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Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

  • Cecilia Casetta (a1), Fiona Gaughran (a1), Ebenezer Oloyede (a1), Juliana Onwumere (a2), Megan Pritchard (a3), Sukhi S. Shergill (a1), Eromona Whiskey (a1) and James Hunter MacCabe (a1)...

Abstract

Background

Treatment-resistant schizophrenia is a major disabling illness which often proves challenging to manage in a secondary care setting. The National Psychosis Unit (NPU) is a specialised tertiary in-patient facility that provides evidence-based, personalised, multidisciplinary interventions for complex treatment-resistant psychosis, in order to reduce the risk of readmission and long-term care costs.

Aims

This study aimed to assess the long-term effectiveness of treatment at the NPU by considering naturalistic outcome measures.

Method

Using a mirror image design, we compared the numbers of psychiatric and general hospital admissions, in-patient days, acuity of placement, number of psychotropic medications and dose of antipsychotic medication prescribed before and following NPU admission. Data were obtained from the Clinical Records Interactive Search system, an anonymised database sourced from the South London and Maudsley NHS Trust electronic records, and by means of anonymous linkage to the Hospital Episode Statistics system.

Results

Compared with the 2 years before NPU admission, patients had fewer mental health admissions (1.65 ± 1.44 v. 0.87 ± 0.99, z = 5.594, P < 0.0001) and less mental health bed usage (335.31 ± 272.67 v. 199.42 ± 261.96, z = 5.195 P < 0.0001) after NPU admission. Total in-patient days in physical health hospitals and total number of in-patient days were also significantly reduced (16.51 ± 85.77 v. 2.83 ± 17.38, z = 2.046, P = 0.0408; 351.82 ± 269.09 v. 202.25 ± 261.05, z = 5.621, P < 0.0001). The reduction in level of support required after treatment at the NPU was statistically significant (z = −8.099, P < 0.0001).

Conclusions

This study demonstrates the long-term effectiveness of a tertiary service specialising in treatment-resistant psychosis.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Cecilia Casetta. Email: cecilia.casetta@gmail.com

References

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Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

  • Cecilia Casetta (a1), Fiona Gaughran (a1), Ebenezer Oloyede (a1), Juliana Onwumere (a2), Megan Pritchard (a3), Sukhi S. Shergill (a1), Eromona Whiskey (a1) and James Hunter MacCabe (a1)...

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