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Unheard voices: outcomes of tertiary care for treatment-refractory psychosis

  • S. Neil Sarkar (a1) (a2), Derek K. Tracy (a2) (a3), Maria-Jesus Mateos Fernandez (a2), Natasza Nalesnik (a2), Gurbinder Dhillon (a3), Juliana Onwumere (a4), Anne-Marye Prins (a4), Karen Schepman (a2), Tracy Collier (a2), Thomas P. White (a2), Anita Patel (a5), Fiona Gaughran (a4) and Sukhwinder S. Shergill (a2) (a4)...
Abstract
Aims and method

In up to a quarter of patients, schizophrenia is resistant to standard treatments. We undertook a naturalistic study of 153 patients treated in the tertiary referral in-patient unit of the National Psychosis Service based at the Maudsley Hospital in London. A retrospective analysis of symptoms on admission and discharge was undertaken using the OPCRIT tool, along with preliminary economic modelling of potential costs related to changes in accommodation.

Results

In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care. The preliminary cost analysis showed net savings to referring authorities due to changes from pre- to post-discharge accommodation.

Clinical implications

Despite the enormous clinical, personal and societal burden of refractory psychotic illnesses, there is insufficient information on the outcomes of specialised tertiary-level care. Our pilot data support its utility in all domains measured.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Sukhwinder S. Shergill (sukhi.shergill@kcl.ac.uk)
Footnotes
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These authors contributed equally to the work.

Declaration of interest

S.N.S., D.K.T., M.-J.M.F., G.D., J.O., A.-M.P., K.S., F.G. and S.S.S. work, or have worked, on the National Psychosis Unit where the study was undertaken.

Footnotes
References
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2 Tracy, DK, Sendt, KV, Shergill, SS. Antipsychotic polypharmacy: still dirty, but hardly a secret. A systematic review and clinical guide. Curr Psychopharmacol 2013; 2: 91130.
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Unheard voices: outcomes of tertiary care for treatment-refractory psychosis

  • S. Neil Sarkar (a1) (a2), Derek K. Tracy (a2) (a3), Maria-Jesus Mateos Fernandez (a2), Natasza Nalesnik (a2), Gurbinder Dhillon (a3), Juliana Onwumere (a4), Anne-Marye Prins (a4), Karen Schepman (a2), Tracy Collier (a2), Thomas P. White (a2), Anita Patel (a5), Fiona Gaughran (a4) and Sukhwinder S. Shergill (a2) (a4)...
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