Clinical outcome of patients with schizophrenia without maintenance treatment in a nonindustrialized society

The outcome of 51 patients with schizophrenia (DSM-III-R) consecutively admitted to Bangli State Mental Hospital (Bali) with no prior psychiatric treatment was assessed by the Positive and Negative Syndrome Scale (PANSS) and Eguma's Social Adjustment Scale (ESAS) at a 5-year followup evaluation. The subjects were divided into two groups according to their medication patterns determined at the assessment. Mann-Whitney U test revealed no significant differences in the PANSS scores between the treated group (n = 22) and the nontreated group (n = 29), whereas a significant difference in the distribution of the scores was observed (Kolomorov-Smirnoff test, p < 0.05). Subjects in the nontreated group showed a greater tendency to be scored either high or low in the PANSS than did subjects in the treated group. Moreover, subjects in the nontreated group tended to be classified more often into the best or worst outcome categories when the ESAS was performed than subjects in the treated group (chi-square analysis, p < 0.05). In the present study, nontreatment may reflect a good outcome in terms of no requirement for continuing treatment but still be causally related to poor outcome in terms of absence of the necessary treatment. The results suggest the importance of therapeutic intervention for schizophrenia patients who have severe psychopathology without maintenance treatment in nonindustrialized societies.