What happens with schizophrenia patients after their discharge from hospital? Results on outcome and treatment from a “real-world” 2-year follow-up trial

• Published in: European archives of psychiatry and clinical neuroscience Vol. 270; no. 6; pp. 661 - 671
• Main Authors: Schennach, Rebecca, Riedel, Michael, Obermeier, Michael, Jäger, Markus, Schmauss, Max, Laux, Gerd, Pfeiffer, Herbert, Naber, Dieter, Schmidt, Lutz G., Gaebel, Wolfgang, Klosterkötter, Joachim, Heuser, Isabella, Maier, Wolfgang, Lemke, Matthias R., Rüther, Eckart, Klingberg, Stefan, Gastpar, Markus, Seemüller, Florian, Spellmann, Ilja, Musil, Richard, Möller, Hans-Jürgen
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2020; Springer Nature B.V
• Subjects: Antipsychotics; Extrapyramidal system; Medicine; Medicine & Public Health; Mental disorders; Neurosciences; Original Paper; Patients; Psychiatry; Remission; Schizophrenia; Side effects; Response; Schizophrenia; Remission; Relapse; Functioning; 2-year follow-up
• ISSN: 0940-1334; 1433-8491
• DOI: 10.1007/s00406-019-01055-4

Aim of the study was to examine the course of schizophrenia patients within 2 years after discharge. Within a multicenter study of the German Competence Network on Schizophrenia, patients suffering from a schizophrenia spectrum disorder were examined regarding their psychopathological improvement, tolerability, and the treatment regime applied during hospitalization and a 2-year follow-up period. Response, remission, the level of everyday functioning, and relapse were furthermore evaluated during the follow-up period using established definitions for these outcome domains. The psychopharmacological treatment was specifically evaluated in terms of a potential association with relapse. 149 patients were available for analysis, with 65% of the patients being in response, 52% in symptomatic remission, and 64% having a satisfiable everyday functioning 2 years after their discharge from hospital. Despite these favorable outcome rates, 63% of the patients suffered from a relapse within the 2-year follow-up period with 86% of these patients being rehospitalized. Discharge non-responder and non-remitter were twice as likely to relapse during follow-up. A significant decrease of side-effects was observed with negligible rates of extrapyramidal side-effects, sedation, and weight gain during follow-up. Patients receiving treatment with atypical antipsychotics were found to have the lowest risk to relapse (
p
 < 0.0001). The results highlight the natural and unsteady course of schizophrenia in most patients underlining the need to develop more specific treatment strategies ensuring ongoing stability and preventing relapse.