[Community psychiatric management of severely ill schizophrenic patients. An exemplary case study]

Psychiatric care for chronic schizophrenic patients has improved in recent years, but for severely ill patients, often with multiple comorbid psychiatric conditions and in great need of care, the situation remains unsatisfactory. Community-based psychiatric care is limited and psychiatric hospitals are now cutting back on inpatient care. The quality of care that chronically mentally ill patients receive at independent psychiatric nursing homes removed from population centers is undetermined, and many patients end up in asylums or homeless shelters unable to provide for their psychiatric needs. Neither a reliable way to assess the needs of these complicated patients nor a scientific basis for therapeutic intervention exists yet. The case study presented here illustrates an interdisciplinary approach to the care and treatment of a chronic schizophrenic patient with several comorbid conditions. Based on the individual needs of the patient and developed over the last 4 years, this approach had positive effects on the course and outcome of treatment and resulted in an impressive reduction of costs. The average annual number of days of hospitalization over a 3-year period was reduced from 206 to two and the total cost of care was reduced from US$70,000 annually to $8000. The results from this single case study are promising. Further investigation of the development and evaluation of highly individualized treatment plans for severely disturbed schizophrenic patients is warranted.