Epidemiology of Schizophrenia in an Indian Hospital

 

Vinod K Mathew¹*, Kishore Gnana Sam², Beulah Samuel³, Amit Kumar Das⁴

¹Dept. of Pharmacy Practice, Krupanidhi College of Pharmacy, Bangalore – 35

²Associate Professor, Department of Pharmacy Practice, College of Pharmacy Gulf Medical University, Ajman, UAE

³HOD, Department of Pharmacy Practice. RR College of Pharmacy, Bangalore.

⁴Principal, Krupanidhi College of Pharmacy, Bangalore – 35

 

ABSTRACT:

According to WHO estimates, schizophrenia affects approximately 24 million people worldwide As epidemiological studies on schizophrenia are sparse in India, present study was undertaken to analyze the Sociodemographic profile and distribution pattern of schizophrenia in India. Demography of the patients like age, sex, family history, ICD – 10 sub class, outcome as clinical status of patient at the time of discharge and length of hospital stay were also studied. Marital status and family history of psychiatric illness were also studied. Majority of the patients were males 81(58.27 %) The average age was 34.4±11.9 years. Predominance of males below 40 years and females above 40 years were observed. Paranoid schizophrenia was the major subclass (63.3%). The present study revealed an increasing trend of schizophrenia among the patients admitted in a tertiary care hospital.

 

 

INTRODUCTION:

Mental Health is vital for the growth and productivity of every society and for a healthy and happy life. The definition of health includes mental health along with its physical, emotional, social and spiritual components. According to WHO estimates, schizophrenia affects approximately 24 million people worldwide.¹ The prevalence of schizophrenia varies across the world, within countries, and at the local and neighborhood level.^2,3

 

Prevalence studies of schizophrenia in India report rates of between 1.5 per 1000 and 2.5 per 1000. There appears to be no consistent difference between rural and urban areas in the frequency of the illness, and no clear pockets of high or low prevalence. Incidence studies are few, with estimates of an annual incidence of 0.35–0.38 per 1000 in urban populations and 0.44 per 1000 in the rural population.^4,5,6.

 

 

 

 

However, a survey of an urban community in southern India, served by four state-run general hospitals with psychiatric services and a large psychiatric institution, found that a third of people with schizophrenia had never accessed any treatment. Even after these individuals and their families were offered treatment, a third of them continued in their untreated state.^4,7

 

As epidemiological studies on schizophrenia are sparse in India, present study was undertaken to analyze the sociodemographic profile and distribution pattern of schizophrenia in India.

 

METHODOLOGY:

The study was a retrospective medical record review conducted at the Department of Psychiatry at Kasturba Hospital, Manipal, a 1472 bed hospital. Following a standard protocol all the 909 schizophrenic Patients admitted in Psychiatry ward during the period of 10 years were included in the study. A written informed consent in local language (Kannada & Malayalam) & English was obtained from the patient or care providers. Demography of the patients like age, sex, family history, ICD – 10 sub class, outcome as clinical status of patient at the time of discharge and length of hospital stay were also studied. Marital status and family history of psychiatric illness were also studied.

RESULTS:

For analyzing trends of schizophrenia, ICD-10 classification of mental and behavioral disorders was followed. Distribution pattern for last ten years was taken into consideration. Trends of schizophrenia at Kasturba hospital, Manipal is described below.

 

Year wise distribution of schizophrenia:

A total of 909 patients were admitted in 10 years. The number of patients diagnosed to have schizophrenia for last ten years was found to be inconsistent showing variable trends. Ten year distribution of schizophrenia shows that maximum patients was admitted in 2003 (n =121), where as minimum patients (n = 60) was admitted in the year’s 1997 &1999.

 

Figure 1: Year wise distribution of schizophrenia

 

 

Figure 2: Age group wise distribution of schizophrenia

 

Gender wise distribution of schizophrenia:

Out of a total of 909 patients 540 (59.41%) were males and 369 (40.59%) were females. Males were more than females. Males were more than females for all years except for 1998 in which females were more (33) as compared to males (32). Maximum number of males were admitted in the year 2003 (77) and females in the year 2002 (66). The male to female ratio was found to be 1.46: I.

Age group wise distribution:

Age group wise distribution showed that highest number 318 (34.98%) of patients were classified in the age group 21-30 years, while 6 patients (0.60%) were aged above 70 years. The average age was 34.44 ± 11.94 years.

