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8 This report presents information on the delivery of specialised and non-specialised mentalhealth care relating to all mental disorders categorised by the type of care provided. Data canalso be presented for specific mental disorders to illustrate disorder-specific patterns in serviceuse.This chapter presents an overview of the available data on the prevalence and burden ofschizophrenia in the Australian community, the characteristics of mental health care andmedication provided for people with this disorder and the health system costs associated withit. In this chapter the termrelated disorders as specified below. Definitions Schizophrenia is a condition that can affect a person’s thoughts, perceptions, emotions andbehaviour in a variety of ways. It is not a single illness, but a cluster of illnesses in which signsand symptoms can overlap. First onset often occurs during adolescence or early adulthood(NSW Health Department 2001). Mental health care forschizophrenia and relateddisorders schizophrenia is used to encompass schizophrenia and a number of
ICD-10-AM 3rd edition groups schizophrenia, schizotypal and delusional disorders undercodes F20–F29 (schizophrenia, schizotypal disorder, persistent delusional disorders, and a larger group ofacute and transient psychotic disorders and schizoaffective disorders (NCCH 2002).For the purposes of this chapter we have also included specific sub-categories from codesF10–F19 (psychotic disorders due to substance use. There are 10 sub-categories used in codes F10–F19(from .0 to .9). Relevant sub-categories used in this chapter are Residual and late-onset psychotic disorders The following definitions are from ICD-10-AM 3rd edition (NCCH 2002). Mental and behavioural disorders due to psychoactive substance use (F10–F19) ‘This block contains a wide variety of disorders that differ in severity and clinical form butthat are all attributable to the use of one or more psychoactive substances, which may or maynot have been medically prescribed. The third character of the code identifies the substanceinvolved, and the fourth character specifies the clinical state’ (NCCH 2002).The psychoactive substances included in F10–F19 are: alcohol (F10); opioids (F11);cannabinoids (F12); sedatives or hypnotics (F13); cocaine (F14); other stimulants includingcaffeine (F15); hallucinogens (F16); tobacco (F17); volatile solvents (F18); multiple drug useand use of other psychoactive substances (F19).The two relevant sub-categories used in this chapter are .5 and .7. Mental and behavioural disorders due to psychoactive substance useSchizophrenia, schizotypal and delusional disorders (.7). ). This grouping comprises Psychotic disorders ) as they comprise (.5) and
Psychotic disorder (.5) ‘A cluster of psychotic phenomena that occur during or following psychoactive substance usebut are not explained on the basis of acute intoxification alone and do not form part of awithdrawal state. The disorder is characterised by hallucinations (typically auditory, but oftenin more than one sensory modality), perceptual distortions, delusions (often of a paranoid orpersecutory nature), psychomotor disturbances (excitement or stupor), and an abnormalaffect, which may range from intense fear to ecstasy. The sensorium is usually clear but somedegree of clouding of consciousness, though not severe confusion, may be present’ (NCCH2002). Residual and late-onset psychotic disorder (.7) ‘A disorder in which alcohol- or psychoactive substance-induced changes of cognition, affect,personality, or behaviour persist beyond the period during which a direct psychoactivesubstance-related effect might reasonably be assumed to be operating. Onset of the disordershould be directly related to the use of the psychoactive substance’ (NCCH 2002). Schizophrenia (F20) ‘The schizophrenic disorders are characterised in general by fundamental and characteristicdistortions of thinking and perception, and affects that are inappropriate or blunted. Clearconsciousness and intellectual capacity are usually maintained although certain cognitivedeficits may evolve in the course of time. The most important psychopathological phenomenainclude thought echo; thought insertion or withdrawal; thought broadcasting; delusionalperception and delusions of control; influence or passivity; hallucinatory voices