An Observational study of clinical profile and cognitive insight in patients of treatment resistant schizophrenia

Dr Kundan S. Kamble; Dr. Arun Kumar V; Dr Ajita S Nayak

Volume : VII, Issue : III, March - 2018

An Observational study of clinical profile and cognitive insight in patients of treatment resistant schizophrenia

Dr Kundan S. Kamble, Dr. Arun Kumar V, Dr Ajita S Nayak

Abstract :

Objectives –It has been estimated that 20–50% patients with Schizophrenia can develop treatment resistance. Treatment resistance is associated with increased morbidity in these patients and it also increases the burden for the caretakers. Very few Indian studies have tried to establish the factors associated with resistance in Schizophrenia. Hence, this study was conducted to identify the socio–demographic profile, illness variables, co–morbidities and cognitive insight in patients with Treatment Resistant Schizophrenia.

Methodology: The study was conducted after permission from Institutional Review Board. 50 consecutive patients of Treatment Resistant Schizophrenia (treated with 2 antipsychotics from different classes with adequate doses for 6 weeks each and currently satisfying the DSM IV TR criteria for Schizophrenia) were included in the study. Patients were administered a semi–structured questionnaire to obtain details about socio–demographic status, age of onset, family history, number of episodes and treatment received. DSM–IV–TR was used to identify psychiatric co–morbidities. Becks cognitive insight scale was used to assess cognitive insight.

Results: The mean age of patients in the study with Treatment Resistant Schizophrenia (TRS) was found to be 33.5yrs with M: F ratio of 1.77:1. It was found that 34% of patients had an onset before 20 yrs of age. Positive family history of mental illness was present in 48% of the TRS patients. Multiple episodes (>5) were present in 36% of patients. TRS was characterized by absence of affective symptoms in 90% of patients. On applying Beck�s cognitive insight scale, patients of TRS were found to have higher Self–Certainty score as compared to Self–Reflection, indicating poor awareness into their illness and treatment.

Conclusions: It is important to identify Schizophrenia patients with early age of onset, positive family history, absence of affective features and poor cognitive insight to improve the long–term course of Schizophrenia.