This presentation covers a comprehensive review of Indian research on schizophrenia.

1. Indian Research in
Schizophrenia
Dr. S. K. Kar
Assistant Professor
in psychiatry,
King George’s
Medical University,

2. • Indian Research in Schizophrenia
– Epidemiological
– Course & Outcome studies
– Biological
– Treatment
– Psycho-social
– Others

3. 1960s
• Etiology (Psychodynamics, Cultural factors,
initial exploration of biological causes)
• Clinical features (operationalization of
diagnostic criteria)
• Treatment (ECT, drug trials – prochloperazine,
chlorpromazine, thioproperazine)
• Course and outcome (Prognostic factors)

4. 1970s
– Epidemiology (in specific populations – first born)
– Biological research (dermatoglyphics, Blood groups –
O +ve, Lymphocytic abnormalities, serum protein)
– Phenomenology (gender differences in C/Fs, socio-
cultural attributes to C/Fs, Obsessve features in
schizophrenia, psychometry in schizophrenia)
– Treatment (comparing efficacy of antipsychotics,
trials of depot preparations, ECT)
– Course & outcome (Prognostic factors, socio-clinical
variables in long-stay patients)
– Others (Family dynamics, childhood characteristics)

5. 1980s
• Epidemiology (Community prevalence – Madras)
• Biological (Plasma CPK, VMA, 5 HIAA, Steroid, CSF Ig, Platelet MAO
activity, serum Prolactin, GH, LH, EEG patterns, soft neurological
signs, karyotyping, brain structural changes on CT)
• Phenomenology (Delusion- using PSE, Thought-Language-
Communication, -Ve symptoms Vs depression)
• Psychological (validation of tools-SANS, EPI)
• Psychosocial (parenting, social problems, care giver- expressed
emotion, Burden of care, social support system)
• Treatment (trials of oral & depot antipsychotics, ECT)
• Course & outcome (SOFACOS, relapse in schizophrenia, factors
affecting outcome – socio-cultural, clinical)
• Rehabilitation (need, factors affecting performance)

6. 1990s
• Epidemiology (WHO – Rural Vs Urban-Chandigarh, ICMR- Madras
longitudinal study)
• Biological (dermatoglyphics, palmar flexion crease pattern, Eye
movement-SP, Platelet MAO, HVA, gonadal hormones, visual
information processing, Neuroimaging, Soft signs, cognitive
dysfunction, biomarkers)
• Phenomenology (ATPD-ICD-10, Schiz-Late onset Vs Early onset,
Insight, linguistic competence)
• Psychology (Luria-Nabraska Neuropsychological Battery)
• Course & Outcome (predictors of outcome, disability)
• Psychosocial factors & Rehabilitation (family burden, life events,
social support, Social Functioning Index, BAS)
• Treatment (2nd Gen. antipsychotics, Clozapine)
• Others (coping strategies, medical comorbidity)

7. 2000s
• Biological (CSF – DA, 5HT & metabolites; Ser. Prl,
antioxidant enz, oxidative stress, neuroimaging-MRI,
FDG-PET, SPECT; HLA)
• Phenomenology (insight, substance use)
• Psychology (sleep latency, neurocognitive function)
• Psychosocial & rehabilitation (WHOQOL-Bref, stigma,
Coping, burden on caregivers, disability, vocational
rehabilitation, social functioning, cognitive functioning)
• Treatment (RCTs-antipsychotics, clozapine, ECT, CBT)
• Course & outcome (DUP)

8. 2010s
• Epidemiology (NMHS…
• Biological (ECT, drugs, rTMS, tDCS, fMRI, PET,
newer depots, Oxytocin, comorbidity, BDNF,
P300, immune axis, NMDA receptor, Cavum
septum pellucidum, soft signs, DTI….
• Psycho-social (stigma, suicide…..
• Phenomenology (sleep, cognition….
• Treatment (cognitive remediation, metabolic
syndrome….

9. Some land mark studies….

10. • IPSS
• International Pilot Study of
Schizophrenia
• Conducted by WHO
• 9 countries (5 developed & 4
developing)
• Indian center - Agra
• Aim: Feasibility in conducting F/U
study
• Assessment: Baseline, 2yr, 5yr
• Drop out at 5yr: 24%
• Conclusion: Outcome of
Schizophrenia better in developing
countries than developed countries

11. DOSMeD
• Determinants of Outcome of Severe
Mental Disorders
• Conducted by WHO
• 12 centers in 10 countries
• Indian centers – Agra & Chandigarh
(rur/urb)
• Aim: Prevalence of Schiz & outcome
• Follow up: 2 years (80%)
• Conclusion: Developing countries
had better outcome. Indian
population – less time spent in
psychotic episode & less impairment
of social functioning

12. ISoS
• International Study of Schizophrenia
• Conducted by WHO
• Follow up of cohorts from DOSMeD
and RAPyD (Assessment &
Reduction of Psychiatric Disability)
• Cohorts – Incidence cohorts &
Prevalence cohorts
• Incidence cohorts – 12 from
DOSMeD & RAPyD, Hong Kong ,
Madras
• Prevalence cohorts- 3 from IPSS,
Beijing
• ICD-8 , 9 diagnoses were converted
to ICD-10

13. ISoS
• 3 groups (Schizophrenia only – F20;
other psychotic disorders- F10.5,
F22 to 29, F30 to 34; total psychosis)
• PSE-9, DAS, GAF, SANS,
Psychological Impairment Schedule
used
• Conclusion: Outcome of
schizophrenia is poorest. No
independent role of type of onset.
Percentage of time spent in
experiencing psychotic symptoms in
the first 2 years of onset was the
best predictor of outcome.

14. • ICMR
• Conducted by ICMR
• Centers: Vellore, Madras, Lucknow
• Aim: Course & outcome of F20
• Modified criteria for Schizophrenia
used (Modified Feighner et al.)~
duration 3mon. instead of 6mon.
• Follow up period – 2 years
• Follow up rate- Madras 86%,
Lucknow 85%, Vellore 76%
• Conclusion: Best pattern of course
in 45%, worst pattern 10%.
Confirmed the findings of IPSS,

15. • IPSS Agra Cohort
• Long term follow up
• Aim: Long term Course & outcome
of F20
• The cohort was followed up upto 14
years (KC Dube and team)
• Conclusion: Illness tends to lose its
intensity with passage of time
• Limitation: High attrition rate

16. • Madras longitudinal study
• Long term follow up (10 years)
• Aim: Long term Course & outcome
of F20
• The ICMR cohort was followed up
upto 10 years (Thara et al.)
• Conclusion: Clinical and social
outcomes are better than
developed countries