Treatment of acute schizophrenia in open general medical wards in Jamaica

Objective The study assessed the efficacy of treating acute psychotic illne ss in open medical wards of general hospitals. Methods: The sample consiste d of 120 patients with schizophrenia whose first contact with a psychiatric sen ice in Jamaica was in 1992 and who were treated as inpatients during t he acute phase of their illness. Based on the geographic catchment area whe re they lived, patients were admitted to open medical wards in general hosp itals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illne ss was assessed, and sociodemographic variables, pathways to care, and lega l status were determined. At discharge and for the subsequent 12 months, pa tients' outcomes were assessed by blinded observers using variables that in cluded relapse, length of stay, employment status after discharge, and clin ical status. Results: More than half (53 percent) of the patients were admi tted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of sym ptoms, and severity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychia tric units, and 17.3 days in the general hospital medical wards. Clinical o utcome variables were significantly better for patients treated in the gene ral hospital medical wards than for those treated in the mental hospital, a s were outpatient compliance and gainful employment. Conclusions: While all owing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards resu lts in outcome that is at least equivalent to, and for some patients superi or to, the outcome of treatment in conventional psychiatric facilities.