Schizophrenic subjects with no history of admission to hospital

Abstract

SYNOPSISIt 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.

Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2‐year follow‐up study

“…This is especially so for the frequency of readmission over the follow‐up, which might have been lower in those subjects. Although no information is available on the frequency of first‐episode subjects treated in the community in France, studies carried out in other countries have demonstrated that their percentage is low (30), suggesting that the selection bias probably had moderate impact on the present findings.…”

Age, sex and first treatment of schizophrenia in a population cohort

“…A mean of 5.3%, or 6.7% after adjustment for possible misclassification, of patients diagnosed as suffering from schizophrenia each year were not admitted, and there was no secular trend for this proportion over the years in the study. They concluded that first admission rates for schizophrenia in Scotland are a reasonable approximation of incidence rates (Geddes & Kendell, 1995). Geddes et al's findings may be reflected in the Jerusalem cohort, whose members enjoyed a national health system similar to Scotland's.…”

A Longitudinal Study of Premorbid IQ Score and Risk of Developing Schizophrenia,Bipolar Disorder, Severe Depression, and Other Nonaffective Psychoses

“…Outcome misclassification is likely to be low for schizophrenia given that more than 90% of people with schizophrenia are admitted to a hospital at some point during their illness. 31 Subjects in the cohort with severe depression or bipolar disorder, however, are likely to be somewhat less representative of all such cases in the population, because admission to a hospital is less invariable. The results of such misclassification, if nondifferential with regard to IQ score, would be to underestimate any true associations between IQ and risk of developing these disorders.…”