Schizophrenia Outcome

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Schizophrenia Outcome

• Dr. Salina Abdul Aziz
• Peadiatrik Institute
• 18th Mei 2006

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Registered Cases
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Gender - Age distribution (2004)
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Employment Status - 2004
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Epidemiology

• Schizophrenia
• Male Female - 32
• Majority were Malays- reflective of Malaysian
  population.
• Most patients were single, with 25 being
  married.
• 29 have PMR and 30 had SPM .

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Duration of Untreated illness (DUI) Incidence
cases
Affected by extreme values
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Comorbidities
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Past or current medical disorder
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Physician Practices

• Typical antipsychotic is still the first line
  treatment.
• Haloperidol is the first choice followed by
  Sulphiride and Chlopromazine.
• There are still patient being given Thioridazine.

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Physician Practices

• Less then 20 of patient started on atypical.
  differ widely from centers (0 76).
• Professional, Uniform services and Students made
  up of the majority started on atypical.
• Risperdal is the first choice as atypical drug.
• Followed by Olanzapine and Clozapine.

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Summary

• In Malaysia patients with schizophrenia tends to
  present late, usually brought by family members
  and nearly half needed hospitalization.
• Most of them are single and unemployed and have
  comorbidity of substance abuse.
• The duration of untreated psychosis is long, (32
  months)

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Methodology

• Identify cases 3 4 months .
• Tag the cases.
• Put forms in the files.
• Check the daily list in clinic .
• Remind the doctor to do it.

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Methodology

• Identify cases .(Jan 2005)
• Cases Mac to May 2004 (1 year f/u now)
• List their names.
• Find out their next appointment.

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Methodology

• Tag their file.
• Inform doctors about forms needs to be filled.

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Methodology

• Put the forms in the file when patient comes for
  follow-up.
• Again remind doctor to fill in the forms.
• Collect the form at the end of clinic day.

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Methodology

• Check the data entry.
• Send to the NMHR unit

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Outcome data

• Data collection started since April 2005.
• All cases registered from March 2004 were
  reassessed after 1 year.

2003
2004
2006
2005
Outcome
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Main Outcome
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Main Outcome

• Only 28 remain in treatment after 1 year.
• 26 loss to follow-up.
• 46 transfer to new centre.
• 5 died.

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Comparing notification and outcome data
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Employment outcome

• Most remain employed.
• Those who were unemployed previously 27 were
  employed after 1 year of treatment.
• Amongst those unemployed 43 sited the reason of
  unable to work.

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Reasons for unemployment
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Weight gain
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Weight gain more than 5kg 1/3
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Outcome

• 17 (46) had been admitted to psychiatric ward
  with average length of stay of 25 days.
• Only 2 (6) needed to be transferred to a
  psychiatric institution.
• 6 patients (2) attempted suicide .
• 10 patients (4) had history of arrest by police
  mainly due to violent and public disturbance

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Pharmacotherapy.
Reasons for change in treatment

• Change in treatment since notification- 40 - (
  110)
• The common causes of change in treatment is side
  effects to treatment and the non effectiveness of
  the former treatment.

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Pharmacotherapy.

• There is an increased in the use of atypical
  antipsychotics and Depot.
• In the used of typical antipsychotics there is an
  increased in the use of sulphiride with a
  decreased in the use of haloperidol.

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Summary

• After 1 year only ¼ remained in treatment.
• Those who were unemployed previously 27 were
  employed after 1 year.
• Only a very very small number of patient was
  transferred to Institution.

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Summary

• Nearly 40 of patient had their treatment
  changed.
• The most common cause of treatment changed is
  side effects.
• More than 1/3 of the treated patients gain weight
  more than 5 kg in that 1 year.

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Thank you

• To all the centers that had send their data to
  make this presentation possible.
• To all the coordinators for doing a very good
  job.
• To Ministry of Health and our sponsors for the
  money given that made this possible.
• To all of you for listening.

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National Mental Health Registry

• For further information, please contact
• Mental Health Registry Unit
• Department of Psychiatry and Mental Health
• Hospital Kuala Lumpur
• 50586 Kuala Lumpur
• Tel [phone] ext 5701
• Fax [phone]