ABSTRACT
BACKGROUND: There is growing recognition that people presenting with psychotic symptoms for the first time need specialized treatment. The Hamilton Health Sciences Corporation, McMaster Hospital, offers one such program, the Psychotic Disorders Clinic (PDC); it addresses some of the problems posed by long waiting lists, lack of family interventions, and long-term hospitalizations. The PDC is affiliated with the Department of Psychiatry and Behavioural Neurosciences at McMaster University. The program's goals are to provide comprehensive outpatient care and early interventions for persons in the early stages of illness and, consequently, to improve symptom control and functioning and reduce hospitalizations. Key service components include providing low dosages of antipsychotics, offering specialized family education, and supporting return to school and work settings. OBJECTIVES: This study compared outcomes before and after enrolment in the PDC to determine whether first-episode patients achieved improved symptom control and functioning and fewer hospitalizations. METHOD: For a 12-month period, we followed 40 patients, aged between 16 and 45 years, who experienced their first episode of psychotic illness between 1997 and 2000. Prospective longitudinal data were collected at baseline, 3, 6, and 12 months. Outcome measures included symptoms, global functioning, employment rates, duration of untreated psychosis, and number of bed-days. RESULTS: Of the patients, 37 completed the study at 6 months, and 31 at 12 months. Over the 12 months, significant improvements occurred in psychiatric symptoms (P < 0.001), global functioning (P < 0.001), and the mean number of hospital bed-days (P < 0.001). CONCLUSIONS: It is feasible for small outpatient services to provide early intervention strategies and obtain good outcomes among first-episode patients.
Subject(s)
Ambulatory Care Facilities/statistics & numerical data , Mental Health Services/standards , Psychotic Disorders/rehabilitation , Adolescent , Adult , Antipsychotic Agents/therapeutic use , Brief Psychiatric Rating Scale , Feasibility Studies , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Program Evaluation , Prospective Studies , Psychotic Disorders/diagnosis , Psychotic Disorders/drug therapy , Time FactorsABSTRACT
BACKGROUND: Increasingly alarmed by the health risks (that is, weight gain, elevated lipids, and poor glucose tolerance) posed by novel antipsychotic medications, clinicians who treat schizophrenia are attempting to help patients improve lifestyle factors. Unfortunately, schizophrenia research has neglected exercise as a legitimate adjunctive treatment for schizophrenia. OBJECTIVE: To assess the extent to which stable patients with schizophrenia would adhere to an exercise program if offered access to a fitness facility. METHODS: Ten of 20 stable patients with schizophrenia or schizoaffective disorder who were treated with olanzapine for at least 4 weeks had the opportunity to receive access to a Young Men's Christian Association (YMCA) fitness facility, based on random allocation. The intervention included a free membership to the YMCA for 6 months, with access to all the fitness amenities and equipment. The mean dosage of olanzapine was 11.5 mg daily for the YMCA group. RESULTS: Of the 10 subjects, 2 did not attend at all. One subject met criteria for full attendance for each of the 6 months and lost 15 Kg. Dropout rates were as follows: 90% at 6 months, 70% at 5 months, and 40% at 4 months. The main reason they gave for poor attendance was lack of motivation. The mean weight gain was 2 kg in the YMCA group. CONCLUSION: Most subjects did not regularly exercise or attend. They cited poor motivation as the main reason. The subject who exercised regularly lost a significant amount of weight.
