Clinical and functional outcomes of integrated treatment for people with severe schizophrenia and substance abuse

Objectives: To know the clinical (severity, substance use and hospital admissions) and functionality (disability, need of care) long term improvement of patients with schizophrenia and substance abuse undergoing treatment in an integrated comprehensive program.

Method: Eight-year follow-up observational study of people with severe schizophrenia (CGI-S=> 5) treated in a specific, integrated and comprehensive program (N = 200). Reasons for discharge, medications prescribed and substances used were registered. The GCI-S, the disability WHO-DAS and the Camberwell's scale of needs (CAN) were administered. Hospital admissions in psychiatric ward and in detoxification unit the eight years prior to treatment and during the follow-up were recorded.

Results: CGI-S was 5.9(0.9). After eight years remained in treatment 36% (CGI-S=4.2(0.9); p<0.01). 48% were medical discharges (GCI-S=3.2(1.2); p<0.001). In patients who continued treatment and in those medically discharged, the WHO-DAS decreased in the four areas (p<0.01), as well as the CAN (p<0.001). 8% were voluntary discharges. There was a decrease in the abuse of alcohol (p<0.01) and in the illegal drugs use (p<0.005). 64% received atypical long-acting antipsychotics, with high tolerability and almost without losses (2%). There were significantly less psychiatric (p<0.001) and detoxification (p<0.001) hospital admissions than in the eight previous years.

Conclusion: Treatment of people with schizophrenia and substance abuse in an integrated program reached a high retention, and a remarkable clinical (decrease of severity, substance use and hospital admissions) and functional (decrease of the need of care and disability) improvement. The comprehensive approach of the programme and the routine use of atypical long-acting antipsychotics could explain these results.