ABSTRACT
Schizophrenia has a high rate of relapse. Treatment compliance is challenging in the long-term management of schizophrenia. The outcomes of previous studies on Community Psychiatry Service - Home Visit Treatment [CPS-HVT] are inconclusive. To evaluate the effectiveness of CPS-HVT in [a] reducing the number of admissions and [b] duration of admissions of chronic schizophrenic patients. A retrospective analysis by auditing files of all cases of adult schizophrenic patients in Bahrain who underwent CPS-HVT treatment. A total of 10 years follow-up [5 years of outpatient treatment before the referral to the community service and 5 years follow-up in the community service after the referral] was carried out. The number of admissions and the duration of admissions were compared. Of the total number of 232 patients 51 [22%] fulfilled the inclusion criteria. The sum total of 77 admissions during 5 years before the referral to the CPS-HVT was 2577 days [50.5 d/patient]. After the referral to the CPS-HVT the sum total of 48 admissions was 1383 days [27.1 d/patient], and no patient had more than 3 admissions. The number of non-hospitalized patients doubled during the 5 years follow-up in the CPS-HVT [n=13; 4 males vs. n=27; 10 males]. The proportion of males was 47.1% [n=24]. CPS-HVT is effective and superior to standard outpatient treatment of chronic schizophrenic patients in reducing the number and duration of admissions, in Bahrain. Future studies should evaluate a wide range of other outcomes, including the cost effectiveness of CPS-HVT. Considering the massive impact of community-based care on patients, caregivers, clinicians and the community at large, such studies are urgently needed
Subject(s)
Humans , Ambulatory Care , House Calls , Patient Admission , Retrospective Studies , Length of StayABSTRACT
The definition, prevalence, etiology and clinical significance of lithium-associated subclinical hypothyroidism are uncertain. To determine the prevalence and risk factors for subclinical hypothyroidism among Bahraini patients on long-term lithium therapy. A retrospective study was conducted in all patients attending the out-patient clinic at the Bahrain Psychiatric Hospital who were diagnosed according to ICD-10 criteria as bipolar affective disorder, schizoaffective disorder or resistant depression, and were receiving maintenance lithium therapy for one year or longer. The age, gender, dosage of lithium, duration of lithium therapy, and duration of therapy until the development of thyroid dysfunction if it occurred, was the variables analyzed. Thyroid stimulating hormone [TSH; reference range 0.25 - 4.5 mU/L] and free thyroxine [T[4]; reference range 6.0 - 24.5 pmol/L] in serum were measured. In a sample of 32 patients 12 were female and 20 were male with a mean [ +/- SD] age 40.41 +/- 9.13 years. The age at onset of illness was 22.78 +/- 7.4 years, and lithium therapy was initiated at the age of 30.53 +/- 8.85 years. The dosage of lithium [mean +/- SD] was 812.5 +/- 282.6 mgs/day administered for a duration of 10.72 +/- 7.02 years. The level of TSH and thyroxine [mean +/- SD] were 3.45 +/- 3.1 mU/L and 15.5 +/- 3.14 pmol/L, respectively. Seven patients [21.9%] were considered to have had a subclinical hypothyroidism judged by a TSH level of >/= 4.5 mU/L; of these four were females. None of the patients had overt hypothyroidism or hyperthyroidism. Subclinical hypothyroidism is a relatively common adverse effect associated with lithium maintenance therapy. The duration of lithium therapy and female gender are important predictive factors. It is important to screen patients on lithium therapy for thyroid dysfunction for early detection and management