Six-month outcome following a relapse of schizophrenia

Objective: To analyse clinical data on patients with schizophrenia on admission to acute care and 6 months later in order to identify factors associated with frequent hospitalisations and poor outcome. Method: Information was collected from the medical records of 99 patients with schizophrenia consecutively admitted to acute care in hospital or by community based 24 h Crisis Teams and prospectively studied for 6 months. Results: One-quarter of patients were being admitted to acute care within 3 months of their last hospital discharge and only 34 patients were compliant with their neuroleptic medication 3 months prior to the index admission. Twenty-one patients were managed entirely by the Crisis Teams, 27 patients received inpatient care only and the remainder (n = 51) had both types of acute care. Six months after admission, 42 patients had been discharged and did not require further acute care, 29 patients had been re-admitted at least once and three patients had been transferred to an inpatient rehabilitation unit and, therefore, remained in hospital over the entire period. Of the remaining 25 patients, one committed suicide 2 months after discharge and the other patients were not contactable by Community Mental Health Teams at the 2 and/or 6 month follow up. Conclusions: Some of the factors associated with relapse identified in the present study were non-compliance with medication, stress, inadequate social support and substance abuse. The poor outcome in patients with frequent relapses emphasises the need to reduce the occurrences of schizophrenic symptoms to provide a better quality of life. The 25% of patients dropping out of care soon after a relapse indicates that more should be done to engage these people in long-term treatment programs.