The International Journal of Psychosocial Rehabilitation

 

Disability in schizophrenia and its relationship
with duration of illness and age of onset


Arif Ali 
Junior faculty (psychiatric social worker)
Department of psychiatric social work
LGB regional institute of mental health Tezpur
Assam, India
   



Citation:
Ali A. (2009). Disability in schizophrenia and its relationship with duration of illness and
 age of onset. International Journal of Psychosocial Rehabilitation. Vol 14(1).  37-41

Introduction
A commonly accepted prevalence rate for schizophrenia is that it affects approximately 1% of the population at any time, but epidemiological studies differ (Andreasen, 1984; Torrey, 2001). A review of recent major epidemiological studies concluded that schizophrenia occurs in all populations with a prevalence rate in the range of 1.4 to 4.6 per 1000 (Jablensky, 2000). Schizophrenia usually starts during young age and is frequently associated with deterioration from the previous level of functioning .Schizophrenic patients are reported to have multiple psychological and physical impairment (King and Nazareth, 1996). Impairments are more marked in these patients who have continuous or deteriorating course. In schizophrenic patients deterioration takes diverse forms and results in various functional deficits leading to social isolation and poor occupational functioning. The peak age of onset of schizophrenia is 15-30; however, approximately 15% of persons with the disorder may experience initial symptoms after age 45 (Harris & Jeste, 1988). Psychiatric illnesses like schizophrenia, bipolar affective disorder and obsessive-compulsive disorder, impact negatively on the academic, occupational, social and family functioning of the patients. Schizophrenia may cause disability leading to restrictions on many domains of daily life such as hygiene, self-management, vocational and leisure activities, and family and social relationships.

 Defining disability is not an easy task, and it is becoming clear that no single definition can cover all aspects of disabilities. According to the International Classification of Impairment, Disability and Handicap (ICIDH, 1980), disability is interference with activities of the whole person in relation to the immediate environment. Disability associated with mental illness is a major contributor to the global burden of disease. As per the National Sample Survey Organization (NSSO) 1991 statistics, 1.9% of India's population is disabled in one way or the other. Study of disability associated with mental disorder therefore becomes a matter of prime importance. The purpose of this study was to assess disability in schizophrenia patients and to see its relationship with age of onset and duration of illness.

Material and Method
The study was carried out in in Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi (Jharkhand).Based on purposive sampling technique, samples of 60 subjects with diagnosis of schizophrenia were selected. The study was conducted on schizophrenic patient who were selected from in patient unit of RINPAS, Knake, Ranchi. All the patients had been diagnosed by a psychiatrist in accordance to the DCR-ICD-10 criteria at the time of their entry into the hospital. Following inclusion and exclusion criteria was taken into consideration: Age range between 18 to 60 years of both the gender and having no active psychopathology. Patients with any organic involvement, who have any significant physical illness and with co morbid disorder were excluded.

Assessment:
Socio-demographic and Clinical Data Sheet: It is semi-structured Performa especially designed for this study. It contained information about social demographic variables like age, sex, education, marital status, religion, employment status, domicile background etc. It contains information about clinical profile of the individual with schizophrenia.

Disability Assessment Scale: Disability Assessment Scale in a standardized scale developed by Dr. P.B. Behere and Dr. K. Tiwari (1991). It measures the level of disability covering five areas of disability viz. Personal, Social, Occupational, Physical and General. There are total 46 items in the scale, consists of 10 items each in personal, social and occupational area and 8 items in Physical and General Areas. Each item has 4 alternative answers and scores for each item ranges from 0-3, where

0-                 indicate no disability

1-                 indicates mild disability

2-                 indicates moderate disability

3-                 indicates severe disability

Psychopathology was assessed on the Positive and Negative Syndrome Scale (PANSS) (Kay & Linden Mayer, 1987). PANSS gives scores on positive symptoms, negative symptoms and general psychopathology

Patient was identified on the basis of DCR ICD-10 diagnosis criteria. Informed consent was taken from the patient as well as from the informant before eliciting relevant information and the nature and purpose of the study was explained. All the subjects who were selected for the present study were interviewed and then assessed with the help of semi-structured clinical data sheet .Thereafter disability assessment scale were administered to know the severity level of disability of each subject in all the areas viz. Personal, Social, Occupational, Physical and General.

