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Schizophrenic subjects with no history of admission to hospital

Published online by Cambridge University Press:  09 July 2009

John R. Geddes*
Affiliation:
Department of Psychiatry, Royal Edinburgh Hospital and The Scottish Office, Edinburgh
Robert E. Kendell
Affiliation:
Department of Psychiatry, Royal Edinburgh Hospital and The Scottish Office, Edinburgh
*
1Address for correspondence: Dr John R. Geddes, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX.

Synopsis

It has often been assumed that all subjects with schizophrenia will eventually be admitted to hospital and therefore little bias is introduced by restricting research to hospitalized subjects. Using the Lothian Psychiatric Case Register, 66 subjects were identified who had been diagnosed in Edinburgh as suffering from schizophrenia between 1978 and 1989 but had no history of hospital admission by December 1991. This represented an adjusted average of 6·7% of the estimated annual rate of first diagnosis of schizophrenia: the proportion of such patients did not change over the period. Using a case–control design, the index cases were compared with a control group of schizophrenic patients who had been admitted to hospital within 3 months of diagnosis. At the time of diagnosis, the cases were generally less disturbed with lower levels of violent behaviour and less evidence of neglect or hallucinations. They had a longer duration of illness prior to diagnosis, were more often diagnosed by a consultant and unemployed. In a follow-up study of the index cases, 59 (89%) were traced, of whom 6 (10%) were deceased. The outcome of the illness was heterogeneous although the course was often chronic. The general practitioner provided most of the care they received. The small proportion of such patients suggests that their exclusion from most published series does not seriously bias our picture of the natural history of schizophrenia. Moreover, as there was no increase in the proportion over the period, first admission rates for schizophrenia in Scotland are a reasonable approximation to incidence rates.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1995

