Twenty-Five and Thirty-Five Year Follow up of First Admissions to Mental Hospital

Abstract

This has been a report of a study designed to assess the feasibility of long-term follow-up studies on Prince Edward Island. Cohorts of patients first admitted to the Island's only mental hospital during the early nineteen-thirties and early nineteen-forties were followed in retrospect in order to determine, a) the course and outcome of the major disorders over periods ranging up to thirty-five years and, b) the long-term effects of these disorders upon the families of the patients. Needed information was gathered through a review of hospital records, a search for death records and community interviews. The results of the study suggest that lifetime prognosis in the absence of modern treatment methods may be even worse than believed by most professionals working in the field. As might be expected the outlook was found to be particularly grave for schizophrenia. Success in following up a very high proportion of the cases over several decades supports the belief that Prince Edward Island offers unusual opportunities for studies of this kind.

14‐year outcome in early schizophrenia

“…Five patients (11.6 %) stayed in hospital longer than 1 year on the first admission. Although this may seem an excessively long 21f initial hospitalization, it is much less than the figures for the 1930-40 period, when 60-65 % of schizophrenics were continuously hospitalized (Brown et al (1961), Beck (1968)), although by the 1960's only 10-13 % of British patients were retained more than 2 years (Brown (1959), MandeZbrote h Trick (1970)). Achte' (1967) reporting on two series of patients, from 1950 and 1960, gave mean lengths of stay on first admission of 121 and 148 days respectively.…”

The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics

“…Although the duration of the follow-up period is evidently a crucial determinant of the outcome data, reported studies of outcome have varied from one (Johnstone et al 1979) to more than thirty years (Beck, 1968;Ciompi & Miiller, 1976). Clearly, comparison between such varied time spans is meaningless.…”

“…Few studies of the longterm course of schizophrenia have assessed clinical and social morbidity independently (Beck, 1968;Waxier, 1979;Salokangas, 1983), and fewer have employed standardized methods of diagnosis and outcome assessment (Tsuang & Winokur, 1975;Sartorius et al 1986), rendering the comparison of reported outcome hazardous. These are principally the unrepresentativeness of sampling; the lack of standardized diagnosis, with reliance on clinical records; and a lack of measurement of observer concordance and a lack of clear clinical and social criteria in the assessment of outcome.…”

“…The sample must be selected according to the standard epidemiological principles employed in determining the incidence rate of any disease, i.e. Samples may be drawn either from all admissions to hospital during a defined period (Langfeldt, 1937;Malamud & Render, 1939;Masterson, 1956;Brown et al 1966;Tsuang & Winokur, 1975;Hiiber et al 1980;Sartorius et al 1986) or only from first admission cases (Rupp & Fletcher, 1940;Astrup et al 1962;Astrup & Noreik, 1966;Beck, 1968;Stephens, 1970;Murphy & Raman, 1971;Ciompi & Miiller, 1976;Kulhara & Wig, 1978;Bland & Orn, 1979;Salokangas, 1983). It is, furthermore, essential that the base population is complete and that all cases arising within the specified time period should be included.…”