Diagnosis and treatment of schizophrenia in a general hospital based acute psychiatric ward

Abstract

Objectives: To review and describe the clinical profile and acute in-patient treatment of patients diagnosed with schizophrenia over a four-year period; to review and describe the documented evidence for the diagnosis of schizophrenia; and to identify possible associated or predictive factors in the acute in-patient treatment outcome of patients at an acute (designated for 72-hour assessments) ward – within a general hospital, Helen Joseph Hospital (HJH). Method: Routine discharge summaries were used in a retrospective clinical review of patients with schizophrenia. The demographic, clinical and treatment profile of these patients were described and the documented evidence for the diagnosis of schizophrenia was reviewed using descriptive and comparative statistics. Factors were evaluated to assess their association with the length of stay (LOS) as outcome variable, using “Generalized Linear Latent and Mixed Models” (GLLAMM). Results: A total of 436 patients were diagnosed with schizophrenia, constituting on average about 20% of the total numbers of admissions. The overall mean LOS was 19.5 days. Considering DSM IV-TR criteria for schizophrenia, behavior problems were confirmed in 71.8% (n=313), perceptual disturbances in 29% (n=126) and thought disorders in 83.5% (n=364). The duration of symptoms were specified in 68% (n=298) patients. Age (p<0.001), gender (p<0.019), substance abuse (p<0.019) and follow-up referral (p<0.000) were significantly associated with LOS. Conclusion: The study contributed by identifying these predictive indicators for the acute in-patient treatment outcome of patients with schizophrenia. Future standard operational procedures for diagnostic and treatment  processes in acute wards may have to include structured interviews in order to enhance the quality of the routine process of diagnosis and treatment of patients with schizophrenia.

Key words: Acute management; Schizophrenia; Diagnosis; Treatment; Length of stay; Predictive factors