so far in Africa, the writers propose to study the distribution of births of a population of schizophrenics born in Tunisia in comparison to the general population and to compare it to a group of patients hospitalized because of major affective disorders. The results achieved show a significant decrease in the number of schizophrenics births during the third trimester and an excess of births during the month of october, the risk being greater in the case of disorganized schizophrenia. The greater risk for people born in october to develop subsequently schizophrenia is not found in the case of major affective disorders but it is found rather in the case of schizo-affective disorders. More over, we notice a decrease in the number of births during the month of July for the patients presenting major affective disorders and for those presenting schizo-affective disorders. Results seem to demonstrate that there would exist seasonal environmental factors specific to North Africa which are likely to affect the subsequent appearance of schizophrenic disorders. A particular interest should be given to viral infectious to enteroviruses which are responsible for summer diarrhea in Tunisia.(ABSTRACT TRUNCATED AT 250 WORDS)
L Encéphale 20(5):473-7. · 0.63 Impact Factor
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ABSTRACT: Clinical symptoms of bipolar disorders onset act as a prognostic risk-factor. Discrepancies of data are related with geographical or cultural conditions. Within a patient population of bipolar (ICD 10) in and out patients of a psychiatric department, manic or hypomanic disorders initiate the space disease in 33% of the cases theses features are similar within the western psychiatric population. In a maghrebian population this proportion reaches 50%. A percentage of 65% of bipolar 1 patients was found within our sample. Sex ratio is 1 for bipolar 1, when, for bipolar 2 disorders sex-ratio was superior to 1, in favor of females. Mean age of the first episode of the disease was younger for patients with a familial history of the disease.
L Encéphale 25(6):523-7. · 0.63 Impact Factor
