Effectiveness of a community-based, multicomponent and case managed treatment for patients with severe schizophrenia

Introduction Case management is a model of community intervention in people with severe mental illness. Objectives To explore the treatment adherence and effectiveness of patients with severe schizophrenia undergoing treatment in a community-based, case management program (CMP) with an integrated pharmacological and psychosocial approach compared to the standard treatment. Methods An observational, longitudinal study was conducted with a ten-year follow-up of patients with severe schizophrenia (CGI-S ≥ 5) treated in mental health units (MHUs) or on a CMP (N = 688). All causes of treatment discontinuation, psychiatric hospital admissions, suicide attempts, and antipsychotic (AP) medications were recorded. Clinical severity was assessed with the CGI-S. Results Adherence to the CMP was higher than to the standard treatment (p < 0.001). There were fewer hospital admissions and suicide attempts on the CMP than in standard care (p < 0.001). Clinical severity decreased more in the CMP than in MHUs (p < 0.005). Long-acting injectable (LAI) AP medication was more closely related to these outcomes than oral APs (p < 0.001) in both settings, but especially on the CMP. Treatment clinical outcomes after 10-year follow-up N = 688 Mental Health Units (N = 344) Case Management Program (N = 344) χ 2 ; P value Treatment discontinuation (N (%)) 150 (43.6) 42 (12.1) 26.16; < 0.0001 CGI-S (Av (SD)) 3.9 (1.1) 3.1 (0.9) 7.63; < 0.005 Hospitalization (N (% )) 160 (46.5) 60 (17.4) 10.54; < 0.0001 Hospitalization (Av (SD)) 3.2 (3.4) 0.9 (0.3) 13.23; < 0.0001 Involuntary hospital. (N (% )) 34 (9.9) 5 (1.4) 28.01; < 0.0001 Involuntary hospital. (Av (SD)) 0.5 (0.3) 0.01 (0.2) 21.31; < 0.0001 Suicide attempt (N (%)) 85 (24.7) 20 (5.8) 10.54; < 0.0001 Num. suicide attempts (Av (SD)) 0.3 (0.1) 0.07 (0.02) 11.32; < 0.0001 N: number of patients %: percentage of patients Av: average SD: standard deviation *: basal (at beginning of program) **: standard treatment ***: Program treatment Conclusions The treatment of patients with severe schizophrenia in a multicomponent, case-managed program recorded higher compliance and effectiveness compared to standard care. Treatment with LAI antipsychotics was linked to these outcomes. A combination of case management, psychosocial approach, and LAI AP medication contributed more to the achievement of clinical goals in these patients than the standard treatment and oral APs. Disclosure of Interest None Declared