Analysis:
The statistical package for social sciences (SPSS), version 13.0 was used for the analysis of the data of this study. Percentage and correlation was used to examine the data.

Results
Table 1 shows clinical profile of sample. Majority of the patients were having 21-30 years (53.3%) as age of onset of illness and duration of illness more than two years. Table 2 show nature and severity of disability of schizophrenic patients in personal, social, occupational ,physical general area and it was found that majority of the patients were having moderate level of disability  in all the areas . Duration of illness has a significant correlation with personal areas of disability. Age of onset has significant (p<0.05) positive correlation with personal and occupational area of disability (table 3).

 Table 1:          Clinical Profile of Patients

Variables		N (%)
Age of onset	Up to 20 years	4 (6.7)
	21 – 30years	32 (53.3)
	31-40 years	22 (36.7 )
	41-50 years	1 (1.7)
	51-60 years	1 (1.7)
Duration of illness	Up to 1 year	30 (50)
	1 – 2 years	11 (18.3)
	More than 2 years	19 (31.7)

 

Table 2:          Showing nature and severity of disability of schizophrenic patients in personal, social,
 occupational, physical general area: 

Level of disability	Personal Area N=%	social Area N=%	occupational Area N=%	Physical Area N=%	General Area N=%
Normal	(7) 11.7	(2) 3.3	(9) 15.0	(6) 10.0	(7) 11.7
Mild	(24) 40.0	(21) 35.0	(21) 35.0	(25) 47.1	(19) 31.7
Moderate	(28) 46.7	(36) 60.0	(27) 45.0	(24) 40.0	(30) 50.0
Severe	(1) 1.7	(1) 1.7	(3) 5.0	(5) 8.3	(4) 6.7

 

Table 3
Correlation between various areas of disability, duration of illness and age of onset

Variables	Disability personal	Disability occupation	Disability social	Disability physical	Disability general
Duration of illness	.263*	.062	.074	.036	-124
Age of onset	.298*	.269*	.038	.100	-134

* Correlation is significant at the 0.05 level.

Discussion
Schizophrenia is definitely the most disabling psychiatric disorder. Long-term hospitalization has been recognized as an important factor contributing to the disability associated with schizophrenia (Johnstone et al, 1981).  Following deinstitutionalization a number of studies have found decrease in disability associated with the illness and improvement in social functioning (Dickey et al, 1981; Barbato et al, 2004).  Disability has been found to be affected by characteristics like age of onset, duration of illness, severity and type of symptoms, duration of untreated psychosis, cognitive deterioration, and intellectual functioning (Alptekin et al, 2005).Irrespective of the setting, most of the schizophrenic patients have moderate disability (Parker and Hadzipavlovic, 1995). Our finding was also similar that most of the patients included in the study were having moderate level of disability. Thara and Raj Kumar (1995), in prospective study reported moderate disability in schizophrenics, who had remained stable over a period of time with minimal fluctuations. Most of the patients with schizophrenia having duration of illness between 2-5 yr had moderate to severe disability (Indra et al, 2005). In our study, it was found that duration of illness has a significant correlation with personal areas of disability an age of onset has significant (p<0.05) positive correlation with personal and occupational area of disability .Thara and Joseph, 1995 found that the socio-demographic and clinical variables like gender, age of onset, mode of onset, duration of illness and premorbid functioning which are related to course and outcome have also been reported to have an effect on disability. The study had a few limitations like a small sample size, absence of longitudinal assessment and lack of randomization. The findings are difficult to generalize considering a small sample. Future studies are needed to assess the effects of psychiatric interventions that could ameliorate the long-term prognosis of social disability in patients with schizophrenia. The relationship between disability and socio-demographic variables like family structure, family income etc., needs to be evaluated in further studies.

Conclusion: Disability has been found to be affected by characteristics like age of onset and duration of illness in schizophrenia.