Comparative assessment of quality of life of patients with schizophrenia attending a community psychiatric centre and a psychiatric hospital

Background: Over the past few decades, there has been an emphasis on the de-institutionalisation of psychiatric care with a focus on community care. With Quality of Life (QoL) as an outcome measure, this study compared the QoL of patients with schizophrenia attending a psychiatric hospital and a community psychiatric centre. Design: This was a cross-sectional study in two psychiatric facilities Methods: Data were obtained through a socio-demographic and clinical questionnaire; the QoL was assessed with the WHOQOL-BREF and patient satisfaction with care with CPOSS. Total and domain scores of WHOQOL-BREF for each group were calculated and compared with each other and other group characteristics. Diagnosis of schizophrenia was based on ICD-10.Results: Participants from the two centres did not differ significantly on any of the socio-demographic characteristics measured. Similarly, there was no significant difference in their overall mean WHOQOL-BREF scores as well as the mean WHOQOL-BREF of domain scores. However, the married and females from both centres significantly had higher mean WHOQOL-BREF scores than their male counterparts. Patients in remission for more than two years or those on a single type of medication (either oral or depot preparation) from both centres significantly had higher mean WHOQOL-BREF score compared with those who had less than two years of remission or on both oral and depot preparations. Conclusion: Overall QoL of patients managed at the two centres was comparable, with similar socio-demographic as well as clinical variables influencing QoL. This suggests that patients with schizophrenia can be well managed at community psychiatric centres

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

Analyse des elements du diagnostic de schizophrenie porte au sein du DHM de l'INSP d'Abidjan

"L'objectif de ce travail est de determiner les elements cliniques sur lesquels se fondent les praticiens pour poser le diagnostic de schizophrenie au sein du DHM de I'INSP d' Abidjan. Il s'agit d'une etude retrospective portas sur 90 sujets consultant dans la periode du l""janvier 2001 au 31 decembre 2003. Les informations concernant les caracteristiques socio familiales; cliniques et therapeutiques de la schizophrenie ont ete recueillies. Il en resulte: AU PLAN SOCIO FAMILIAL : Une predominance de patients de sexe masculin (74;4pour cent). Une forte proportion de sujets ages de 2l a 25 ans (32;2pour cent) et de l6 a 20 ans (30pour cent). Une predominance des eleves et etudiants (43;3pour cent); des familles dont les parents vivent ensemble (57;8pour cent) et des aines de familles (26;7pour cent). AU PLAN CLINIQUE : L'etat delirait est le motif de consultation qui predomine (60pour cent). Selon les criteres A du DSM IV : Tous les symptomes caracteristiques sont exprimes; les plus importants etant les hallucinations (23;2pour cent) et le comportement desorganise (21;6pour cent). Selon le critere B : Il existe un dysfonctionnement social ou professionnel (97;8pour cent). Selon le critere C : La duree d'evolution se situe pour la plupart entre 6mois et 1an (47;8pour cent). Selon le critere D : Les troubles schizoaffectift ou troubles de l'humeur n'existent pas (87;8pour cent). Selon le critere E : Les troubles dus a une affection medicale ou a une substance ne sont pas retrouves (98;9pour cent). Selon le critere F : Les troubles anterieurs de la personnalite existent (23;3pour cent). En fonction de la classification du DSM IV ;les criteres A; B; D et E nous pemettent de justifier le diagnostic de schizophrenie au sein du DHM."