Positive and negative symptoms of schizophrenia as correlates of help-seeking behaviour and the duration of untreated psychosis in south-east Nigeria

Paul Chigozie Odinka,M O Bakare,M Oche,M U Osika,A O Agomoh,R C Muomah,A C Ndukuba,R Uwakwe

doi:10.4102/sajpsychiatry.v20i4.536

Abstract

Background. Duration of untreated psychosis (DUP) has been widely recognised in recent years as a potentially important predictor of illness outcome, and the manifestations of schizophrenia have been known to influence its early recognition as a mental illness. Objective. To assess the association between the positive and negative symptoms of schizophrenia, help-seeking and DUP. Methods. We performed a cross-sectional study of 360 patients with schizophrenia, who had had no previous contact with Western mental health services. The Sociodemographic Questionnaire, World Health Organization Pathway Encounter Form and a questionnaire to establish DUP were used. The positive and negative syndrome scale and Composite International Diagnostic Interview were used for the assessment of mental disorders and to diagnose.Results. Respondents who had predominant positive symptoms and who had a median DUP of 8 weeks or 24 weeks, tended to use psychiatric hospitals and other Western medical facilities, respectively, as their first treatment options. However, those who had predominant negative symptoms and who had a median DUP of 144 weeks or 310 weeks, tended to use faith healers and traditional healers, respectively, as first treatment options.Conclusion. The predominance of negative symptoms could militate against early presentation among people with schizophrenia, probably because negative symptoms are poorly recognised as indicating mental illness in Nigeria, as they could be interpreted as deviant behaviour or spiritual problems that would require spiritual solutions.

Highlights

Duration of untreated psychosis (DUP) has been widely recognised in recent years as a potentially important predictor of illness outcome, and the manifestations of schizophrenia have been known to influence its early recognition as a mental illness
The influence of positive and negative symptoms on DUP and treatment delay has been covered by numerous articles during the last 15 - 20 years, the objectives of this current study were mainly to bring out the south-east Nigerian perspective
We observed that patients with predominant negative symptoms (PNS) who first visited faith healers and traditional healers had median DUPs of 76 weeks and 96 weeks, respectively; while patients with positive symptoms (PPS) who visited psychiatric hospitals and other Western medical facilities as their first treatment choice had median DUPs of 8 weeks and 24 weeks, respectively

Summary

Introduction

Duration of untreated psychosis (DUP) has been widely recognised in recent years as a potentially important predictor of illness outcome, and the manifestations of schizophrenia have been known to influence its early recognition as a mental illness. To assess the association between the positive and negative symptoms of schizophrenia, help-seeking and DUP. Respondents who had predominant positive symptoms and who had a median DUP of 8 weeks or 24 weeks, tended to use psychiatric hospitals and other Western medical facilities, respectively, as their first treatment options. Those who had predominant negative symptoms and who had a median DUP of 144 weeks or 310 weeks, tended to use faith healers and traditional healers, respectively, as first treatment options. The predominance of negative symptoms could militate against early presentation among people with schizophrenia, probably because negative symptoms are poorly recognised as indicating mental illness in Nigeria, as they could be interpreted as deviant behaviour or spiritual problems that would require spiritual solutions

Objectives

Methods

Conclusion