commentingor discussing the patient in the third person; thought disorders and negative symptoms’ (NCCH 2002). Schizotypal disorder (F21) resemble those seen in schizophrenia, though no definite and characteristic schizophrenicanomalies occur at any stage. The symptoms may include a cold or inappropriate affect;anhedonia; odd or eccentric behaviour; a tendency to social withdrawal; paranoid or bizarreideas not amounting to true delusions; obsessive ruminations; thought disorder andperceptual disturbances; occasional transient quasi-psychotic episodes with intense illusions,auditory or other hallucinations, and delusion like ideas, usually occurring without externalprovocation. There is no definite onset and evolution and course are usually those of apersonality disorder’ (NCCH 2002). Persistent delusional disorders (F22) most conspicuous, clinical characteristic and which cannot be classified as organic,schizophrenic or affective’ (NCCH 2002). Acute and transient psychotic disorders (F23) such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption ofordinary behaviour. Acute onset is defined as a crescendo development of a clearly abnormalclinical picture in about two weeks or less. For these disorders there is no evidence of organiccausation. Perplexity and puzzlement are often present but disorientation for time, place and ‘A disorder characterised by eccentric behaviour and anomalies of thinking and affect which ‘Includes a variety of disorders in which long-standing delusions constitute the only, or the ‘A heterogeneous group of disorders characterised by the acute onset of psychotic symptoms
person is not persistent or severe enough to justify a diagnosis of organically caused delirium
Box 8.1: Schizophrenia data sources, type of data and classification system used ABS National Survey ofMental Health andWellbeing: LowPrevalence (Psychotic)Disorders ComponentAIHW NationalMortality DatabaseAIHW Burden ofDisease and Injury inAustralia studyBEACH survey of GPs This study included people with psychotic disorders that could be classified usingthe ICD-10-AM codes: Schizophrenia (F20); Schizoaffective disorders (F25);Persistent delusional disorder (F22); Acute or transient psychotic disorder (F23);Other and Unspecified non-organic psychotic disorder (F28, F29; Manic episodewith psychotic symptoms (F30.2); Bipolar affective disorder with psychoticsymptoms (F31.2, F31.5); Severe depressive episode with psychotic symptoms(F32.3); or recurrent depressive disorder with psychotic symptoms (F33.3). For theprevalence estimate reported in this chapter all of the above codes were used.Data on the underlying cause of death. Schizophrenia was defined as ICD-10 codesSchizophrenia, schizotypal and delusional disorders (F20–F29); and Mental andbehavioural disorders due to psychoactive substance use (F10–F19) limited topsychotic disorders or residual and late-onset psychotic disorders due topsychoactive substance use (codes .5 and .7 only).Data are disability-adjusted life years data (DALY). Schizophrenia was definedusing the ICD-9 code Schizophrenic disorders (295),which includes: Simple type(295.0); Disorganised/hebephrenic type (295.1); Catatonic type (295.2); Paranoidtype (295.3); Acute-schizophrenic-like psychotic disorder (295.4); Latentschizophrenia (295.5); Residual schizophrenia (295.6); Schizo-affective type(295.7); Other specified types of schizophrenia (295.8); Unspecified schizophrenia(295.9).Data on encounters from the 2003–04 BEACH survey of GPs. Schizophrenia wasdefined using the International Classification for Primary Care (ICPC–2) as codes:P72 (Schizophrenia: Hebephrenic, catatonic, schizoaffective and schizophrenicpsychoses; Paranoia; Paranoid schizophrenia, reaction or state; Paraphrenia;Schizophrenia; and Delusions); P15002 (Chronic alcohol abuse, Psychosis);
