Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme

Abstract

Objectives: To determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case-managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable).

Methods: Observational, mirror image study of ten years of follow-up and ten retrospectives ('pre-treatment': standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (N = 344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed.

Results: The retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (P < .0001), as well the involuntary admissions (P < .001). Being on long-acting injectable antipsychotic medication was related with these results (P < .0001).

Conclusions: Treatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Keywords: Adherencia al tratamiento; Antipsicóticos; Antipsychotics; Case management; Esquizofrenia; Gestión de casos; Hospitalización; Hospitalization; Schizophrenia; Treatment adherence.