Inpatient Treatment of People With Schizophrenia: Quantifying Clinical Change Using the Health of the Nation Outcome Scales

Abstract

Schizophrenia can require hospital inpatient care in crisis periods or times of severe symptoms, although the length of hospital stays has been considerably reduced in the last few decades. Evidence on individual outcomes under routine psychiatric practice conditions is sparse. This study aims to evaluate the outcomes of inpatient treatment in patients with schizophrenia using the reliable and clinically significant change approach. We used routinely collected Health of the Nation Outcome Scales (HoNOS) data to assess the extent to which and the areas where symptomatic and functional improvement was achieved. Data from 1783 schizophrenia patients admitted to a large psychiatric centre in Switzerland were examined. Mean HoNOS total score dropped from 17.9 to 11.7 (effect size 0.8) during treatment; the greatest improvements were achieved regarding symptomatic problems and aggressive, agitated behaviour. According to the reliable change index formula, 24.5% of patients were to be considered improved, 73.3% unchanged and 2.2% deteriorated. In total, 56.6% were discharged from the hospital in a subclinical or mild functional state. The degree of individual improvement and time to achieve maximum symptom reduction varied considerably, depending on the patients' functional state at admission, as did the length of hospital stay (median 28 days). Rates of readmission within 28 days (17.8%) were significantly lower in patients with clinically significant improvement, discharged in better clinical condition. These findings support reconsidering (length of) inpatient treatment within the overall framework of meaningful clinical change and subsequent treatment needs in patients with schizophrenia.

Effect of Seclusion on Mental Health Status in Hospitalized Psychiatric Populations: A Trial Emulation using Observational Data

“…There is no established threshold regarding the clinical significance of HoNOS changes. Some authors have argued that an 8-point change might be considered as clinically relevant, while others argued for the use of a categorical approach, or a combination of both ( Lay et al, 2021 ; Ronk et al, 2016 ). Of note, this 8-point change deals with an intra-individual change and not a between-group comparison, as performed in this study.…”

Clinical decision-making before discharge in hospitalized persons with schizophrenia: a Spanish Delphi expert consensus

“…Indeed, one in two individuals with a first episode of psychosis (FEP) will require at least one hospitalization within 7 years after their first contact with mental health services ( 4 ). Furthermore, hospitalization is considered unavoidable for PWS who exhibit an acute exacerbation that cannot be managed safely on an outpatient basis ( 5 ).…”

Predictor factors of number of hospitalizations in a group of schizophrenia patients

“…Although, in European Union, psychiatric care beds in hospitals decreased considerably (from an average per 100 000 inhabitants of 74.9 in 2008 to 68.0 in 2018) and the length of hospitalization for individuals with schizophrenia was considerably re-duced, approximately 50% of people in mental hospitals are still represented by patients diagnosed with schizophrenia [1][2][3]. Despite the continuous interest and effort for finding better treatment options and enhance both pharmacological and non-pharmacological approaches for schizophrenia patients, unfortunately, the vast majority still do not receive mental health care [1].…”

“…Hospital readmission soon after a discharge is a commonly used indicator of quality of care and it is considered incompatible with functional recovery. Taking this into consideration, clinically significant change can be translated into readmission rates [3,6].…”