8.1 Between September 1997 and January 1998, the University of Western Australia undertook theLow Prevalence (Psychotic) Disorders component of the ABS’s National Survey of MentalHealth and Wellbeing. This study aimed to examine the prevalence of psychotic disorders^ AIHW NationalCommunity MentalHealth Care DatabaseAIHW NationalHospital MorbidityDatabaseHealth serviceexpenditure data Prevalence P15003 (Chronic alcohol abuse, Alcoholic brain syndrome); P15004 (Chronicalcohol abuse, Dementia); P19004 (Drug abuse, Psychosis); P98003 (Psychoses nototherwise specified, other Psychotic); P98004 (Psychoses not otherwise specified,other Psychosis).Data are for service contacts in specialised mental health outpatient andambulatory community-based services. Schizophrenia was defined using theuse (F10–F19) limited to psychotic disorders or residual and late-onset psychoticdisorders due to psychoactive substance use (codes .5 and .7 only).Ambulatory-equivalent admitted-patient care data and hospital-admitted-patientcare data (separations and patient-days). Schizophrenia was defined using theICD–10–AM codes Schizophrenia, schizotypal and delusional disorders(F20–F29); and Mental and behavioural disorders due to psychoactive substanceuse (F10–F19) limited to psychotic disorders or residual and late-onset psychoticdisorders due to psychoactive substance use (codes .5 and .7 only).Health service expenditure data by disease and injury categories for schizophrenia.Schizophrenia was defined ICD–10–AM codes Schizophrenia, schizotypal anddelusional disorders (F20–F29).ICD–10–AM codes Schizophrenia, schizotypal and delusional disorders(F20–F29); and Mental and behavioural disorders due to psychoactive substance
among Australians aged 18–64 years. The first phase of the study involved conducting asystematic one-month census to identify people with a psychotic disorder who attendedmental health services, such as hospitals and community clinics, in geographically definedareas of the Australian Capital Territory, Queensland, Victoria and Western Australia. Otherrelevant service providers and agencies, such as general practitioners, private psychiatrists,boarding houses and homeless shelters, were also approached and invited to participate in thestudy. In the second phase of the study, a sample of 980 persons were interviewed to obtaininformation on sociodemographic characteristics, symptoms, functioning in daily lifeactivities, use of mental health and social services, and quality of life of adults with psychoticdisorders.This study found the treated prevalence of psychotic disorders in the adult urban populationto be between 4 and 7 persons per 1,000, depending on the catchment area. Schizophrenia andschizoaffective disorders were reported for over 60% of the people identified with psychoticdisorders (Jablensky et al. 1999). Mortality In 2002, there were 73 deaths for which schizophrenia (ICD-10 codes F20–F29 and F10–F19 for4th subdivisions of .5 and .7 only) was the underlying cause of death (43 deaths for males and30 for females). Between 1997 and 2002, the age-standardised mortality rate for schizophreniaas the underlying cause of death remained between 0.4 to 0.5 deaths per 100,000 population,with the exception of a drop in 2000 to 0.2 per 100,000 population, mainly due to a drop in therate for males (AIHW National Mortality Database). For males, the age-standardised mortalityrate varied over this time from a high of 0.7 per 100,000 population in 1997 to a low of 0.2 in
- The rate was 0.5 in 2002. For females, the age-standardised mortality rate varied from ahigh of 0.3 per 100,000 population in 1997 and a low of 0.2 in 2002. Males were more thantwice as likely as females to have schizophrenia as their underlying cause of death with anage-standardised mortality rate of 0.5 per 100,000 population and 0.3 per 100,000 population in2002. Burden In 1999, thethe burden for all diseases and injuries in Australia (AIHW: Mathers et al. 1999). The studyused a health summary measure called a disability-adjusted life year, or DALY, developed byMurray and Lopez (1996). This measure was designed to combine the concept of years of lifelost due to premature death with a concept of years of equivalent healthy life lost throughdisability. One DALY represents one lost year of healthy life whether through prematuredeath or disability.In this study, among the 75 leading causes of disease burden, schizophrenia was ranked 35thfor males and 27th for females. It accounted for 0.7% (8,960) of total DALYs for males and 0.7%(8,728) of total DALYs for females (AIHW: Mathers et al. 1999). For persons withschizophrenia the years of healthy life lost (DALY) are almost completely due to the disabilityburden (98.7% for males and 98.2% for females) rather than to premature death (1.3% formales and 1.8% for females). Burden of Disease and Injury in Australia study attempted to measure and compare