 

 

 

 

Figure 3: Age group and gender wise distribution of schizophrenia

 

Age group and gender wise distribution of schizophrenia:

Age group and gender wise distribution showed that highest numbers of males and females were in the age group 21-30 years, in this age group 210 patients (38.89%) were males and 108 (29.27%) were females. Minimum patients (n=6) where there in the age group more than 70 and 2 patients (0.37%) where males and 4 (1.08%) were females. Males were more than females in age groups < 20, 21–30, & 31–40 were as females were more than males in age group 41–50, 61–70, & > 70 years. The average age of males was 32.66±10.7 with a minimum age of 10 to 72 years. The average age of females was 37.04±13.2 years with a minimum age of 13 and maximum age of 82 years. There was a statistically significant association (P<0.001) between the age distribution and gender.

 

Outcome wise distribution:

Assessment of Outcome of clinical status at discharge showed that majority of the patients ‘Improved’, 792 (87.13%) patients. 105 (11.55%) patients were unchanged at the time of discharge and 12 (1.32%) patients were recovered at the time of discharge.

 

	F20.0	Paranoid Schizophrenia
	F20.1	Hebephrenic Schizophrenia
	F20.2	Catatonic Schizophrenia
	F20.3	Undifferentiated Schizophrenia
	F20.5	Residual Schizophrenia
	F20.8	Other Schizophrenia
	F20.9	Unspecified Schizophrenia
	F20.4	Post Schizophrenic Depression
	F20.6	Simple Schizophrenia

Figure 4: ICD – 10 Sub class wise distribution of schizophrenia

 

 

Distribution of sub class of schizophrenia according to ICD – 10 diagnostic criteria:

The ICD – 10 sub class wise distribution has shown that paranoid schizophrenia (F20.0) was the most prominent diagnosis 546 (60.07 %) and the least patients 3 (0.33%) diagnosed was in the sub type post schizophrenic depression (F20.4). Maximum of 71 patients were diagnosed with paranoid schizophrenia in the year 2006 and minimum patients 32 in the year 1999. The total number of patients diagnosed in other ICD – 10 sub types are hebephrenic schizophrenia (F20.1) 10(1.10%), catatonic schizophrenia (F20.2) 48(5.28%), undifferentiated schizophrenia (F20.3) 170(18.70%), residual schizophrenia (F20.5) 38(4.18%), other schizophrenia (F20.8) 9(0.99%), unspecified schizophrenia (F20.9) 81(8.91%) and simple schizophrenia (F20.6) 4(0.44%).

 

 

 

 

 

 

Gender wise distribution within subclass of schizophrenia:

Results of the gender wise distribution within subclass of schizophrenia showed that highest numbers of males and females occur in the subclass paranoid schizophrenia (F20.0). In this subclass 325(60.19%) patients were males and 221(59.89%) patients were females. For males minimum patients 2(0.37%) patients belong to the sub class post schizophrenic depression (F20.4) where as for females minimum patients was in the subclass post schizophrenic depression (F20.4) and simple schizophrenia (F20.6), 1 (0.27%) patient was female. Males were more than females in diagnosis paranoid schizophrenia (F20.0), hebephrenic schizophrenia (F20.1), unspecified schizophrenia (F20.9), post schizophrenic depression (F20.4), and simple schizophrenia (F20.6) were as females were more than males in the diagnosis catatonic schizophrenia (F20.2), undifferentiated schizophrenia (F20.3), other schizophrenia (F20.8). There was no statistically significant association between gender and subclass of schizophrenia.

 

Figure 5: Gender wise distribution within subclass of schizophrenia

 

DISCUSSION:

This is a naturalistic study, which provides data in the context of real-world practice. Therefore, such data are likely to be more representative of day-to-day practice than randomized trials. The gender wise distribution showed that males predominantly had schizophrenia with 59.41% males and 40.59% females. This observation is similar to a study by Dutta et al.⁸ (2003) carried out in Uttaranchal, India and Andor et al.⁹ (2003) study in Switzerland. The male to female ratio was found to be 1.46: 1 but a study conducted by Padmavathi et al.⁴ in Chennai (1986) showed a male: female ratio of 1.06:1. Studies in USA by WU EQ et al.¹⁰ (2002) have shown higher prevalence of schizophrenia in males than in females. The average age among the patients was 34.44 ±11.94 years, which is similar to other Indian studies by Chaudhary et al.¹¹ (2004) in Assam and Padmavathi et al.⁴ study in Chennai. The present study is also supported by a study conducted by Meltzer et al.⁵⁹ On the contrary studies conducted in UK by Burns et al.¹² (2000) showed a mean age of 42.65±13.4 years, and Acquaviva et al.¹³ (2002) showed an average age of 39.7± 12 years in France. An average age of 47.7 years was reported by Clark et al.¹⁴ (1995); 43.1 ± 11.3 years by Mallinger et al.¹⁵ (2004) in New York and 40.3 ± 10.9 years by Rosenheck et al.¹⁶ (2006). Age distribution showed that higher numbers of patients belonged to the age group 21-30 years as supported by Welham et al.¹⁷ (1991) in Australia. In the present study it was observed that majority of the males belonged to the lower age group of less than 40 years while females dominated in higher age group of more than 40 years, similar to a study by Welham et al.¹⁷ which revealed a female predominance in the 40 – 50 age group. However studies in USA by WU EQ et al.¹⁰ revealed that majority of males belonged to 46–55 year age group and females belonged to 56 – 65 age group.

