Casetta Cecilia, Gaughran Fiona, Oloyede Ebenezer, Onwumere Juliana, Pritchard Megan, Shergill Sukhi S, Whiskey Eromona, MacCabe James Hunter
King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, South London and Maudsley NHS Foundation Trust, London, UK.
King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, South London and Maudsley NHS Foundation Trust, London, UK.
BJPsych Open. 2020 Aug 3;6(5):e82. doi: 10.1192/bjo.2020.51.
Treatment-resistant schizophrenia is a major disabling illness which often proves challenging to manage in a secondary care setting. The National Psychosis Unit (NPU) is a specialised tertiary in-patient facility that provides evidence-based, personalised, multidisciplinary interventions for complex treatment-resistant psychosis, in order to reduce the risk of readmission and long-term care costs.
This study aimed to assess the long-term effectiveness of treatment at the NPU by considering naturalistic outcome measures.
Using a mirror image design, we compared the numbers of psychiatric and general hospital admissions, in-patient days, acuity of placement, number of psychotropic medications and dose of antipsychotic medication prescribed before and following NPU admission. Data were obtained from the Clinical Records Interactive Search system, an anonymised database sourced from the South London and Maudsley NHS Trust electronic records, and by means of anonymous linkage to the Hospital Episode Statistics system.
Compared with the 2 years before NPU admission, patients had fewer mental health admissions (1.65 ± 1.44 v. 0.87 ± 0.99, z = 5.594, P < 0.0001) and less mental health bed usage (335.31 ± 272.67 v. 199.42 ± 261.96, z = 5.195 P < 0.0001) after NPU admission. Total in-patient days in physical health hospitals and total number of in-patient days were also significantly reduced (16.51 ± 85.77 v. 2.83 ± 17.38, z = 2.046, P = 0.0408; 351.82 ± 269.09 v. 202.25 ± 261.05, z = 5.621, P < 0.0001). The reduction in level of support required after treatment at the NPU was statistically significant (z = -8.099, P < 0.0001).
This study demonstrates the long-term effectiveness of a tertiary service specialising in treatment-resistant psychosis.
难治性精神分裂症是一种严重的致残性疾病，在二级护理环境中往往难以管理。国家精神病治疗单元（NPU）是一家专门的三级住院设施，为复杂的难治性精神病提供基于证据的、个性化的多学科干预措施，以降低再次入院风险和长期护理成本。
本研究旨在通过考虑自然主义结局指标来评估NPU治疗的长期效果。
采用镜像设计，我们比较了NPU入院前后的精神科和综合医院入院次数、住院天数、安置 acuity、精神药物数量和抗精神病药物剂量。数据来自临床记录交互式搜索系统，这是一个匿名数据库，源自南伦敦和莫兹利国民保健服务信托基金的电子记录，并通过与医院事件统计系统的匿名链接获取。
与NPU入院前的两年相比，患者在NPU入院后的心理健康入院次数减少（1.65±1.44对0.87±0.99，z = 5.594，P < 0.0001），心理健康病床使用量减少（335.31±272.67对199.42±261.96，z = 5.195，P < 0.0001）。综合医院的总住院天数和总住院天数也显著减少（16.51±85.77对2.83±17.38，z = 2.046，P = 0.0408；351.82±269.09对202.25±261.05，z = 5.621，P < 0.0001）。NPU治疗后所需支持水平的降低具有统计学意义（z = -8.099，P < 0.0001）。
本研究证明了专门治疗难治性精神病的三级服务的长期有效性。
