Schizophrenia is one of mental disorders characterized by abnormal perception and expression of reality. It is a social, economic and health burden on patients' families, the community and the ministry of health of any country. Relapses and recurrent admissions are common in such disorder due to certain risk factors like poor compliance to antipsychotic treatments, comorbidity with drug abuse, stressors, nature of the disorders, and other risk factors. Fortunately, most of these risk factors are controllable and relapses can be delayed or minimized by certain strategies and psychological programs. The aim of this study is to detect the most common risk factors for relapses of schizophrenic patients following at Abha Psychiatric Hospital (APH) to be able to emphasize on them for intervention programs in the future. Objectives: To assess the risk factors responsible for relapses and recurrent admissions of schizophrenic patients following up at APH in the past two years and to provide information based recommendations for possible solutions for prevention and control of relapses and subsequent recurrent admissions.
Methodology
A descriptive-cross sectional study based on medical records by researcher filling a well-designed questionnaire. The study was conducted in (APH), which is the only governmental hospital, specialized for management of psychiatric disorders in Abha and the nearby villages and towns. This hospital has 100-bed capacity wards for admitted cases, 70 beds for male and 30 for female cases. The sample included all the schizophrenic patients who were admitted three times or more per year to APH from July 2007 to July 2009.
Results
Total of 140 schizophrenic patients met the inclusion criteria of this study. They were all schizophrenic diagnosed and admitted three times or more per year to Abha Psychiatric Hospital during the period from July 2007 to July 2009. The age ranged from 17 to 60 years old (mean 38±10 years). The highest age group was between 36-45 years (47.1%). All of those patients were Saudis, 98 (70.0%) were males and 42 (30.0%) were females. The age of onset of schizophrenia of these patients ranged from 15 to 34 years of age (mean 22.4 ± 4.5 years). Fifty-eight patients (41.4%) developed this disorder when they were below 20 years of age, 78 (55.7%) were between 21 and 30 years and only 4 patients (2.9%) were above 30 years of age when they developed schizophrenia. Those patients were frequently readmitted to APH in the past 2 years due to relapses. Twenty-two patients (15.7%) were readmitted 3 times, 36 patients (25.7%) readmitted 4 times, 24 (17.1%) readmitted 5 times, 44 of them (31.4%) readmitted 6 times and 14 (10.0%) readmitted 8 times in the last 2 years. The majority of the patients (78.6%) were readmitted for the first time due to poor compliance to treatment, followed by readmission due to comorbidity of substance abuse (15.7%). The duration of hospitalization of those patients during the first readmission ranged from 2 days up to 321 days (mean 27.5 ± 37.3 days). The reasons for the second readmission were due to poor compliance to treatment in (64.3%), followed by substance abuse (18.6%). The duration of hospitalization of those patients ranged from 5 days up to 150 days (mean 31.4 ± 24.4 days). The third readmission were due to poor compliance to treatment (62.9%), followed by substance abuse (22.9%). The duration of hospitalization of those patients during the third readmission ranged from 7 days up to 292 days (mean 30.9 ± 32.7 days). The most common reasons for the subsequent readmissions were also poor compliance to treatment followed by substance abuse. The study showed that (24.3%) of patients were on old generation of antipsychotic tablets only, (74.3%) were on depot of long acting antipsychotics beside the tablets and only (1.4%) were on the new generation of antipsychotic tablets as pre-lapse medication. The discharged medication was found to be an old generation of antipsychotic tablets for (2.9%) of patients, old antipsychotic tablets with depot injection for (48.6%) of patients and new antipsychotics tablets with depot injection for (32.9%).
Conclusion
The majority of the relapsing schizophrenics at APH are males in the age group 36-45 years with mean of 38±10 years. The most common reasons for relapses were poor compliance to treatment followed by comorbidity of substance abuse. Short stay of hospitalization was noticed to be another factor contributing to relapses. Atypical antipsychotic tablets with depot long acting injections of typical antipsychotics as a treatment in the post-relapsing stage was found to be very effective in the control of another relapse.