Guideline adherence in patients with long-term schizophrenia in Germany: Focus on clozapine and electroconvulsive therapy

Introduction: Previous studies suggest a problem in the care of long-term patients in psychiatry, i.e., patients with long hospitalizations and no indication for acute inpatient treatment. Long stays are often associated with treatment resistance, for which evidence-based guideline recommendations exist for patients with schizophrenia. The aim of this study is to assess and characterize long-term patients in German psychiatric clinics and analyze the implementation of guideline recommendations for treatment-resistant schizophrenia. Methods: An anonymous online questionnaire was distributed to the management of 218 acute psychiatric clinics in Germany. The survey covered structural characteristics of the clinic, the number and diagnoses of long-term patients, and the implementation of guideline recommendations for patients with treatment-resistant schizophrenia. Results: =45) of these patients had a diagnosis from the schizophrenia spectrum, with an average length of stay of 267 days. A total of 82.2% of patients with schizophrenia received antipsychotic therapy, 53% received clozapine, and 15.6% received electroconvulsive therapy. The most common reason for not receiving clozapine and electroconvulsive therapy was lack of consent. Discussion: The survey confirms the unresolved problem of long-term patients in acute psychiatric clinics. In addition to demands for improved care structures for people with severe and chronic mental illnesses, the quality of acute psychiatric treatment (guideline adherence) must also be questioned. From an ethical viewpoint, short-term nonvoluntary measures aimed at restoring capacity to consent need to be weighed up against long-term or even permanent detention.