BMJ 1994;308:813-816 (26 March)

Papers

Residence of incident cohort of psychotic patients after 13 years of follow up

Glynn Harrison, consultant psychiatrist,a Peter Mason, senior registrar Mandala Centre, Nottingham,a Cristine Glazebrook, lecturer in behavioural sciences,a Ian Medley, consultant psychiatrist Department of Psychology, University of Nottingham, Nottingham,a Tim Croudace, postgraduate research student Correspondence to: Dr Harrison.,a Sarah Docherty, research assistant Department of Psychiatry, Royal Liverpool Hospital, Liverpool a

a Department of Psychiatry, University Hospital, Nottingham NG7 2UH

Abstract

Objective: To establish the residential history of an incident cohort of psychotic patients 13 years after their first contact with the psychiatric services.
Design: Tracing of all patients admitted to the WHO study on determinants of outcome of severe mental disorders in Nottingham between 1978 and 1980. Patients were assessed using standardised and comparable instruments, and extra information was obtained from key informants and medical records.
Setting: Catchment area of Nottingham psychiatric services.
Main outcome measures: Main place of residence over the previous two years and residential history over 13 years in terms of homelessness, imprisonment, and use of high dependency psychiatric facilities.
Results: 95 patients were traced. At the point of follow up no patients were in long stay psychiatric wards, two were in supervised residence, none was homeless, and none was in prison or a high security hospital. 85 patients were living either independently alone or with their family or friends in the community. Of these, 44 had had no contact with the psychiatric services at the point of follow up.
Conclusions: Although many patients experienced a difficult early course of illness, the longer term outcome of the disorder was associated with remarkably low periods of homelessness and imprisonment and low use of intensive care facilities. These findings offer some reassurance, given the concerns about the effectiveness of community oriented care for this potentially most vulnerable group of psychiatric patients.

Clinical implications

  • Clinical implications

  • Recent studies have challenged earlier notions of the long term nature and poor outcome of schizophrenia and related psychoses

  • Over the longer term course of the illness many patients may experience recovery or substantial reduction in social disability

  • This study showed that in a complete and geographically based cohort of patients with their first onset of psychosis in 1978-80 none was homeless or in long stay accommodation and only two were in supervised accommodation 13 years later

  • During the 13 years 13 patients had experienced homelessness, prison, long stay wards, or supervised accommodation, an initial diagnosis of schizophrenia identifying those patients at most risk

  • These data offer some reassurance about the effectiveness of community care for schizophrenia


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Bromet, E. J, Naz, B., Fochtmann, L. J, Carlson, G. A, Tanenberg-Karant, M. (2005). Long-Term Diagnostic Stability and Outcome in Recent First-Episode Cohort Studies of Schizophrenia. Schizophr Bull 31: 639-649 [Abstract] [Full text]  
  • HARRISON, G., HOPPER, K., CRAIG, T., LASKA, E., SIEGEL, C., WANDERLING, J., DUBE, K. C., GANEV, K., GIEL, R., AN DER HEIDEN, W., HOLMBERG, S. K., JANCA, A., LEE, P. W. H., LEON, C. A., MALHOTRA, S., MARSELLA, A. J., NAKANE, Y., SARTORIUS, N., SHEN, Y., SKODA, C., THARA, R., TSIRKIN, S. J., VARMA, V. K., WALSH, D., WIERSMA, D. (2001). Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br. J. Psychiatry 178: 506-517 [Abstract] [Full text]  
  • Lambert, G., Ricci, P., Harris, R., Deane, F. (2000). Housing Needs of Consumers of Mental Health Services in Rural New South Wales, Australia. Int J Soc Psychiatry 46: 57-66 [Abstract]  
  • Melle, I., Friis, S., Hauff, E., Vaglum, P. (2000). Social Functioning of Patients With Schizophrenia in High-Income Welfare Societies. Psychiatr. Serv. 51: 223-228 [Abstract] [Full text]  
  • (1994). Long-term management of people with psychotic disorders in the community. DTB 32: 73-77 [Abstract] [Full text]  
Access all current jobs at BMJ Group
Whats new online at Student BMJ
Listen to the latest BMJ Interview