Treatment of acute schizophrenia in open medical wards

ABSTRACT

The aim of this study was to compare the pathways to care and outcome of first contact patients with schizophrenia admitted to open medical wards with those treated in closed community psychiatric units and in acute wards of a custodial mental hospital. First contact with patients with schizophrenia who were identified in Jamaica in 1992 and admitted to the three different types of acute treatment facility across the island were followed in a blinded prospective study. Their pathways to care and standard clinical and sociological outcome parameters were identified and compared. 65 first contact patients were admitted to 3 acute wards of the Bellevue Mental Hospital, 20 patients to two closed psychiatric units in general hospitals, and 35 patients admitted to 8 general hospitals islandwide. The mean length of stay in the mental hospital wards was 88.3 days; in the psychiatric units was 29.9 days (p<0.01), and in the general hospitals was 14.1 days (p<0.0001). Clinical outcome variable were significantly better (p<0.03) for patients treated in open medical wards compared with those admitted to acute mental hospital wards. Fewer patients were admitted to open medical wards by the police (p<0.01), or by compulsory legal section (p<0.01). Compared with admissions to conventional psychiatric units, admissions to open medical wards had shorter lengths of stay (p<0.02), fewer admissions by compulsory detention (p<0.05) and had attained relative numerical but not statistical significance for most clinical outcome and pathway to care variables.(AU)