Pathways to care and outcome of first contact schizophrenia in Jamaica - abstract

ABSTRACT

The study was to identify pathways to care and determine clinical outcome after one year in a cohort with first contact schizophrenia in Jamaica. 317 first contact patients identified prospectively were followed blind by psychiatrists and mental health officers and clinical outcome variables were recorded monthly. Relapse was identified as admission/readmission to hospital, re-emergence of symptoms and/or the return of abnormal behaviour. Data in the first 12-month period following first contact were analyzed by the Chi-squared method. 65 percent were males, 98 percent were of African origin, and 90 percent of social classes IV and V. They were treated at home (63 percent), in the mental hospital (20 percent) and community psychiatric beds (17 percent). Only 5 percent were admitted using a compulsory detention section order. The mean length of stay in the mental hospital was 93 days, and in the community beds was 24 days. 70 percent were still being followed in clinics and 21 percent had ceased contact and had been discharged. The relapse rate was 7 percent and these patients were more likely to have come into care through the police or mental health officers (p<0.05), and more likely to have been treated in hospitals (p>0.05) and more likely to have received an increase in psychotropic medication (p>0.05). The relapse status of an additional 7 percent patients could not be ascertained. We concluded that low relapse rate in schizophrenia is related to close involvement of families of the patients as caregivers, early recognition and treatment in community and home settings, significant reduction in the use of compulsory detention, and the provision of high compliance pharmacological follow-up treatment. (AU)