Quality of life among dually diagnosed and non-substance-using male schizophrenia outpatients

Objective. To assess the quality of life (QoL) in an outpatient setting among male patients dually diagnosed with schizophrenia and substance use disorder (SUD); and non-substance-using male schizophrenia patients. Methods. The study was conducted in an outpatient setting with 52 male schizophrenia patients and 49 male schizophrenia patients with SUD comorbidity; who were admitted to Bakirkoy Research and Training Hospital between 1 May 2010 and 30 September 2010. The patients had been in remission for a minimum of 6 months. The subjects were re-evaluated for the persistence of the diagnosis by using the Structural Clinical Interview for DSM-IV Axis I disorders (SCID I) socio-demographic data form; and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and positive and negative syndrome scale (PANSS) were administered to detect the factors affecting diagnostic stability and clinical course. Results. Schizophrenia patients with no SUD comorbidity had a significantly earlier age of disease onset than the comorbid group. SUD comorbidity in schizophrenia patients leads to increased rates of unemployment and homicidality. WHOQOL-Bref psychological health scores were significantly lower among patients in the comorbidity group. No statistically significant difference was identified between the groups with regard to the PANSS scores. Conclusions. It is necessary to focus on the treatment challenges for schizophrenia patients with SUD comorbidity; such as the provision of treatment in criminal justice settings; in which a high proportion of such patients are found

An audit of non-urgent general adult referrals to Stikland State Psychiatric Facility

Objectives. The national Department of Health strongly advocates the strengthening of primary health care systems; and recommendations for appropriate level of care referrals exist. Very few published data on the scope of current ambulatory specialised psychiatric hospital services in South Africa are currently available; making it difficult to assess whether these recommendations are being followed. As a starting point; an audit was conducted to obtain a profile of new non-urgent general adult patients seen at Stikland Hospital with a view to evaluating system needs and demands. Methods. The folders of 103 consecutively seen patients were selected for retrospective review. Patient demographic; referral and assessment information was entered into a single database. Descriptive statistics were compiled with reference to the above variables using SPSS. Results. Overall 58.3 of referrals were from the private sector. More than a third (36.7) of referral letters stated no clear reason for referral and 41.7 no psychiatric diagnosis; and 29.1 of patients were referred without psychotropic medication being started. On assessment 62.1 of patients were found to have a single Axis I diagnosis. Despite virtually no referral letters making any mention of them; substance use disorders (30.1); personality traits/disorders (35.9) and co-morbid medical illness (36.7) were commonly found on assessment. Conclusions. A significant portion of the patients in our sample could have been managed at primary care level and were referred prematurely. The overall quality of referral letters was poor; and they lacked vital information required for appropriate preassessment decision making. Undergraduate training focusing on these skills should be intensified; and consideration should be given to incorporating aspects of our findings into primary health care updates