title: Unheard voices: outcomes of tertiary care for treatment-refractory psychosis.
abstract: Aims and method In up to a quarter of patients, schizophrenia is resistant to standard treatments. We undertook a naturalistic study of 153 patients treated in the tertiary referral in-patient unit of the National Psychosis Service based at the Maudsley Hospital in London. A retrospective analysis of symptoms on admission and discharge was undertaken using the OPCRIT tool, along with preliminary economic modelling of potential costs related to changes in accommodation. Results In-patient treatment demonstrated statistically significant improvements in all symptom categories in patients already identified as having schizophrenia refractory to standard secondary care. The preliminary cost analysis showed net savings to referring authorities due to changes from pre- to post-discharge accommodation. Clinical implications Despite the enormous clinical, personal and societal burden of refractory psychotic illnesses, there is insufficient information on the outcomes of specialised tertiary-level care. Our pilot data support its utility in all domains measured.
authors.affiliation: Central and North West London NHS Foundation Trust ; Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London.
authors.forename: S Neil
authors.initials: SN
authors.lastname: Sarkar
authors.affiliation: Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London ; Oxleas NHS Foundation Trust, London.
authors.forename: Derek K
authors.initials: DK
authors.lastname: Tracy
authors.affiliation: Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London.
authors.forename: Maria-Jesus Mateos
authors.initials: MJ
authors.lastname: Fernandez
authors.affiliation: Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London.
authors.forename: Natasza
authors.initials: N
authors.lastname: Nalesnik
authors.affiliation: Oxleas NHS Foundation Trust, London.
authors.forename: Gurbinder
authors.initials: G
authors.lastname: Dhillon
authors.affiliation: South London and Maudsley NHS Foundation Trust.
authors.forename: Juliana
authors.initials: J
authors.lastname: Onwumere
authors.affiliation: South London and Maudsley NHS Foundation Trust.
authors.forename: Anne-Marye
authors.initials: AM
authors.lastname: Prins
authors.affiliation: Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London.
authors.forename: Karen
authors.initials: K
authors.lastname: Schepman
authors.affiliation: Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London.
authors.forename: Tracy
authors.initials: T
authors.lastname: Collier
authors.affiliation: Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: White
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London.
authors.forename: Anita
authors.initials: A
authors.lastname: Patel
authors.affiliation: South London and Maudsley NHS Foundation Trust.
authors.forename: Fiona
authors.initials: F
authors.lastname: Gaughran
authors.affiliation: Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, Institute of Psychiatry, King's College London ; South London and Maudsley NHS Foundation Trust.
authors.forename: Sukhwinder S
authors.initials: SS
authors.lastname: Shergill