Abstract

Background: The heterogeneity of schizophrenia psychopathology has led to a search for symptom clusters that could be related to broad features of the disease. The objectives of the study were to: (1) highlight the pattern of symptoms among Kuwaiti subjects with schizophrenia, using the ICD-10 symptom checklist; (2) assess the factor structure of the Brief Psychiatric Rating Scale 18 (BPRS-18) and BPRS-24, and (3) evaluate the relationship of the resulting factors with sociodemographic characteristics, age at onset of illness, family history of mental illness, objective indicators of quality of life, self-esteem, affect balance, family caregiver burden, patient's perceptions of service satisfaction and needs for care.

Method: Consecutive outpatients in stable condition were assessed with the BPRS and ICD-10 symptom checklist, as well as measures of quality of life, needs for care, service satisfaction and family caregiver burden.

Results: There were 130 patients (66.1% men, mean age = 36.8 years, age at onset of illness = 24.2 years, duration of illness = 12.9 years). Of the ICD-10 symptoms, the commonest positive symptoms were hallucinations (58.5%) and delusions (72%). Catatonic symptoms were rare (2.9%). About a quarter of the subjects experienced 4 of the negative symptoms. In exploratory factor analysis, we broadly replicated the known syndromes for BPRS-24 (disorganization, positive, activation, manic, negative and depression) and BPRS-18 (negative, positive, activation and affect). In regression analyses, the variables independently associated with psychopathology were family income, negative affect, self-esteem, duration of illness, age, lack of money for enjoyment, met needs for care and caregiver tension. The negative syndrome had more significant associations with the variables investigated than the positive syndrome. Psychopathological scores were separable from indices of psychological well-being.

Conclusion: In this first study of schizophrenia psychopathology from the Arab world, the clinical manifestations were similar to the data from the developed countries. The persistence of psychotic symptoms despite freely available antipsychotic treatment and the impact on caregiver burden call for attention to the perennial issue of treatment resistance and underscore the need for continued interaction with family members after the acute inpatient phase of treatment, in order to address the impact of symptoms.