Abstract
Background: Schizophrenia is a serious mental illness that can relapse after treatments. Risk and protective factors for relapse are dependent on multicultural contexts. Objective: To identify risk and protective factors related to relapse in first-episode schizophrenia (FES) in northeastern Thailand from perspectives of health professionals. Methods: This qualitative research collected data from 21 health professional staff members (psychiatric nurses, psychiatrists, psychologists, social workers, occupational therapists and nutritionist) of a tertiary psychiatric hospital of northeastern Thailand who had been involved in mental health care for schizophrenia for at least 5 years by in-depth interviews and group interview using semi-structured interview schedule. Content analyses was used to identify staff perception of factors that put patients at risk of relapse. Results: Data analyses demonstrated that factors related to relapse in FES patients were drug adherence (drug discontinuation, limited access to new generation drugs, self-dose reduction and skipping medication, and poor insight), family factors (stressful circumstances and family supports), substance abuses (narcotics, addictive substances, caffeinated drinks), concurrent medical illness (insomnia, thyroid diseases, and pregnancy-related hormonal changes), and natural course of disease. Conclusion: Factors affecting relapse in FES was not only drug adherence. Family factors, drug abuses, and concurrent health status should be also taken into account. A comprehensive mental health care program should be developed for FES patients in the region.
Highlights
Schizophrenia is a chronic mental health disorder manifested by positive symptoms and negative symptoms[1,2]
Khon Kaen Rajanagarindra Psychiatric Hospital is one of five psychiatric hospitals in Northeast Thailand responsible for four provincial health areas (Roi-Et, Khon Kaen, Maha Sarakham, and Kalasin). This qualitative study revealed multiple important factors associated with relapse in first-episode schizophrenia (FES) from perspectives of health professionals working at the Khon Kaen Rajanagarindra Psychiatric Hospital
Family’s poverty hinders psychotic symptom recovery and limits resource allocation to family members, especially in low- and middleincome countries[41,42]. This present study indicated a positive influence of family supports on adaptation mechanisms of outpatients with schizophrenia
Summary
Schizophrenia is a chronic mental health disorder manifested by positive symptoms (suspiciousness, hallucinations, delusions, impaired cognitive ability, and disorganized speech or behavior) and negative symptoms (impairments in attention, loss of volition, social withdrawal, poverty of speech, and affective flattening)[1,2]. Even though schizophrenic patients with first-episode psychosis (FEP) can be completely recovered by treatment programs, relapse can still occur. The present qualitative study was aimed to investigate risk and protective factors in patients with first-episode schizophrenia in northeastern Thailand from perspectives of health professionals. Objective: To identify risk and protective factors related to relapse in first-episode schizophrenia (FES) in northeastern Thailand from perspectives of health professionals. Methods: This qualitative research collected data from 21 health professional staff members (psychiatric nurses, psychiatrists, psychologists, social workers, occupational therapists and nutritionist) of a tertiary psychiatric hospital of northeastern Thailand who had been involved in mental health care for schizophrenia for at least 5 years by in-depth interviews and group interview using semistructured interview schedule. Content analyses was used to identify staff perception of factors that put patients at risk of relapse. A comprehensive mental health care program should be developed for FES patients in the region
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