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Predictors and Clinical Outcome of Patients Admitted with First Episode Psychosis at Mirembe Mental Health Hospital in Dodoma, Tanzania: A Prospective Longitudinal Study
Isack C Rugemalila*,Azan Nyundo
Objective: First Episode Psychosis (FEP) presents with varying clinical outcome on patients especially in early phase of treatment. Heterogeneity of the study populations, setting, and clinical diagnosis may all predict remission of symptoms. This study aimed at assessing the predictors of symptom remission in early phase of treatment among patients admitted for the FEP.
Methods: A sample of 131 FEP patients (aged ≥ 18) admitted with FEP were followed for 28 days. Mini International Neuropsychiatric Instrument (MINI) was used to make diagnosis at baseline. Positive and Negative Symptom Scale (PANSS), Montgomery and Asberg Depression Scale (MADRS) and Young Mania Rating Scale (YMRS) were used to measure severity and progression of symptoms during the follow-up period. Univariate and multivariable cox regressions were used to determine the predictors of symptom remission.
Results: Out of 131 subjects, 126 (96.18%) completed follow-up, of which 110 (87.30%) achieved remission of symptoms within follow-up period. Patients with longer Duration of Untreated Psychosis (DUP), 3-6 months adjusted Hazard Ration (aHR)=0.65, 95% CI=( 0.40-1.03) had decreased likelihood to remission of symptoms relative to those with less than three months of DUP and also patients living with their spouses had 0.31 decreased likelihood of remission of symptoms (aHR)=0.31, 95% CI=( 0.13-0.69) relative to those living alone.
Conclusion: Longer duration of untreated psychosis is associated with poorer remission of symptoms as reported in previous studies. Strikingly, living with a spouse could not predict better remission of symptoms as findings of earlier studies. Instead, this study suggests there may be more positive effect with social support on remission of symptoms of patients with FEP who live with their spouse and have longer DUP