In 2002–03, schizophrenia (ICD-10-AM codes F20–F29, or codes F10–F19 where the fourth digitwas .5 or .7) was reported for 1.4 million service contacts (47.6%) provided by thoseambulatory mental health services for which a principal diagnosis was reported.Schizophrenia was more frequently reported for males (110.1 of service contacts with aschizophrenia diagnosis per 1,000 population) than for females (69.5 per 1,000 population)(Table 8.1). Patients in the 25–34 year age group had the highest rate of service contacts with aschizophrenia diagnosis (173.5 per 1,000 in this age group) followed by patients aged 35–44 years (149.8 per 1,000).Of those service contacts that were schizophrenia-related, 9.6% had a mental health legalstatus of involuntary. This proportion excludes Western Australia, which was unable to reportmental health legal status for 2002–03. A small proportion of schizophrenia-related servicecontacts were for patients who identified as Aboriginal and/or Torres Strait Islander peoples(0.8%). Ambulatory-equivalent admitted-patient care Figure 8.2 presents hospital separations that were considered equivalent to ambulatory mentalhealth care (see Appendix 2) and where the patient’s principal diagnosis was schizophrenia(ICD-10-AM codes F20–F29, or codes F10–F19 where the fourth digit was .5 or .7). In 2002–03,there were 8,950 separations with a principal diagnosis of schizophrenia with 7,592 psychiatriccare days. Over two-thirds (66.7%) of separations with this principal diagnosis were in privatehospitals and the majority of separations (95.3%) were for patients who received acute care. Asmall proportion of these separations were involuntary (3.9%).Between 1998–99 and 2002–03, the number of these separations that were in private hospitals increased 53% (from 3,895 separations to 5,974) and those in public hospitals decreased by 13%(from 3,409 separations to 2,976) (Table 8.2).The most common diagnosis in addition to a principal diagnosis of schizophrenia was Problems related to lifestyle Psychological/psychosocial therapies The most commonly reported AR-DRG was electroconvulsive therapy Medications used in ambulatory mental health care General practice Based on BEACH data in 2003–04, medications were prescribed or supplied for schizophreniaat a rate of 89.4 per 100 schizophrenia problem contacts. Olanzapine and fluphenazinedecanoate were the medications most frequently prescribed for schizophrenia, at rates of 14.6and 10.5 per 100 schizophrenia problem contacts, respectively (Figure 8.1).Male patients were prescribed 91.2 medications per 100 schizophrenia problems managed byGPs compared with 87.0 per 100 for female patients. Persons aged between 25 and 44 years(41%) received the highest proportion of medications for schizophrenia prescribed by GPs. Highly Specialised Drugs Program Under the Department of Health and Ageing’s Highly Specialised Drugs Program (HSDP), theantipsychotic drug clozapine is provided to treat schizophrenia. In 2003–04, expenditure byHSDP on clozapine was $30.9 million, 92.7% of which was supplied by public hospitals (Table (AR-DRG U60Z). (Z72); and the most common procedures performed were (Block 1873) and Mental health treatment same day without Other counselling or education (Block 1869).
8.2). Information on the provision of clozapine is reported differently for public and private
hospitals. For 2003–04, private hospitals dispensed 7,846 prescriptions for clozapine andpublic hospitals provided 121,890 individual packs of this drug (Table 8.3). Figures in theHSDP show that patient numbers for clozapine increased from just over 5,000 in 1998–99 toapproximately 9,000 in 2003–04. Low Prevalence (Psychotic) Disorders survey According to the 1998 Low Prevalence (Psychotic) Disorders component of the NationalSurvey of Mental Health and Wellbeing, a majority of the survey respondents with a diagnosisof schizophrenia used a typical (conventional or older) antipsychotic (61.4%) such asfluphenazine decanoate, almost one quarter used an atypical (newer) antipsychotic (34.9%)such as olanzapine or clozapine, and 16.4% used an antidepressant (DHA 2002). Respondentsmay have used more than one medication at a time so percentages are not additive. Hospital admitted patient care Figure 8.3 describes available data for mental health-related separations that were notconsidered equivalent to ambulatory mental health care