Hello again Mike,
Below you will find the results of my research regarding
rehospitalizations and relapses of schizophrenic patients.
General Schizophrenia Facts and Statistics
After 10 years, of the people diagnosed with schizophrenia:
25% Completely Recover
25% Much Improved, relatively independent
25% Improved, but require extensive support network
15% Hospitalized, unimproved
10% Dead (Mostly Suicide)
After 30 years, of the people diagnosed with schizophrenia:
25% Completely Recover
35% Much Improved, relatively independent
15% Improved, but require extensive support network
10% Hospitalized, unimproved
15% Dead (Mostly Suicide)
(Source: Surviving Schizophrenia)
?Many individuals with schizophrenia revolve between hospitals, jails
and shelters. In Illinois 30% of patiants discharged from state
psychiatric hospitals are rehospitalized within 30 days.
In New York 60% of discharged patients are rehospitalized within a year.?
The Cost of Schizophrenia to Society:
?Schizophrenia, long considered the most chronic, debilitating and
costly mental illness, now consumes a total of about $65 billion a
year for direct treatment, societal and family costs. Richard Wyatt,
M.D., chief of neuropsychiatry, National Institutes of Mental Health,
has said that nearly 30 percent ($19 billion) of schizophrenia's cost
involves direct treatment and the rest is absorbed by other factors --
lost time from work for patients and care givers, social services and
criminal justice resources.?
?Wyatt said schizophrenia affects one percent of the population,
accounts for a fourth of all mental health costs and takes up one in
three psychiatric hospital beds. Since most schizophrenia patients are
never able to work, they must be supported for life by Medicaid and
other forms of public assistance. Source: NIMH
A more recent estimate of the cost of schizophrenia and other serious
mental illnesses (biplar disorder, serious depression, etc) from Dr,
E. Fuller Torrey in Q1, 2004 was that federal costs for the care of
seriously mentally ill individuals now total $41 billion yearly and
are rocketing upward at a rate of $2.6 billion a year.?
Source: Surviving Schizophrenia
http://www.schizophrenia.com/szfacts.htm
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Rehospitalization
Approximately 50% of discharged patients with Schizophrenia will be
rehospitalized within 1 year
Medical Education Systems (MES)
http://www.mesinc.com/education/monographs2/cme013/content/02.html
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?Antipsychotic medications are important in reducing or eliminating
the chances of relapse. One study showed that 60 to 80 percent of
those who did not take medication as part of their treatment had a
relapse the first year after leaving the hospital. Between 20 and 50
percent of those who did take medication were rehospitalized that
first year; however, if the patients continued taking medication
beyond the first year, relapse rates fell to 10 percent.?
Schizophrenia Overview
http://www.healthyplace.com/communities/thought_disorders/site/schizophrenia_overview.htm
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Excerpts from "Surviving Schizophrenia"
Length of hospital stay - from weeks, or even months, to days.
Chance of rehospitalization ?
"On the average, a person who takes drugs has a 3-out-of-5 chance
(60%) of not being rehospitalized, whereas the person who does not
take the drugs has only a 1-out-of-5 chance (20%) of not being
rehospitalized." (p. 111)
In studies "on the long-acting injectable form of antipsychotics
(where compliance in taking the drug is assured, the results were even
more impressive. In one study of schizophrenic patients, only 8% of
the patients who were taking the drug relapsed within one year but 68%
of those not taking the drug relapsed. In another study of
schizophrenic patients taking injectable antipsychotics, 8% Relapsed
within two years when the drug was stopped." (p. 11)
Mentalhealth.com
http://www.mentalhealth.com/book/p40-sc03.html
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Gender differences
?Findings demonstrated that schizophrenic women experience fewer
rehospitalizations, shorter lengths of stay, and survive longer in the
community than schizophrenic men.?
This study tested the hypothesis that schizophrenic men experience a
poorer course than schizophrenic women. Implications of the role of
gender for schizophrenia are discussed.
Source:
Gender differences in schizophrenia: rehospitalization and community survival.
