Schizophrenia patients fare well with outpatient care

Nov 7 2013

By Lucy Piper, Senior medwireNews Reporter

Study findings corroborate that patients with schizophrenia who receive outpatient care only during the early stages of their illness have better outcomes than those requiring inpatient hospitalization.

“The mortality rates and number of psychiatric treatment days and relapses during the 5-year follow up were notably lower among the [outpatient-treated] group compared with the [hospitalized patients] group,” report the study researchers, led by Marjo Kiviniemi (Social and Mental Health Services, Oulu, Finland).

The study participants included 5867 first-admission hospital patients who were diagnosed with schizophrenia and 1220 first-onset schizophrenia patients who had never been hospitalized but who had been granted a disability pension for schizophrenia.

Over the 5-year study, 5.3% of hospitalized patients died, compared with 3.8% of outpatients, equating to a significant 1.97-fold increased risk for hospitalized patients.

These patients also had a more than fourfold higher risk for suicide. This could be due to a number of factors, suggest the researchers, including a greater use of medication in the year prior to the time of first schizophrenia onset among outpatients and greater severity of initial symptoms in hospitalized patients.

Outpatients also had a lower number of hospital days than hospitalized patients, at a median of 91 versus 150, and the percentage of patients staying in hospital for over a year was just 5.8% among outpatients compared with 21.7% among hospitalized patients.

The hospital treatment duration tended to be shorter for outpatients and they had fewer involuntary treatment days, note the researchers, which suggests greater symptom severity among the hospitalized patients.

The risk for relapse among outpatients was a third of that for hospitalized patients, at 39.6% versus 74.2%.

“It is possible that the [outpatient-treated] group had less hospital admissions during the follow-up time because treatment and rehabilitation in outpatient services had already improved their ability to live independently,” the team postulates in the International Journal of Clinical Practice.

“Alternatively, the same factors that helped them to manage in outpatient care in the early phases of illness – possibly less severe illness or better social support – continued to support their ability to cope with the illness during the 5-year follow up.”

Kiviniemi and colleagues make special reference to a subgroup of 737 outpatients with schizophrenia who, despite their symptoms, did not require any psychiatric hospitalization over the 5-year study.

These patients tended to be older at the onset of schizophrenia and therefore may have had good support networks and functioning and a milder course of illness than patients with earlier onset, they comment.

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