and for which the patient’s principaldiagnosis was schizophrenia (ICD-10-AM codes F20–F29, or codes F10–F19 where the fourthdigit was .5 or .7). In 2002–03, there were 43,826 separations with a principal diagnosis ofschizophrenia with 1,072,393 psychiatric care days. The majority of separations (96.7%) werefor patients who received acute care. Almost half of the separations were involuntary (45.6%).Separations with a principal diagnosis of schizophrenia (ICD-10-AM codes F20–F29, or codesF10–F19 where the fourth digit was .5 or .7) accounted for 35,694 (31.6%) mental health-relatedseparations with specialised psychiatric care and 8,132 (10.3%) of those separations without specialised psychiatric care.The most common diagnosis in addition to a principal diagnosis of schizophrenia was Problems related to lifestyle Generalised allied health interventions commonly reported AR-DRG was (AR-DRG U61A).The total number of mental health-related separations, including ambulatory-equivalentseparations, with a principal diagnosis of schizophrenia increased from 43,896 in 1998–99 to52,776 in 2002–03 (Table 8.4), with 86% of the increase in public acute hospitals. However thenumber of patient-days decreased (1,153,361 in 1998–99 to 1,140,220 in 2002–03). The numberof same-day separations (excluding ambulatory-equivalent) in public acute hospitals rose 68%during this period (from 2,255 to 3,792) and 135% in private hospitals (from 113 to 265), but,for public psychiatric hospitals this number decreased 76% (from 503 to 121). 8.3 For health service expenditure, a detailed analysis by disease and injury categories, includingmental health, was undertaken for 1993–94 and 2000–01 (AIHW 2004b). Note that data forhospital services expenditure have been adjusted to take into account the impact of long-staypatients on annual expenditure figures.For 2000–01, it was estimated that health care expenditure for schizophrenia (ICD-10–AMcodes F20–F29) was $709 million (1.3% of recurrent health expenditure) (Table 8.5). (Thisexpenditure excludes community mental health expenditure, as it was not able to be allocated Health service expenditure for schizophrenia (Z72), while the most common procedures performed were Schizophrenia disorders with mental health legal status (Block 1916) and Cerebral anaesthesia (Block 1910). The most
to the different mental health disorders.) The majority of this $709 million expenditure was for
Table 8.1: Community mental health care service contacts with a principal diagnosis of schizophrenia
(a)^ (b)^ , by sex and age group, Australia^ , 2002–
Less than 15 years^ 15–24 years^ 25–34 years^ 35–44 years^ 45–54 years
(c) 55–64 years 65 years and over Total Sex^
Number Males^ 1,691^ 150,438^ 286,^
229,699^ 129,131^ 47,284^ 28,974^ 873,
Females^ 1,338^ 63,391^ 118,^
132,627^ 116,063^ 68,932^ 59,296^ 560,
(c) Total3,392^ 214,018^ 405,^ 363,725^ 245,672^ 116,387^ 88,341^ 1,438,731(d) Per 1,000 population Males^ 1.0^ 135.3^ 245.^
189.9^ 118.8^ 58.6^ 31.6^ 110.
Females^ 0.9^ 59.5^ 100.^
108.8^ 105.8^ 87.0^ 51.3^ 69.
(c) Total1.1^ 98.3^ 173.^
149.8^ 112.5^ 72.8^ 42.6^ 89.
(a)^ Schizophrenia includes principal diagnoses of^ Schizophrenia, schizotypal and delusional disorders^ (F20–F29) and
Mental and behavioural disorders due to psychoactive substance abuse^ (F10–F19, for .5 and. sub- categories only).(b) Excluding Queensland who was unable to provide principal diagnosis for 2002–03.(c) Includes service contacts for which sex and/or age group was not reported.(d) The rate per 1,000 population is a crude rate based on the Estimated Resident Population, excluding Queensland, at 31 December 2002. Queensland was unable to provide principal diagnosis for 2002–03. Note: These data should be interpreted with caution due to incomplete coverage and inconsistencies in the definition of a service contact used between jurisdictions. For more information refer to Appendix 2.
Table 8.2: Highly Specialised Drugs Program expenditure ($’000) on clozapine, by state or territory, 1998–99 to 2003–04^ NSW^ Vic^ Qld^ WA^
PrivatePublichospitals^ SA Tas ACT NThospitals^ Total 1998–99^ 5,488.8^ 5,875.1^ 2,856.6^ 1,341.^
859.2^ 365.4^ 276.8^ 82.7^ n.a.^ n.a.^ 17,146. 1999–00^ 6,382.3^ 6,986.7^ 3,639.4^ 1,620.^
1,182.7^ 456.6^ 303.2^ 90.0^ n.a.^ n.a.^ 20,660. 2000–01^ 6,867.8^ 7,972.4^ 4,006.6^ 1,704.^
1,383.6^ 515.0^ 303.9^ 83.5^ 873.7^ 21,963.8^ 22,837.
