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Effectiveness of a community-based, multicomponent and case managed treatment for patients with severe schizophrenia
Published online by Cambridge University Press: 26 August 2025
Abstract
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Introduction
Case management is a model of community intervention in people with severe mental illness.
Objectives
To explore the treatment adherence and effectiveness of patients with severe schizophrenia undergoing treatment in a community-based, case management program (CMP) with an integrated pharmacological and psychosocial approach compared to the standard treatment.
Methods
An observational, longitudinal study was conducted with a ten-year follow-up of patients with severe schizophrenia (CGI-S ≥ 5) treated in mental health units (MHUs) or on a CMP (N = 688). All causes of treatment discontinuation, psychiatric hospital admissions, suicide attempts, and antipsychotic (AP) medications were recorded. Clinical severity was assessed with the CGI-S.
Results
Adherence to the CMP was higher than to the standard treatment (p < 0.001). There were fewer hospital admissions and suicide attempts on the CMP than in standard care (p < 0.001). Clinical severity decreased more in the CMP than in MHUs (p < 0.005). Long-acting injectable (LAI) AP medication was more closely related to these outcomes than oral APs (p < 0.001) in both settings, but especially on the CMP.
Treatment clinical outcomes after 10-year follow-up
| N = 688 | Mental Health Units (N = 344) | Case Management Program (N = 344) | χ 2; P value |
|---|---|---|---|
| Treatment discontinuation (N (%)) | 150 (43.6) | 42 (12.1) | 26.16; < 0.0001 |
| CGI-S (Av (SD)) | 3.9 (1.1) | 3.1 (0.9) | 7.63; < 0.005 |
| Hospitalization (N (% )) | 160 (46.5) | 60 (17.4) | 10.54; < 0.0001 |
| Hospitalization (Av (SD)) | 3.2 (3.4) | 0.9 (0.3) | 13.23; < 0.0001 |
| Involuntary hospital. (N (% )) | 34 (9.9) | 5 (1.4) | 28.01; < 0.0001 |
| Involuntary hospital. (Av (SD)) | 0.5 (0.3) | 0.01 (0.2) | 21.31; < 0.0001 |
| Suicide attempt (N (%)) | 85 (24.7) | 20 (5.8) | 10.54; < 0.0001 |
| Num. suicide attempts (Av (SD)) | 0.3 (0.1) | 0.07 (0.02) | 11.32; < 0.0001 |
N: number of patients %: percentage of patients Av: average SD: standard deviation
*: basal (at beginning of program) **: standard treatment ***: Program treatment
Conclusions
The treatment of patients with severe schizophrenia in a multicomponent, case-managed program recorded higher compliance and effectiveness compared to standard care. Treatment with LAI antipsychotics was linked to these outcomes. A combination of case management, psychosocial approach, and LAI AP medication contributed more to the achievement of clinical goals in these patients than the standard treatment and oral APs.
Disclosure of Interest
None Declared
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- European Psychiatry , Volume 68 , Special Issue S1: Abstracts of the 33rd European Congress of Psychiatry , April 2025 , pp. S331 - S332
- Creative Commons
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of European Psychiatric Association
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