Certifiable Disability in First Episode Schizophrenia: The Role of Adherence to Antipsychotic Treatment

The incidence rate of schizophrenia in India is about 3 per 10,000 per year—every year around 200,000 individuals get afflicted with it. Patients with disability greater than 40 % are eligible for disability benefits from the government of India. However, it is not known as to what proportion of patients with new-onset schizophrenia would be eligible for this. At the National Institute of Mental Health and Neurosciences, Bangalore, 80 patients with FES were studied prospectively. Diagnosis was confirmed using the Computerized Diagnostic Interview Schedule Version-4. Disability was assessed after about 2 years of follow-up using the Indian Disability Assessment and Evaluation scale. Those with 40 % or more disability on the IDEAS were categorized as ‘disabled’. ‘Non-adherence’ was defined as a continuous 3 months period of not taking antipsychotic medication. At the end of 2 years of follow-up, 19/80 (23.8 %) of the 80 patients had met the criterion for certifiable disability. Only 3 (9.7 %) of the 31 patients who were adherent to medication met this criteria, vis-à-vis 16 (32.7 %) of the 49 who were non-adherent (p = 0.02; odds ratio = 4.52; 95 % CI: 1.2–17.2). Older age and higher psychopathology score were also associated with disability. Psychopathology emerged as a significant predictor of disability after controlling for the effects age and treatment adherence. Only a small proportion of patients with FES remain disabled if they are adherent to medications. Efforts towards enhancing adherence could be cost-effective from a public health perspective. © 2014, Springer India Pvt. Ltd.