A nation under siege: The 15-year outcome of Iraqi patients with schizophrenia in Babylon, Iraq

Background:An extensive literature addresses factors that influence outcome in patients with schizophrenia. However, the effect of these factors under national crisis remains unclear. Aims:The study explores the outcome of schizophrenia in a 15-year follow up in Iraq. Methods:A total of 298 patients with first-onset schizophrenia from 19851987 were recruited from all subjects who had consecutively visited the psychiatric service in Merjan Hospital in Al-Hilla city, Babylon Governorate, Iraq. Of these, 84 were excluded and did not have the research assessment. Results:The 150 males and 64 females had an average age at onset of the disorder of 24.8 years. Forty three subjects were untraceable, and 12 subjects committed suicide, 11 subjects had alcohol dependence, 8 subjects had clear learning disability, 7 subjects had organic brain diseases, and 3 subjects had epilepsy. All of them were excluded in the analysis. The entire sample was of the same ethnic Iraqi origin, mostly unemployed 151 (70.6) and all subjects were living with their families. More than 47 of subjects at final assessment had good or partial symptomatic and psychosocial outcomes and nearly 53 had a poor outcome. Thirty patients (20) of the male group showed good prognosis versus 31.3 of the female group. Furthermore, 54.7 of the males were in the poor prognosis group versus 48.7 of the females. Conclusions:Despite Iraq being under siege and exposed to economic sanctions, with very limited resources including the deprivation of atypical antipsychotic medications, its schizophrenia outcome is similar to that in developing countries. The existence of large, supportive families and a strict, committed regimen for active follow-up treatment may be important contributory factors to better outcomes.