▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai

▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years

▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, using the SAS system of statistical analysis

▪ 61 of 101 patients showed good outcome on the CGIS after ten years

▪ Predictors of good recovery were high baseline positive symptoms and low negative symptoms, higher anxiety-depressive symptoms, lower level of depressive symptoms, lower level of aggression, higher work performance and ability to live independently.

▪ Characteristics of non-recovered patients showed higher extra pyramidal symptoms, severe aggressive symptoms, higher frequency of disorganization symptoms at baseline and higher level of family burden at the end of the term

▪ Our study shows reasonably good outcome [61.7%] in first episode-hospitalized patients

▪ Good outcome correlated with severity of positive symptoms, level of work function and ability to live independently at baseline

Method: we conducted a ten years follow up study of first episode hospitalized DSM III-R schizophrenia and correlated multiple outcome criteria with DUP at Mumbai. We carefully determined onset of psychosis using criteria for appearance of positive symptoms, negative symptoms or significant social decline. Data was analyzed using SAS.

Results: we analyzed 101 patients available at ten years. We found that mean DUP was higher for group, which showed Clinical recovery on GCIS [14.0(SD=8.0) months for recovered & 10.8 (SD=5.7) months in nonrecovered group p=0.091]. There is a significant difference in favour of DUP≤6 months in terms of subscales of PANSS; However DUP was not found to be significantly associated with the end point parameters of good clinical or social outcome.

Conclusion: We find that DUP is just one factor in determinants of outcome. Several other psychopathological & phenomenological factors collectively play a role in determining outcome. Future research needs to be directed towards combination of determinants of outcome in early intervention of psychosis.

METHOD: RECENT LITERATURE FROM ELECTRONIC DATA BASE SEARCH IDENTIFIES ROLE AND RELATIONSHIP OF CANNABIS AND PSYCHOSIS.

RESULTS. CANNABIS IS A RISK FACTOR FOR BOTH PSYCHOSIS AND SCHIZOPHRENIA & APPEARS TO HAVE CAUSAL RELATIONSHIP FOR EARLY AND LATERAGE PSYCHOSIS. MOOD SYMPTOMS ARE ALSO SIGNIFICANT BUT LESS RECOGNIZED. UNDERSTANDINGS OF THE PROCESS AND CAUSES HAVE SIGNIFICANTLY ADVANCED WITH DISCOVERY OF CANNABINOID RECEPTORS AND ENDOGENOUS CANNABINOIDS. IT IS CLEAR THAT CANNABIS INCREASES BRAIN VULNERABILITY, CAUSES POORER OUTCOME AND MORE SIDE EFFECTS. CANNABIS CAUSES COGNITIVE DYSFUNCTION THAT PERHAPS WORKS AS A COMMON DENOMINATOR FOR THE RISK-VULNERABILITY. IT APPEARS TO HAVE INDEPENDENT GENETIC COMPONENT RELATED TO DISRUPTION IN NEUROTRANSMISSION AFFECTING NEURONAL PLASTICITY. MUCH LESS ATTENTION HAS BEEN PAID IN DEVELOPING SERVICES TARGETED TOWARDS HARM REDUCTION AND DEVELOPING THERAPEUTICS.

CONCLUSION. CANNABIS IS POTENTIAL RISK FACTOR FOR POORER OUTCOME IN PSYCHOSIS. NEW BIOLOGICAL AND SOCIAL SERVICE INITIATIVES WILL ADD VALUE TO EARLY PSYCHOSIS PROGRAMS.