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References

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. (DSM-III). APA: Washington, DC.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. Revised (DSM-III-R). APA: Washington, DC.Google Scholar
Bamrah, J. S., Freeman, H. L. & Goldberg, D. P. (1991). Epidemiology or schizophrenia in Salford, 1974–84. Changes in an urban community over ten years. British Journal of Psychiatry 159, 802810.CrossRefGoogle ScholarPubMed
Breslow, N. E. & Day, N. E. (1980). Statistical Methods in Cancer Research. International Agency for Research on Cancer: Lyon.Google ScholarPubMed
Castle, D. J., Phelan, M., Wessely, S. & Murray, R. M. (1994). Which patients with non-affective functional psychosis are not admitted at first contact? British Journal of Psychiatry 165, 101106.CrossRefGoogle ScholarPubMed
Creed, F., Black, D., Anthony, P., Osborn, M., Thomas, P. & Tomenson, B. (1990). Randomised controlled trial of day patient versus inpatient psychiatric treatment. British Medical Journal 300, 10331037.CrossRefGoogle ScholarPubMed
Dean, C. & Gadd, E. M. (1990). Home treatment for acute psychiatric illness. British Medical Journal 301, 10211023.CrossRefGoogle ScholarPubMed
Der, G., Gupta, S. & Murray, R. M. (1990). Is schizophrenia disappearing? Lancet 335, 513516.CrossRefGoogle Scholar
Drake, R. E., Gates, C., Whitaker, A. & Cotton, P. G. (1985). Suicide among schizophrenics: a review. Comprehensive Psychiatry 26, 90100.CrossRefGoogle ScholarPubMed
Eagles, J. M. & Whalley, L. J. (1985). Decline in the diagnosis of schizophrenia among first admissions to Scottish mental hospitals from 1969–1978. British Journal of Psychiatry 146, 151154.CrossRefGoogle Scholar
Essen-Moller, E. (1956). Individual traits and morbidity in a Swedish rural population. Acta Psychiatrica and Neurologica Scandinavica 32 (suppl. 100).Google Scholar
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G. & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5763.CrossRefGoogle ScholarPubMed
Geddes, J. R., Black, R., Whalley, L. J. & Eagles, J. M. (1993). Persistence of the decline in the diagnosis of schizophrenia amongst first admissions to Scottish hospitals from 1969–1988. British Journal of Psychiatry 163, 620626.CrossRefGoogle Scholar
Geddes, J. R., Newton, J. R., Bailey, S., Young, G., Freeman, C. P. & Priest, R. G. (1994). Comparison of the prevalence of schizophrenia among the residents of hostels for the homeless in 1966 and 1992. British Medical Journal 308, 816819.CrossRefGoogle ScholarPubMed
Helgason, T. (1964). Epidemiology of mental disorders in Iceland. Acta Psychiatrica Scandinavica 40 (suppl. 173).Google ScholarPubMed
Iastrebov, V. S. (1987). Clinico-epidemiological characteristics of non-hospitalised schizophrenics. Zhurnal nevropatologii i psikiatrii imenii s s Korsakova 87, 12071215.Google Scholar
Jablensky, A. (1986). Epidemiology of schizophrenia: a European perspective. Schizophrenia Bulletin 12, 5269.CrossRefGoogle ScholarPubMed
Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A., Cooper, J. E., Day, R. & Bertelsen, A. (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine Monograph Supplement 20. Cambridge University Press: Cambridge.Google Scholar
Johnstone, E. C. (1991). Disabilities and circumstances of schizophrenic patients – a follow-up study. British Journal of Psychiatry 159 (suppl. 13).Google Scholar
Kammerling, R. M. & O'Connor, S. (1993). Unemployment rate as a predictor of rate of psychiatric admission. British Medical Journal 307, 15361539.CrossRefGoogle ScholarPubMed
Keith, S. J., Regier, D. A. & Rae, D. S. (1991). Schizophrenic disorders. In Psychiatric Disorders in America (ed. Robins, L. N. and Regier, D. A.), pp. 3352. New York: Free Press.Google Scholar
Kendell, R. E., Malcolm, D. E. & Adams, W. (1993). The problem of detecting changes in the incidence of schizophrenia. British Journal of Psychiatry 162, 212218.CrossRefGoogle ScholarPubMed
Kendrick, T., Sibbald, B., Burns, T. & Freeling, P. (1991). Role of general pratitioners in care of long term mentally ill patients. British Medical Journal 302, 508510.CrossRefGoogle Scholar
McCreadie, R. G. (1982). The Nithsdale schizophrenia survey: 1. Psychiatric and social handicaps. British Journal of Psychiatry 140, 582586.CrossRefGoogle ScholarPubMed
McGlashan, T. (1988). A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophrenia Bulletin 14, 515542.CrossRefGoogle ScholarPubMed
McGuffin, P., Farmer, A. E. & Harvey, I. (1991). A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764770.CrossRefGoogle ScholarPubMed
Mantel, N. (1963). Chi-squared tests with one degree of freedom: extensions of the Mantel–Haenszel procedure. Journal of the American Statistical Association 58, 690700.Google Scholar
Mantel, N. & Haenszel, W. (1959). Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute 22, 719748.Google ScholarPubMed
Merskey, H. & Shafran, B. (1986). Political hazards in the diagnosis of ‘sluggish’ schizophrenia. British Journal of Psychiatry 148, 247256.CrossRefGoogle ScholarPubMed
Muijen, M., Marks, I., Connolly, J., Audini, B. & McNamee, G. (1992). Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial. British Medical Journal 304, 749754.CrossRefGoogle ScholarPubMed
Munk-Jørgensen, P. & Mortensen, P. B. (1993). Is schizophrenia really on the decrease? European Archives of Psychiatry and Neurological Sciences 242, 244247.Google ScholarPubMed
Ödegaard, Ö. (1952). The incidence of mental diseases as measured by census investigations versus admission statistics. Psychiatric Quarterly 26, 212218.CrossRefGoogle Scholar
Schneider, K. (1959). Clinical Psychopathology (transl. Hamilton, M. W.). Grune and Stratton Inc.: New York.Google Scholar
Shepherd, M., Watt, D., Falloon, I. & Smeeton, N. (1989). The natural history of schizophrenia: a five year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychological Medicine Supplement 15, Cambridge University Press: Cambridge.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.CrossRefGoogle ScholarPubMed
Statistics and Epidemiology Research Corporation (1991). EGRET: Epidemiological graphics, estimation and testing. SERC: Seattle, Washington.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1972). The prediction of outcome in schizophrenia. I. Characteristics of outcome. Archives of General Psychiatry 27, 739746.CrossRefGoogle ScholarPubMed
Watts, C. A. H. (1973). Review of schizophrenics in a rural practice over 26 years. British Medical Journal ii, 465469.CrossRefGoogle Scholar
Watts, C. A. H., Cawte, E. C. & Kuenssberg, E. V. (164). Survey of mental illness in general practice. British Medical Journal ii, 13511359.Google Scholar
Westermeyer, J. F. & Harrow, M. (1988). Course and outcome in schizophrenia. In Handbook of Schizophrenia, volume 3 (ed. Tsaung, M. S. and Simpson, J. C.), pp. 205243. Elsevier Science Publishers: BV.Google Scholar
World Health Organization (1979). Report of the International Follow-up Study of Schizophrenia. John Wiley and Sons: New York.Google Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. WHO: Geneva.Google Scholar