Angermeyer MC, Goldstein JM, Kuehn L.
Department of Psychiatric Sociology, Central Institute of Mental
Health, Mannheim, FRG.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2762441&dopt=Abstract
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Long-term course of hospitalization for schizophrenia: Part I. Risk
for rehospitalization.
Eaton WW, Mortensen PB, Herrman H, Freeman H, Bilker W, Burgess P, Wooff K.
Johns Hopkins University, School of Hygiene and Public Health, Dept.
of Mental Hygiene, Baltimore, MD 21205.
?The probability of rehospitalization following the initial discharge
on which a diagnosis of schizophrenia was made is described using data
from psychiatric case registers in Victoria, Australia; Maryland,
U.S.A.; Denmark; and Salford, England.?
?The percentage eventually rehospitalized, after followup intervals as
long as two decades, varies from about 50 to 80 percent in the four
service systems.?
?Survival curves for duration in the community without
rehospitalization bend sharply in the period between 2 and 3 years
following discharge in all four cohorts and are almost flat after 20
years.?
?Early age of onset predicts higher risk for rehospitalization in
multivariate proportional hazards models in each cohort.?
PubMed Medline
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1621069
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?Episodes of hospitalization for schizophrenia tend to cluster earlier
rather than later in the treatment career, suggesting a progressive
amelioration rather than deterioration. When overall chronicity is
adjusted, each additional episode of hospitalization lowers the risk
for a further hospitalization by about 10 percent.?
PubMed Medline http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1621070
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?50% of schizophrenic patients, under normal treatment conditions,
relapse within 1 year after their latest episode, frequently spending
15-20% of their time in psychiatric institutions.?
?The overwhelming majority of schizophrenic patients who suffered a
clinical exacerbation and required hospitalization (73%) did not
comply with the treatment prescribed.?
PubMed Medline http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9468354
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Close monitoring of clinic visits and outreach service appear to be
important in preventing rehospitalization of schizophrenic patients.
PubMed Medline http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14629702
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From the New England Journal of Medicine, Jan. 3, 2002
?In general, a hospitalization for schizophrenia lasts about two weeks
and costs in the neighborhood of $500 per day, so cutting the relapse
rate by half could have significant economic benefits,?
John G. Csernansky, et. al., ?A comparison of risperidone and
haloperidol for the prevention of relapse in patients with
schizophrenia,?
New England Journal of Medicine, Jan. 3, 2002.
http://www.eurekalert.org/pub_releases/2002-01/wuso-nga122801.php
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Although the following study is not current, valuable information is provided.
Cost of Relapse in Schizophrenia
By Peter J. Weiden and Mark Oltson
Schizophrenia Bulletin, Vol. 21, No. 3, 1995
National Institute of Mental Health
Cost of Relapse.
?The United States spends roughly $2.3 billion each year on short-term
inpatient services for multiple-episode schizophrenia patients. Using
the real world survival analysis, we estimate that within 2 years
after discharge, the first rehospitalization episodes for these
patients will cost almost $2 billion in direct hospital expenditures.
Approximately 63 percent of these expenditures will be from loss of
medication response ($1.2 billion) and 37 percent from medication
noncompliance ($705 million) . The relative contribution of loss of
medication efficacy is greater in the first postdischarge year and
that of noncompliance is greatest during the second year.?
Read the full text of this study here:
http://www.mentalhealth.com/mag1/scz/sb-cost.html
?The specific cost of rehospitalization attributable to neuroleptic
noncompliance is approximately $700 million with $370 million for the
first year and$335 million for the second."
http://www.schizophrenia.com/family/involtreatment.html
?The monthly relapse rates are estimated to be 3.5 percent per month
for patients on maintenance neuroleptics and 11.0 percent per month
for patients who have discontinued their medication. Postdischarge
noncompliance rates in community settings are estimated to be 7.6
percent per month.?
(. . .)
?Schizophrenia inflicts incalculable suffering on patients and their
families, and imposes a substantial economic burden on society (Wyatt
and Clark 1987; McGuire 1991).