2001–02^ 7,770.1^ 8,968.7^ 4,376.6^ 1,817.^
1,721.8^ 571.7^ 326.0^ 87.9^ 1,705.0^ 23,935.7^ 25,640.
2002–03^ 8,357.3^ 9,576.4^ 4,955.4^ 2,071.^
1,985.8^ 603.2^ 343.8^ 121.2^ 1,948.2^ 26,066.1^ 28,014.
2003–04^ 9,298.7^ 10,389.3^ 5,844.3^ 2,134.^
2,110.6^ 636.5^ 334.3^ 156.7^ 2,241.8^ 28,662.8^ 30,904.
n.a. Not available. Source:^ DHA. Table 8.3: Highly Specialised Drugs Program: number of packs and prescriptions for clozapine, by hospital sector and state or territory, 2003–04^ NSW^ Vic^ Qld^
WA^ SA^ Tas^ ACT^ NT^ Total Public hospitals^ Number of individual packs^ 35,715^ 40,509^ 23,^
8,742^ 7,821^ 2,979^ 1,648^667 121,
Private hospitals^ Number of prescriptions^ 3,168^ 2,757^918
352 634 17..^..^ 7,
.. Not applicable. Source:^ DHA.
(a)^ (b)^ Table 8.5: Health system costs of schizophrenia^ in Australia, 2000–01 and 1993–94 ($ millions)Out-of-hospital(c) (d)^ Year HospitalsAged care homesmedicalPharmaceuticals
Other professionalservices^ Research^ Total expenditure 2000–01^^489 54
(e)^ 1993–94^335 24
(a)^ Excludes expenditure on community mental health care.(b)^ Includes ICD-10-AM codes F20–F29.(c)^ Hospital costs include the costs of admitted and non-admitted patients and in-hospital private medical services.(d)^ Out-of-hospital medical includes unreferred attendances, imaging, pathology and other medical.(e)^ Expenditures for 1993–94 have been converted to 2000–01 prices by adjusting for health price inflation between 1993–94 and 2000–01.
(b)^ Reasons for encounterState/territory of GP
(c)(d) Rate of medications Prescription all*^ 40.4^ Major cities
58.5%^ Olanzapine^ 14. Schizophrenia*^ 24.7^ Inner Regional
22.1%^ Fluphenazine decanoate^ 10. Psychological follow-up^ 8.4^ Outer Regional
15.2%^ Risperidone^ 8. Psychological symptoms^ 4.8^ Remote
3.1%^ Flupenthixol^ 6. General checkup^ 3.6^ Very Remote
1.1%^ Zuclopenthixol^ 4. Follow up unspecified^ 3.^
Diazepam^ 3. Cardiac check-up*^ 3.^
Temazepam^ 2. 2.8^ Clarify/discuss reason for encounter Benztropine^ 2. Sleep disturbance^ 2.^
Quetiapine^ 2. Anxiety^ 2.^
Amisulpride^ 2.3Clozapine^ 2.2Haloperidol^ 2. (c)^ Referrals Oxazepam^ 1.
(a) Mental health team 2.2 SCHIZOPHRENIA Psychiatrist 1.9 n = 519 problems
( n^ = 515) Sex (c)^ ( n^ = 401)^ Pathology Hospital^ 0.3^ (0.4% of problems)
Male^ 54.6% Chemistry^ 5.9^ Ear Nose and Throat specialist^ 0.3^ n =^ 517 encounters
Female^ 45.4% Haematology^ 2.2^ (0.5% of encounters)Microbiology^ 0.^
(b)Other problems managed with schizophrenia^ ( n^ = 362)Hypertension* 6.1Diabetes* 4. (c)^ Clinical treatments ( n^ = 112)^
Depression^ 2. 13.0^ Age group Counselling — psychological ( n^ = 498)^ Osteoarthritis*^ 1. Injection^ 9.4^ < 15^
0.1%^ Oesophagus disease^ 1. Advice/education — medication*^ 4.1^ 15–^
8.0%^ Back complaint^ 1. Advice/education for problem^ 2.3^ 25–^
39.7%^ Sleep disturbance^ 1. Other administration/document*^ 0.9^ 45–^
33.7%^ Lipid disorder^ 1. Counselling/advice—nutrition^ 0.7^ 65–^
9.0%^ Vitamin/nutritional deficiency^ 1. Advice/education — treatment*^ 0.5^ 75+^
9.6%^ Prescription all*^ 1.