 

Paranoid schizophrenia was the most prominent diagnosis among all sub classes. This is similar to studies by Dutta et al.⁸ (2003) in Uttaranchal India and Burns et al.¹² (2000) in United Kingdom. Paranoid schizophrenia was the most common subclass under the age of 70 years, after which unspecified schizophrenia predominated.

 

REFERENCE:

1.      Piccinelli M, Gomez Homen F. Gender differences in the epidemiology of affective disorders and schizophrenia. In: Piccinelli M, Gomez Homen F, eds. Division of Mental Health and Prevention of Substance Abuse. Geneva: World Health Organization (WHO); 1997: 1-163.

2.      Kirkbride JB, Fearon P. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry. 2006; 63(3):250-8.

3.      Kirkbride JB, Morgan C. Neighbourhood-level effects on psychoses: re-examining the role of context. Psychol Med. 2007; 37(10):1413-25.

4.      Padmavati R., Rajkumar S, Srinivasan TN. Schizophrenic patients who were never treated – a study in an Indian urban community. Psychological Medicine 1998; 28:1113-117.

5.      Sethi BB, Gupta SC, Mahendru RK, Kumari P. Mental health and urban life: A study of 850 families. Br J Psychiatry 1974; 124:243-246.

6.      Nandi DN, Mukherjee SP, Boral GC. Socio-economic status and mental morbidity in certain tribes and castes in India: a cross-cultural study. Br J Psychiatry 1980; 136:73-85.

7.      Srinivasan TN, Rajkumar S, Padmavati R. Initiating care for untreated schizophrenia patients and results of one-year follow-up. International Journal of Social Psychiatry 2001; 47(2):73-80.

8.      Dutta SB, Dhasmana DC, Bhardwaj R. Psychotropic drug utilization pattern among patients with schizophrenia. Indian J Psychiatry 2005; 47(4):243 – 44.

9.      Andor E, Peter M, Hess L, Valterio C. Antipsychotic use in patients with schizophrenia treated in private psychiatry. Swiss Med Wkly 2005; 135:109-115.

10.   WU EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: A claims data analysis approach. Psychological medicine 2006 Nov; 36(11):1535-40.

11.   Chaudhary PK, Deka K, Chetai D. Disability associated with mental disorders. Indian J Psychiatry 2006; 48:95-101.

12.   Burns T, Christova L, Cooper S, Harrison L, Mckendrick J, Laugharne R et al. Maintenance antipsychotic medication pattern in outpatients Schizophrenia patients: a naturalistic cohort study. Acta Psychiatr Scand 2006 Feb; 113(2):126-134.

13.   Acquaviva E, Gansquet L, Falissard B. Psychotropic combination in schizophrenia. Eur J Clin Pharmacol 2005; 61:855-61.

14.   Clark RE, Bartels SJ, Mellman TA, Peacock WA. Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorders: Implications for state mental health policy. Schizophrenia Bulletin 2002; 28(1):75-84.

15.   Malinger JB, Fisher SG, Brown T, Lamberti JS. Racial disparities in the use of second- generation antipsychotics for the treatment of schizophrenia. Psychiatric services 2006 Jan; 57(1):133-36.

16.   Rosenheck R, Stroup S, Keefe RS, Mcevoy J, Swartz M, Perkins D et al. Measuring outcome priorities and preferences in people with schizophrenia. British J psychiatry 2005: 187:529 – 36.

17.   Welham JL, Richard J, Thomis RJ, McGrath JJ. Age-at-first-registration for affective psychosis and schizophrenia. Schizophrenia Bulletin 2004; 30(4):849-53.

 

 

 

 

 

 

 

 

Received on 20.06.2019           Modified on 26.07.2019

Accepted on 30.08.2019         © RJPT All right reserved