(. . .)
?The real world survival curve shows that approximately 50 percent of
the initial cohort were rehospitalized during their first
postdischarge year
?By 2 years after discharge, just over 80 percent of the initial
cohort will be rehospitalized.?
?Because the nonrelapsed cohort is smaller since the first year
relapsers are no longer included, the absolute number of relapsers
declines for the second postdischarge year. However, the relative odds
of relapse increases from 49.2 percent during the first-year period to
65.3 percent during the second year, because many patients start the
second year in the higher risk noncompliance group.?
http://www.mental-health-matters.com/articles/article.php?artID=544
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From the Washington Record - January 11, 2002:
?The economic burden of the disease was estimated at $33 billion per
year in the early 1990s. Much of that cost can be attributed to the
consequences of psychotic relapse, which is common among schizophrenic
patients.?
(. . .)
?Reducing the rate of relapse is a tremendous benefit to the patient,
but it's also a benefit for the family and the system of care that has
to pay for the hospitalization that often goes along with relapse,"
Csernansky said. "Most importantly, however, patients who relapse face
many months of difficulty. Hospitalization can last from seven to 21
days, but even after discharge it may take weeks, if not months, to
restore work relationships and social relationships a patient had
established prior to relapse."
(. . .)
?In general, a hospitalization for schizophrenia lasts about two weeks
and costs in the neighborhood of $500 per day, so cutting the relapse
rate by half could have significant economic benefits,"
Washington University: Washington Record
http://record.wustl.edu/2002/01-11-02/schizo.html
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?Goldstein (1987) found that the rehospitalization rate for patients
with schizophrenia in a 6 month period was 0% when family therapy was
part of the treatment plan, but 30% for patients who used drug
treatment alone.?
Virginia Association for Marriage and Family Therapy
http://www.vamft.org/mftfaq.html
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?It has been found in schizophrenic patients that the brain has up to 20 percent
neuronal loss in the hippocampus and entorhinal cortex
(Keltner, 1996).
?Dwork (1997) made observations that contradict the above evidence.
Dwork (1997) found evidence that the entorhinal cortex examined at a
single level by cresyl violet stain, and computerized-image analysis
determined that variance did not differ between schizophrenic patients
and controls in any region.?
Pathological and Anatomical Abnormalities of Schizophrenia
Western Carolina University
http://www.wcu.edu/ceap/psychology/journal/pdf/snell-s-5-00.pdf
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Is there evidence for neuronal loss in schizophrenia?
?Almost all cell counting studies of schizophrenia published between
1972 and 1991 have reported a reduction in the density of neurons in
several different corticolimbic regions. More recently, however,
several groups have failed to detect a change of this type in the
cortex of schizophrenic patients. These discrepant findings are
discussed in relation to a variety of factors, including the
heterogeneity of patient samples, various ways that tissues have been
processed, the use of two-dimensional versus three-dimensional cell
counting techniques and differences in the brain regions that were
examined in various studies. Although no single factor can explain the
discrepancies, it has become clear that neuronal loss in
schizophrenia, where present, is quite subtle and is probably neither
necessary nor sufficient to explain the occurrence of this disorder.?
Ingenta
http://www.ingentaconnect.com/content/carfax/cirp/1997/00000009/00000004/art00012
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From the American Journal of Psychiatry:
?A key finding of our study was a demonstration of relationships
between regional deficits in gray matter and clinical variables in
schizophrenic patients. Although we observed a significant correlation
between global reductions in gray matter and subjects? age, which
suggests progressive, accelerated neuronal loss in schizophrenia, the
rate of gray matter decline with age of schizophrenic patients was
equivalent to that observed in healthy comparison subjects.?
Am J Psychiatry 159:1497-1505, September 2002
http://ajp.psychiatryonline.org/cgi/content/full/159/9/1497
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Search criteria:
Schizophrenia, patients, rehospitalization , relapse, costs, impact, neuronal loss,
I hope you find this information helpful!
Best regards,
Bobbie7 |
