Preliminary findings from a study of first-episode psychosis in Montreal, Canada and Chennai, India: comparison of outcomes

Background: This article reports preliminary findings from a multi-year investigation of onset and course of previously untreated first-episode psychosis in two similarly structured treatment programs in Canada and India. Specifically, the aim of this study was to examine whether one year clinical and functional outcomes of first-episode psychosis varied between these two programs.

Method: Patients with first-episode non-affective psychosis receiving similar treatment in Chennai, India (N=61) and in Montreal, Canada (N=88) were evaluated for demographic variables, duration of untreated psychosis, and baseline diagnosis, and for positive, negative, and general psychopathology symptoms and overall functioning at baseline and one year.

Results: At both sites, there was a significant improvement in symptoms and functioning over the one year course of treatment. There was also a significant time-by-site interaction on negative symptoms and functioning, after controlling for age, sex, and marital status. On these domains, patients in India showed greater improvement over time than their Canadian counterparts. The time-by-site interactions were not significant for positive symptoms and general psychopathology.

Conclusion: First-episode patients in the Indian program demonstrated higher rates of improvement at one year in negative symptoms and functioning than patients receiving similar treatment in Canada. There was no difference in improvement between the sites on positive symptoms and general psychopathology. These results suggest that the sociocultural context of treatment can influence outcomes early in the course of psychotic disorders. Further, outcomes are not uniformly better or worse in one sociocultural context compared to another, but seem to vary from one outcome domain to another.