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Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India

  • Sudipto Chatterjee (a1), Vikram Patel (a2), Achira Chatterjee (a3) and Helen A. Weiss (a2)
Abstract
Background

There are no community services for the majority of the estimated 10 million persons with schizophrenia in India. Community-based rehabilitation (CBR) is a model of care which has been widely used for physical disabilities in resource-poor settings.

Aims

To compare CBR with out-patient care (OPC) for schizophrenia in a resource-poor setting in India.

Method

A longitudinal study of outcome in patients with chronic schizophrenia contrasted CBR with OPC. Outcome measures were assessed using the Positive and Negative Symptom Scale and the modified WHO Disability Assessment Schedule at 12 months.

Results

Altogether, 207 participants entered the study, 127 in the CBR group and 80 in the OPC group. Among the 117 fully compliant participants the CBR model was more effective in reducing disability, especially in men. Within the CBR group, compliant participants had significantly better outcomes compared with partially compliant or non-complaint participants (P<0.001). Although the subjects in the CBR group were more socially disadvantaged, they had significantly better retention in treatment.

Conclusions

The CBR model is a feasible model of care for chronic schizophrenia in resource-poor settings.

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Copyright
Corresponding author
Dr Vikram Patel, Sangath Centre, 841/1 Alto Porvorim, Goa 403521, India. Fax: +91 832 415244; E-mail: vikpat@goatelecom.com
Footnotes
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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes
References
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Chatterjee, S. & Chatterjee, A. (1999) CBR for mental illness in a rural/tribal setting. Action Aid Disability Journal, 10, 4751.
Evans, P. J., Zinkin, P., Harpham, T., et al (2001) Evaluation of medical rehabilitation in community based rehabilitation. Social Science and Medicine, 53, 333348.
Jacob, K. S. (2001) Community care for people with mental disorders in developing countries. Problems and possible solutions. British Journal of Psychiatry, 178, 296298.
Kay, S. R., Fiszbein, A. & Opler, L. A. (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276.
Lagerkvist, B. (1992) Community-based rehabilitation–outcome for the disabled in the Philippines and Zimbabwe. Disability and Rehabilitation, 14, 4450.
McCreadie, R. G., Thara, R., Kamath, S., et al (1996) Abnormal movements in never-medicated Indian patients with schizophrenia. British Journal of Psychiatry, 168, 221226.
Streiner, D. L. (2002) The case of the missing data: methods of dealing with dropouts and other research vagaries. Canadian Journal of Psychiatry, 47, 6875.
Thara, R., Rajkumar, S. & Valecha, V. (1988) The Schedule for Assessment of Psychiatric Disability – a modification of DAS–II. Indian Journal of Psychiatry, 30, 4753.
World Health Organization (1992) Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). Geneva: WHO.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India

  • Sudipto Chatterjee (a1), Vikram Patel (a2), Achira Chatterjee (a3) and Helen A. Weiss (a2)
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