[en] OBJECTIVE: The study was aimed at assessing the clinical evolution and mobility of schizophrenic patients within the healthcare network of the Psychiatric Platform of Liege (Belgium) after a one-year follow-up period. MATERIAL: and methods. The study material consisted of a random sample of 184 patients with schizophrenia drawn from the population of schizophrenic patients treated in the Liege psychiatric care network. The characteristics of these patients have been described previously (18). The 184 patients were followed-up for one-year and reassessed at the end of this period. Mobility (ie, changes between psychiatric care institutions, including home) was recorded for each patient within the institutional network. The diagnosis of schizophrenia was based on the DSM IV. Demographic, social and global functioning (GAF scale) data were collected from the "Resume psychiatrique Minimum (RPM)", a clinical summary which has been imposed by the Belgian Ministry of Public Health for each psychiatric hospital stay. Symptom components were derived from the Psychosis Evaluation tool for Common Use by Caregivers (PECC). RESULTS: Among the 184 patients enrolled in the initial analysis, 6 refused to participate in the follow-up study. The 178 remaining schizophrenic patients included 131 men (74%) and 47 women (26%) with a mean age of 43.1 +/- 13.6 and 48.8 +/- 14.9 years, respectively (p<0.05). The majority of patients (53%) suffered from paranoid schizophrenia. At baseline, 63% of the patients were hospitalised full-time, 6% part-time and 31% received ambulatory care. During the one-year follow-up period, 4 patients died, including one from suicide. When considering mobility, 48% of the patients experienced at least one change of institution, whereas 52% of the patients didn't change at all (see figure 1). The total number of changes over the 1-year period amounted 189, yielding a mean value of 1.1 changes per patient per year. Changes mostly occurred between institutions of similar care setting (see figure 2). Transfers (30%) were also observed directly between hospital and home. A multivariate Poisson regression analysis showed that the number of changes was unrelated to gender and initial care setting but decreased with age (p<0.0001). It was also higher for patients with schizo-affective disorders (2.5 +/- 1.9, p<0.01) or with residual type (1.2 +/- 1.8; p<0.05) than for patients with other types of schizophrenia (ranging from 0.3 +/- 0.5 to 0.9 +/- 1.4). No association was found with initial GAF or PECC, except for negative symptoms (p<0.05). After one year, despite the high proportion of institutional changes (48% of the patients), the distribution of the patients according to care setting remained the same (p=0.77). However, GAF scores significantly improved from 39.7 +/- 16.1 to 44.4 +/- 16.1 (p<0.0001) and likewise for total PECC scores (70 +/- 19.1 vs 63.2 +/- 19.4, p<0.001). Excitatory and disease perception items of the PECC remained unchanged. CONCLUSION: The present study reveals that mobility within the institutional network did affect about half of the schizophrenic patients. Mobility was related to age, type of schizophrenia and disease evolution. Changes occur mainly between psychiatric structures of similar care setting but also directly from hospital to home without passing through an intermediate care structure. Further efforts should be made to provide schizophrenic patients with a more coordinated care provision throughout the course of their disease.
Disciplines :
General & internal medicine
Author, co-author :
Sarto, D.
Desseilles, Martin ; Université de Liège - ULiège > Département des sciences cliniques > Psychiatrie et psychologie médicale
Martin, Michel
Seidel, Laurence ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Language :
French
Title :
Evaluation d'un an de parcours de patients schizophrenes en service psychiatrique liegeois
Alternative titles :
[en] One-Year Follow-up and Mobility Assessment of Schizophrenic Patients in the Liege Psychiatric Care Network.
COTTERILL L, THOMAS R. A typology of care episodes experienced by people with schizophrenia in an english town. Soc Sci Med 1993 ; 36 (12) : 1587-97.
CORMIER HJ, PINARD G, LEFF HS et al. Besoins et utilisation des services de santé mentale dans la psychiatrie. Acta Psychiat Belg 1986 ; 86 : 388-93.
DE HERT M, BUSSELS J, LINDSTROM E et al. PECC, Psychosis Evaluation tool for Common use by Caregivers. Anvers : EPO, 1998.
DE HERT M, PEUSKENS J. Suicide in schizophrenia. Acta Psychiatr Belg 1998 ; (Suppl I) : 37-45.
DE HERT M, BUSSELS J, PEUSKENS J. Use of PECC in naturalistic evaluation of schizophrenic patients in Belgium. Health Use Belg 1999 ; 2 : 54-7.
DENCKER SJ, DENCKER K. Does community care reduce the need for psychiatric beds for schizophrenic patients ? Acta Psychiatr Scand 1994 ; 89 (382) : 74-9.
HAFNER H. The epidemiology of schizophrenia. Triangle 1992 ; 31 (4) : 133-54.
HAFNER H, AN DER HEIDEN W. Epidemiology of schizophrenia. Can J Psychiatry 1997 ; 42 : 139-51.
HOGG LI, BROOKS N. New chronic schizophrenic patients : a comparison of daypatients and inpatients. Acta Psychiatr Scand 1990 ; 81 : 271-6.
HONKONEN T. Problems and needs for care of discharge schizophrenia patients. Psychiatr Fenn 1995 ; 26 : 21-32.
HONKONEN T, SAARINEN S et al. Deinstitutionalization and schizophrenia in Finland. II : Discharged patients and their psychosocial functioning. Schizophr Bull 1999 ; 25 (3) : 543-51.
LEIBE M, KALLERT TW. Social integration and the quality of life of schizophrenic patients in different types of complementary care. Eur Psychiatry 2000 ; 15 : 450-60.
LINDENMAYER JP, BERSTEIN-HYMAN R et al. Five-factor model of schizophrenia. Initial validation. J Nerv Ment Dis 1994 ; 182 : 631-8.
MADIANOS M, ECONOMOU M. Negative symptoms in schizophrenia : the effect of long-term, community-based psychiatric intervention. Int J Health 1988 ; 17 (1) : 22-34.
MORTENSEN PB, JUEL K. Mortality and causes of death in first admitted schizophrenic patients. Br J Psychiatry 1993 ; 163 : 183-9.
PYNE JM, BEAN D, SULLIVAN G. Characteristics of patients with schizophrenia who do not believe they are mentally ill. J Nerv Ment Dis 2001 ; 189 (3) : 146-53.
SALOKANGAS RKR. Living situation, social network and outcome in schizophrenia : a five-year prospective follow-up study. Acta Psychiatr Scand 1997 ; 96 : 459-68.
SARTO D, DESSEILLES M, MARTIN M et al. Analyse diagnostique, symptomatologique et sanitaire des patients schizophrènes en service psychiatrique liégeois. Encéphale 2002 ; 28 (5) : 403-10.
WAMPERS M, DE HERT M, PEUSKENS J. Symptomatology and insight in the disorder in psychotic patients. Abstracts Winter Workshop schizophrenia, Davos, February 2002.