Des études transculturelles suggèrent que le pronostic des schizophrénies est meilleur dans les pays en voie de développement. L’objectif de ce travail était d’étudier le degré de l’handicap social et les facteurs pronostiques des schizophrénies dans une population tunisienne et de comparer cette évolution à celle constatée dans les pays industrialisés. Notre étude a inclus 60 patients répondant aux critères diagnostiques des schizophrénies selon le DSM IV et traités depuis au moins cinq ans. L’adaptation sociale a été évaluée à partir d’un entretien semi-structuré, de la cotation de l’échelle globale du fonctionnement (EGF) et des données recueillies à partir des dossiers médicaux. Il ressort, de cette étude, cinq ans après le début du traitement, 67,9 % avaient un pronostic social défavorable. Tous les indicateurs sociaux, sauf la sexualité et le statut matrimonial, suivaient globalement le même cours : une aggravation statistiquement significative entre la phase prémorbide et l’état évolutif à deux ans. Il y a peu de variabilité entre deux et cinq ans puis une stabilisation statistiquement significative au-delà de cinq ans d’évolution. En conclusion, l’échantillon étudié ne semble pas confirmer la fréquence élevée des évolutions favorables des schizophrénies, sur le plan social, dans les pays en développement.

Transcultural studies suggest that the social outcome of schizophrenia might be better in developing countries than in industrialized ones. This study aims to check this hypothesis and attempted to identify prognostic indicators of schizophrenia among Tunisian patients.

This study included all the outpatients responding to DSM IV criteria of schizophrenia for at least five years, during the study period. The assessment tools were: an interview with the patients and their families, data from medical records and the Global Assessment of Functioning scale (GAF) applied for the premorbid period, at two years after onset, at five years, and during the interview (current assessment). The social outcome was assessed by marital and labour market status, social network, sexuality and the GAF score. The outcome was considered to be good, if the current GAF >60, intermediate if GAF was between 31 and 60 and severe if GAF ≤30. The three prognostic subgroups were compared in order to look for prognostic indicators.

Informed consent was obtained from 60 patients (85.7% of outpatients) and from 56 families. The sex-ratio was 4 (48 men/12 women), the mean age of patients was 39.3 years; the mean follow-up was 14.7 years ([5–45]). School level was six years primary school in the majority of cases, and the living conditions were poor in 48.3% of cases (n=29). During the interview, only 21.6% (n=13) of patients were married. The majority of patients, who were working before the first episode, had lost their job. 76.6% (n=46) did not have any social contacts and only 23.3% (n=14) had any sexual activity. Thus, the social outcome was good in 21% of patients, intermediate in 11.1% and severe in 67.9%. Most social indicators (GAF score, labour market status, social network) revealed a fairly similar progress: a significant decline between the premorbid period and two years after the onset. The course reached a plateau after two years. According to current GAF scores, outcome was good in 25% (n=15) of cases, intermediate in 55% (n=33) of them and severe in 20% (n=12). Some indicators were found to be correlated with this outcome: patient related factors; late language development (correlated with intermediate prognosis [p=0.03]); a comorbid axis II diagnosis (correlated with poorer outcome p=0.04); a poor premorbid global functioning (higher premorbid GAF scores were correlated with a better outcome [p<0.03]); family history related factors; consanguinity in parents (correlated with intermediate-severe prognosis [p=0.04]); elderly father at birth (correlated with severe prognosis [p=0.04]).

Even if these results are limited in their generalisation, this Tunisian sample argues that schizophrenia’s prognosis is not better in such a developing country.