Background: CM persists as the dominant model of community treatment of schizophrenia in Australia and New Zealand, as in most of the developed world despite the failure to demonstrate efficacy. Research has been hampered by the omission of process measures view that relapse is simply a failure of CM.
Aims: To examine how case management influences the recognition management and consequences of psychotic relapse.
Methods: Fifty consecutive patients with schizophrenia were examined as soon as a new episode of illness was identified. Its onset, the development of psychosis, its duration and associated harmful effects were compared in case-managed and non case-managed patients.
Results: Improved monitoring in the case management group was associated with earlier detection of new episodes. More episodes in case managed patients were diagnosed in the non-psychotic phase of relapse where straightforward outpatient treatment reduced progression to psychosis. For the majority of patients already showing psychosis at diagnosis, case management was associated with a significantly reduced duration of active psychosis.
Conclusions: Relapse of psychosis in schizophrenia brings harmful consequences that increase with time for patients, their reputation and their relationships. Treatment of relapse in its earliest phase can prevent psychosis before it starts, or if it has already started introduce treatment more quickly. Perhaps complementing hospitalisation rates with measures of harmful consequences of psychosis would provide a better index of the benefits of case management than rates of hospitalisation alone.
