RESUMEN
Several previous studies have identified high incidence rates, high relapse rates and poor short term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62 percent) were treated at home, and 120 (38 percent) were admitted to hospital for treatment. Two hundred and sixty four (83 percent) were still being seen after one year. The relapse rate was 13 percent (41 patients), higher for admissions (24, 20 percent) than for those treated at home (17, 9 percent; p<0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p<0.005). One hundred and thirty five (43 percent) were in gainful employment within the 12 month period of follow up, contrasted with the 40 percent unemployment rate for the 2.4 million population of the island (chi square = 39.322, p<0.001). There was a self-reported use of medication in 213 (67 percent) patients, with 142 (45 percent) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first srevice contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK. (AU)
Asunto(s)
Humanos , Estudio Comparativo , Esquizofrenia/epidemiología , Reino Unido/epidemiología , Jamaica/epidemiología , Negro o Afroamericano , Diagnóstico por Computador/estadística & datos numéricos , Estudios de Cohortes , Recurrencia , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Inyecciones IntramuscularesRESUMEN
OBJECTIVE: The study assessed the efficacy of treating acute psychotic illness in open medical wards of general hospitals. METHODS: The sample consisted of 120 patients with schizophrenia whose first contact with a psychiatric service in Jamaica was in 1992 and who were treated as inpatients during the acute phase of thier illness. Based on the geographic catchment area where they lived, patients were admitted to open medical wards in general hospitals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illness was assessed, and sociodemographic variables, pathways to care, and legal status were determined. At discharge and for the subsequent 12 months, patients' outcomes were assessed by blinded observers using variables that included relapse, length of stay, employment status after discharge, and clinical status. RESULTS: More that half (53 percent) of the patients were admitted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of symptoms, and s everity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychiatric units, and 17.3 days in the general hospital medical wards. Clinical outcome variables were significantly better for patients treated in the general hospital medical wards than for those treated in the mental hospital, as were outpatient compliance and gainful employment. CONCLUSIONS: While allowing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards results in outcome that is at least equivalent to, and for some patients, superior to the outcome of treatment in conventional psychiatric facilities.(Au)
Asunto(s)
Adulto , Persona de Mediana Edad , Femenino , Humanos , Masculino , Estudio Comparativo , Adolescente , Admisión del Paciente , Esquizofrenia/rehabilitación , Enfermedad Aguda , Estudios de Cohortes , Hospitales Generales , Hospitales Psiquiátricos , Jamaica/epidemiología , Cooperación del Paciente , Servicio de Psiquiatría en Hospital , Rehabilitación Vocacional , Esquizofrenia/epidemiologíaRESUMEN
The aim of this study was to compare the pathways to care and outcome of first contact patients with schizophrenia admitted to open medical wards with those treated in closed community psychiatric units and in acute wards of a custodial mental hospital. First contact with patients with schizophrenia who were identified in Jamaica in 1992 and admitted to the three different types of acute treatment facility across the island were followed in a blinded prospective study. Their pathways to care and standard clinical and sociological outcome parameters were identified and compared. 65 first contact patients were admitted to 3 acute wards of the Bellevue Mental Hospital, 20 patients to two closed psychiatric units in general hospitals, and 35 patients admitted to 8 general hospitals islandwide. The mean length of stay in the mental hospital wards was 88.3 days; in the psychiatric units was 29.9 days (p<0.01), and in the general hospitals was 14.1 days (p<0.0001). Clinical outcome variable were significantly better (p<0.03) for patients treated in open medical wards compared with those admitted to acute mental hospital wards. Fewer patients were admitted to open medical wards by the police (p<0.01), or by compulsory legal section (p<0.01). Compared with admissions to conventional psychiatric units, admissions to open medical wards had shorter lengths of stay (p<0.02), fewer admissions by compulsory detention (p<0.05) and had attained relative numerical but not statistical significance for most clinical outcome and pathway to care variables.(AU)
Asunto(s)
Humanos , Esquizofrenia , Hospitalización , Hospitales Psiquiátricos , JamaicaRESUMEN
The study was to identify pathways to care and determine clinical outcome after one year in a cohort with first contact schizophrenia in Jamaica. 317 first contact patients identified prospectively were followed blind by psychiatrists and mental health officers and clinical outcome variables were recorded monthly. Relapse was identified as admission/readmission to hospital, re-emergence of symptoms and/or the return of abnormal behaviour. Data in the first 12-month period following first contact were analyzed by the Chi-squared method. 65 percent were males, 98 percent were of African origin, and 90 percent of social classes IV and V. They were treated at home (63 percent), in the mental hospital (20 percent) and community psychiatric beds (17 percent). Only 5 percent were admitted using a compulsory detention section order. The mean length of stay in the mental hospital was 93 days, and in the community beds was 24 days. 70 percent were still being followed in clinics and 21 percent had ceased contact and had been discharged. The relapse rate was 7 percent and these patients were more likely to have come into care through the police or mental health officers (p<0.05), and more likely to have been treated in hospitals (p>0.05) and more likely to have received an increase in psychotropic medication (p>0.05). The relapse status of an additional 7 percent patients could not be ascertained. We concluded that low relapse rate in schizophrenia is related to close involvement of families of the patients as caregivers, early recognition and treatment in community and home settings, significant reduction in the use of compulsory detention, and the provision of high compliance pharmacological follow-up treatment. (AU)