Intervention for first episode psychosis in India - The SCARF experience

There have been very few studies or programs in India on early intervention for first episode psychoses. This paper reports the findings of a pilot program, part of a collaboration with the Prevention and Early Intervention Program for Psychoses, Montreal.

A sample of 47 patients with first episode psychosis were followed up for 2 years. Complete data was available on 39 subjects at 2 years. This data was analyzed for socio-demographic and clinical variables and its relationship with outcomes and DUP. Those who had a PANSS score <60 and GAF >80 were categorized to be in remission (N=28) and others as continually ill (N=10).

There was significant improvement from baseline to 1st year with maximal improvement seen at 3 months after intake. However, improvement between 1 and 2 years was not significant. More women relapsed and more men dropped out. 25 out of 28 subjects with shorter DUP (<2 years) were in remission at 2 years as against 3 out of 10 with >2 years DUP. Three different patterns of course of the disorder were found. Single episode followed by total remission for 2 years (N=20; 52.6%) was the commonest. The others were relapses followed by remissions (N=8; 21.1%), and continuous illness (N=10; 26.3%).

Early intervention is effective and more so if DUP is shorter. PANSS scores and GAF at baseline are not predictive of later outcomes. Medication adherence in therapeutic engagement and psychosocial needs should be considered in the implementation of early intervention programs in our cultural context.