PROFESSIONAL ACTIVITY AND SCHIZOPHRENIA: ASSOCIATED FACTORS AND IMPACT IN PROGNOSIS OUERFELLI I., JOMLI R., OUERTANI A., NACEF F. DEPARTMENT OF PSYCHIATRY « A », RAZI HOSPITAL, TUNISIA INTERNATIONAL REVIEW OF PSYCHOSIS AND BIPOLARITY ATHENS, GREECE, MAY 2014

INTRODUCTION  The schizophrenia is a chronic disease that affects young person: onset in 90% of cases before 30 years.  It alters considerably the autonomy and will of the person. That’s why, professional life is always affected.  The objectives of our study:  Determinate socio-demographic and clinical factors associated with patients having schizophrenia and preserving professional activity.  Accurate/precise the impact of professional activity over the prognosis of schizophrenia.

METHODS & OBJECTIVES  It is a retrospective study  Retreat at random of 170 files of patients with schizophrenia masculine sex followed in the our consultation.  Selection of: 28 files of patients with regular professional activity (GPA), 32 files of patients without professional activity (GWP).  Criterion of inclusion: Diagnosis of schizophrenia (DSIV); Age between 23 years and 55 years; Followed since at least 5 years; Global duration of professional activity ≥ 3 years.  Criterion of exclusion: Irregular professional activity.

RESULTS  Comparison of two groups GPA/GWP:  Clinical data GPA GWP P: Age of onset (years) Brutal onset (%) Productive form (%)  Therapeutic observance:  GPA GWP  Good 82% 56% P = 0.03  Bad 18% 44%

RESULTS  Correlation between professional activity and prognosis of schizophrenia: The medium of relapse is 0.75 in the GPA versus 1.78 in the GWP (P= 0.006).  Prognosis Good Bad GPA 23 5 P = GWP  The professional activity is predictive of a good prognosis

DISCUSSION  In our study the factors associated with regular professional activity: Age (~ 40 years); Marriage; Paternity; Independent residence; Onset of the disorders at later age (25 years); Treatment with neuroleptics (Per os); Good therapeutic observance.  Other studies found similar results, in fact:  Agerbo (in 2004) and Zwerling (in 1995) note that marriage is correlated with professional activity  This will be explained by: responsibilisation of the patient, familial support wider, sexual activity (restructuration).  Marwha (2004) found the onset age of disorders is later at the GPA.  This will be explained by: Better clinical prognosis and acquired competences and a job before the onset of disorders.

DISCUSSION  The patient of GPA are more observant. Paradoxically they are less treated by neuroleptic with prolonged action.  This will be explained by: Better insight,The professional engagements Better tolerance of the oral form  Impact of professional activity over the prognosis of schizophrenia:  Marwha RL( 2004): professional activity is correlated with better clinical evolution and a good social operation  Agrébo (2004): the absence of professional activity is correlated with high rate of relapse.  In our sample the prognosis is significantly better in the GPA/GWP

CONCLUSION  The work will play indirectly a prognostic role in schizophrenia.  This role will be linked to better therapeutic observance.  Although the absence of rehabilitation and help structures in our country, some patients with schizophrenia reach to work enough regularly.  The therapist must help the patient with schizophrenia to take this initiative, we recommend:  Educate the patient in order to assure a good therapeutic observance  Decrease psychotic symptoms, especially deficitar symptoms (atypical neuroleptics).  Motivate the patient after clinic improve  Advice a work adapted to patient capacities  Accompany the patient in his steps (psychotherapy).