Abstract
Aims and method In up to a quarter of patients, schizophrenia is resistant to standard treatments. We undertook a naturalistic study of 153 patients treated in the tertiary referral in-patient unit of the National Psychosis Service based at the Maudsley Hospital in London. A retrospective analysis of symptoms on admission and discharge was undertaken using the OPCRIT tool, along with preliminary economic modelling of potential costs related to changes in accommodation.Results In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care. The preliminary cost analysis showed net savings to referring authorities due to changes from pre- to post-discharge accommodation.Clinical implications Despite the enormous clinical, personal and societal burden of refractory psychotic illnesses, there is insufficient information on the outcomes of specialised tertiary-level care. Our pilot data support its utility in all domains measured.
Highlights
In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care
Research in refractory psychosis has generally focused on specific individual pharmacological, psychological or sociological interventions, and far less work has explored specialist tertiary units
Works by Nirodi et al,[12] Ker & Anderson[13] and Shepherd et al[14] describe the difficulties and rationale for tertiary services more broadly, for treatment-resistant depression, and some of these arguments can be considered for refractory psychosis
Summary
Admission and discharge OPCRIT scores were obtained for all 153 case notes. There was a statistically significant decrease in symptom scores in all domains between admission and discharge (Fig. 1: times 1 and 2 respectively). The greatest savings were for those who came from the highest-intensity setting, at an estimated average of £41 358 per person, because many of these moved to a lower-intensity setting post-discharge. Those who moved to a lower-intensity setting (n = 43) had a higher National Psychosis Unit admission cost £98 020; P-value from t-test 0.009) than those who returned to the same or a higher-intensity setting They had a greater OPRIT Mental State Examination score improvement
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