ArticleBJPsych open2026
Multidimensional moderators of treatment trajectories in people with schizophrenia at high risk of relapse: findings from a real-world lower middle-income country cohort.
Article in BJPsych open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile treatment non-adherence is a well-established relapse risk factor, broader contributors require investigation. Studying chronic, high-risk schizophrenia cohorts in real-world lower middle-income country (LMIC) settingsremains methodologically challenging.
aimsTo explore multidimensional factors moderating treatment trajectories in individuals with chronic schizophrenia at high risk of relapse, comparing relapsers and non-relapsers in a real-world LMIC setting.
methodIn this 12-month prospective naturalistic study, 56 clinically stable adults with chronic schizophrenia (≥2 relapses within 3 years), receiving long-acting injectable and/or oral antipsychotics were followed up monthly. Relapse was defined as worsening psychotic symptoms requiring re-hospitalisation. Linear mixed-effects models examined trajectories of Positive and Negative Syndrome Scale (PANSS) total and factor domains (positive, negative and disorganised) and tested group*time*moderator interactions for neurological soft signs (NSS), quality of life (QOL), aberrant salience, anxiety, resilience, self-esteem, social adversity and childhood trauma.
resultsTwenty-three participants (41%) relapsed; overall attrition was 59%, with 21% of discontinuations relapsing. Most relapses (87%) involved non-adherence and substance misuse. No group*time interaction effects were found for PANSS domains. Poorer overall QOL (
conclusionsConducting longitudinal research in chronic, high-risk schizophrenia populations in LMICs is challenging. Although exploratory and hypothesis-generating, QOL and NSS may represent clinically meaningful moderators of treatment course and potential targets for intervention and future research.
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