ABSTRACT
A 2-year follow-up of 328 patients discharged from a psychiatric hospital was carried out to determine the presence and severity of symptoms, disturbed behaviour and functional disability and to assess social performance. Population groups and diagnostic entities (schizophrenia, affective illness, acute and chronic organic brain syndromes and functional non-psychotic conditions) were compared. In general the proportion of patients with symptoms was considerable at discharge in respect of both the diagnostic entities and the population groups, and decreased on follow-up. Disturbed behaviour abated on discharge, but the prevalence of functional incapacity remained high. The pattern for different diagnostic groups was more or less the same, but the proportions differed in some instances. These are discussed in detail. The problem of sequelae of psychiatric illness in patients discharged from a psychiatric hospital is shown to be considerable.
Subject(s)
Mental Disorders , Acute Disease , Chronic Disease , Follow-Up Studies , Hospitals, Psychiatric , Humans , Mental Disorders/rehabilitation , Mood Disorders , Neurocognitive Disorders , Patient Discharge , SchizophreniaABSTRACT
A 2-year follow-up study of 406 patients discharged from a psychiatric hospital revealed that non-compliance with psychotropic medication was a problem in at least half the cases overall. Non-compliance with oral phenothiazine was particularly evident among the cohorts of patients classified as black and coloured (approximately two-thirds and half respectively failing to comply, compared with approximately one-quarter in the white cohort). Compliance was somewhat better for intramuscular medication. The proportion of poor compliers remained at about the same level at the 6-month, 18-month and 24-month follow-ups. There were more male than female non-compliers (51% and 41% respectively) and more among younger patients of all population groups. Understanding of the details of treatment by the relatives of black and coloured patients was particularly poor, only 14% and 12% respectively understanding the purpose and nature of medication. The main reasons for non-compliance were active resistance to taking medication, unpleasant side-effects and non-attendance at clinics. Several areas which allow remediation of the problem have been highlighted.
Subject(s)
Patient Compliance , Psychotropic Drugs/therapeutic use , Black or African American , Age Factors , Black People , Female , Follow-Up Studies , Humans , Male , Sex Factors , Socioeconomic Factors , South Africa , White PeopleABSTRACT
A detailed cross-cultural analysis was carried out of demographic, social, family and diagnostic variables responsible for, or associated with, the admission of 460 sequentially admitted patients to an area psychiatric hospital (Valkenberg Hospital). All patients were socio-economically disadvantaged compared with the population from which they were drawn and socio-economic factors played a significant part in admission. Larger proportions of coloured and black schizophrenics and substance abusers were admitted, and this is related to socio-economic conditions and the fact that the population generally are younger. There were indications that the period of inpatient stay, particularly for coloured and black patients, was too short in many cases for meaningful preparation for discharge, and that supervision after discharge was inadequate. Treatment of the type offered by this hospital appears largely to achieve the diminution or control of aberrant or difficult behaviour and symptoms while functional impairment is little improved.
Subject(s)
Mental Disorders/therapy , Patient Admission , Adult , Black or African American , Black People , Female , Hospitals, Psychiatric , Humans , Male , Middle Aged , Mood Disorders/therapy , Neurocognitive Disorders/therapy , Schizophrenia/therapy , Sex Factors , Socioeconomic Factors , South Africa , White PeopleABSTRACT
Readmissions to South African psychiatric hospitals form 45% of their intake and constitute a considerable burden on staff and facilities. The situation was investigated in a series of 460 patients sequentially admitted to a large, actively admitting hospital (Valkenberg Hospital, Cape Town). There was a difference in the proportion of readmissions within 1 year for different population groups--26,5% for white, 41% for coloured and 42% for black patients. The factors influencing this are explored. There was a marked difference in diagnoses--schizophrenics and affective disorders being more common in the black and coloured cohorts. Possible reasons for this are discussed. A 2-year post-discharge follow-up study showed a marked and sustained fall in the severity of psychiatric symptoms and difficult behaviour for all cohorts, but not of functional impairment, which was present in approximately 90% of all patients. Adequate aftercare and rehabilitation facilities in the community are evidently lacking.
Subject(s)
Mental Disorders/therapy , Patient Readmission , Female , Follow-Up Studies , Hospitals, Psychiatric , Humans , Longitudinal Studies , Male , Mood Disorders/therapy , Neurocognitive Disorders/therapy , Outcome and Process Assessment, Health Care , Schizophrenia/therapyABSTRACT
The progressive increase in readmissions to psychiatric hospitals in South Africa is causing concern. Readmissions now amount to 42% of total admissions, and in some cases their number exceeds that of first admissions. The phenomenon has been identified as occurring overwhelmingly among short-stay patients. Factors associated with readmissions have been examined as the first part of an ongoing investigation. Among these are a decline in available beds, an increasing shortage of psychiatric staff, differing readmission rates for different population groups, and the tendency of certain types of psychiatric disorders to relapse more frequently (schizophrenia and affective illness). The inability of the present psychiatric outpatient and community services to lower the readmission rate has been demonstrated. Factors which may have a bearing on the situation such as socio-economic conditions, substance abuse, compliance with medication and rehabilitative services are discussed.
Subject(s)
Hospitals, Psychiatric , Patient Readmission/trends , Black or African American , Black People , Community Psychiatry , Humans , Mental Disorders/therapy , Recurrence , South Africa , Time Factors , White PeopleABSTRACT
The deinstitutionalization process has confronted psychiatry with the challenge of maintaining patients in the community. This problem is reflected in the ever-increasing rates of readmission to psychiatric hospitals. The ability to predict patients at risk of readmission would aid in improving services by enabling attention to be focused on vulnerable groups. Past psychiatric history has been shown to be the most consistent predictor of readmission. This study verifies this finding among coloured patients discharged from Valkenberg Hospital, Cape Town.