PSYCHO-SOCIAL FEATURES OF IN-PATIENTS IN LONG-STAY PSYCHIATRIC HOSPITALS: CROSS-CULTURAL STUDY

Abstract

In a survey of 226 patients at the Lantoro annex of Aro Neuropsychiatric Hospital, Abeokute, Nigeria, schizophrenic patients. constituted the largest group 163 (72.1%), followed by organic brain syndrome 37 (16.4%), and affective disorders 20 (8.8%) (Table 6). Most of the schizophrenic patients were the chronic, undifferentiated subtypes while in 21 (56,8%) of the 37 patients clinically diagnosed as cases of organic psychoses, the disorder was adduced to their gross abuse of cannabis. One hundred and thirty-three (58.8%) of the patients were found to have spent more than six months in the hospital and were classified as long-stay patients. The factors found to be related such prolonged hospitalization were the diagnosis of chronic schizophrenics, single marital status, loss of contact with relatives and criminal behaviour. Fifty-three (39.9%) of the 133 long-stay patients committed criminal offences as a result of which the law enforcement agencies referred them to the institution for psychiatry opinion and/or treatment. The study highlighted the communication gap between the psychiatric institution and the judicial system culminating in the indefinite hospitalization of such patients. Pharmacological treatment and electroconvulsive therapy (ECT) were the main treatment modalities used at the centre. All the 133 long-stay patients except one were on psychotropic drugs and a1so 37 (27.6%) of them had ECT as adjunct to chemotherapy. Polypharmacy was frequently employed at the centre with different psychotropic drug combination . The diagnosis of chronic schizophrenics and epilepsy were found to have attracted a more frequent practice of polypharmacy. Persistent abnormal involuntary movement was an exclusive finding among the long-stay patients. It was prevalent among the females, in the middle aged adults and the old age group. Also it was found not to be related to the daily and neuroleptic dosage or the num,ber of previous hospitalization for psychiatric disorders. Among the 87 long stay-patients on whom the psychopathological symptom profile schedules (PSP) were completed. 80.5% were schizophrenic patients. These were 50 cases of chronic undifferentiates and 20 cases of paranoid schizophrenia. Symptoms of formal thought disorders were more prevalent among chronic undifferentiated schizophrenics while delusions featured more significantly among paranoid schizophrenic patients. In the comparison of the Lantoro long-stay patients and similar group of patients at the Middle Tennessee Mental Health Institute (MTMHI), close similarities were observed in the preponderance of schizophrenic patients, (Lantoro 80.5%; MTMHI 75%). Similarly, the psychopathologies found in the schizophrenic patients in both population were strikingly identical. Some of such symptoms were episodes of irregular recurrence of symptoms without remission and intermittent deterioration (thrusts), lack of insight, delusions, auditory hallucinations and formal though disorders. When the psycopathological symptom profiles of the chronic undifferentiated schizophrenics were compared with those of the paranoid schizophrenics in both populations, formal disorders of thinking occurred significantly more frequently among the chronic undifferentiated schizophrenics than among the paranoid schizophrenics. Cn the other hand, delusions, irritability and suspiciousness were the symptoms more prevalent among the paranoid schizophrenic patients. These findings tend to support the impression that even though both illnesses were under the same syndrome called schizophrenia, their symptom presentation and course of illness were different. The history of illness in paranoid schizophrenics, showed regular periodic recurrence of episoles with full remission (phases). On the other hand, the chronic undifferentiated schizophrenics had episodes of irregular recurrence without full remission and intermittent deterioration (thrust). Like the PSP findings in both centres, polypharmacy and psychotropic drug combinations were found to be the practice. Contrary to the common belief, the mean daily dose of the psychotropic drugs prescribed in Lantoro located in a developing country was not significantly different from that of MTMHI. However, the prevalence of abnormal involuntary movements was higher (43%) in the MTMHI long-stay population than in those at Lantoro. One important finding at the Lantoro survey was the lack of definite social rehabilitation programmes for the chronic patients. A chronic psychiatric disorder such as chronic undifferentiated schizophrenia, constitutes a major rehabilitation problem which requires urgent hospital and community based programmes. The planning and execution of such rehabilitation programmes will involve psychiatric social workers, occupational therapists, clinical psychologists, psychiatric nurses and psychiatrists. Further, increasing the number of mental health personnel especially psychiatric nurses and psychiatrists, will facilitate a regular clinical review of long-stay patients with its attendant prevention of prolonged hospitalization, polypharmacy and the development of persistent abnormal involuntary movements.