(a)Schizophrenia includes ICPC-2 codes Schizophrenia (P72); Chronic alcohol abuse: resulting in psychosis, alcoholic brain syndrome or dementia (P15002, P15003, P15004);Drug abuse:psychosis (P19004); Psychoses not otherwise specified: other psychotic, other psychosis (P98003, P98004).(b)^ Expressed as rates per 100 encounters at which schizophrenia was managed (n = 517).(c)^ Expressed as rates per 100 schizophrenia problems managed (n = 519).(d)^ Refers to any medication prescribed, supplied or recommended for patients with schizophrenia problems.Includes multiple ICPC-2 or ICPC-2 PLUS codes. *^ Source:^ BEACH survey of general practice activity Figure 8.1: Data reported for general practice encounters at which schizophrenia was managed, BEACH, 2002–
Additional diagnoses (top 10)^
AR-DRGs Z72^ Problems related to lifestyle^ 12,403^ Mental health legal status
U61A^ Schizophrenia Disorders W Mental Health Legal Status^ 15, Z91^ Personal history of risk-factors, not elsewhere classified^ 11,^
Involuntary^ 19,993^ U61B^ Schizophrenia Disorders W/O Mental Health Legal Status^ 14, F12^ Mental and behavioural disorders due to use of cannabinoids^ 5,^
Voluntary^ 16,468^ V61Z^ Drug Intoxication and Withdrawal^
3, F10^ Mental and behavioural disorders due to use of alcohol^ 3,^
Not reported^ 7,365^ U62B^ Paranoia & Acute Psych Disorder W/O Cat/Sev CC W/O MHLS^
3, Z59^ Problems related to housing and economic circumstances^ 2,^
U62A^ Paranoia & Acute Psych Disorder W Cat/Sev CC or W MHLS^ 2, F60^ Specific personality disorders^ 2,^
U60Z^ Mental Health Treatment, Sameday, W/O ECT^ 2, Z63^ Other problems related to primary support group, including family circumstances^ 2,^
U40Z^ Mental Health Treatment, Sameday, W ECT^ 1, F19^ Mental and behavioural disorders due to multiple drug use and use of other psychoactive subst^ 2,^
V60B^ Alcohol Intoxication and Withdrawal W/O CC^376 Sex F15^ Mental and behavioural disorders due to use of other stimulants, including caffeine^ 2,^
Male^ 26,677^ V60A^ Alcohol Intoxication and Withdrawal W CC^223 R45^ Symptoms and signs involving emotional state^ 2,^
Female^ 17,129Not reported^20 Remoteness Area of patient Funding source^ Major cities^ 28,867^ PRINCIPAL DIAGNOSIS
Number of separations^ Care type Public patient^ 40,357^ Inner regional^ 7,890^ Schizophrenia
(a)^ Overnight^ 39,648^ Acute^ 42, Private health insurance^ 2,625^ Outer regional^ 4,^
(^12) Sameday 4,178 Rehabilitation Self-funded^108 Remote^803 Separations
Palliative^
5 Worker's Compensation^18 Very remote^513 Psychiatric care days
(^34) Geriatric evaluation Motor vehicle third party claim^10 Not reported^ 1,736^ Patient days
Psychogeriatric^377 Dept Veterans' Affairs^195 ALOS^
Maintenance^616 Psychiatric care Other^484 Median LOS
With^ 42,233^ Other care^394 Not reported^29 Sector^
Without^ 1,593^ Not reported^12 Public 40,991Private 2, Procedure block (top 10)^ Age group
Separation mode 1916 Generalised allied health interventions^ 12,127^ 0–^
134 State or Territory^ Discharge/transfer to an(other) acute hospital^ 4, 1910 Cerebral anaesthesia^ 2,705^ 15– 9,338^ of hospital^ Discharge/transfer to a residential aged care service^
310 1907 Electroconvulsive therapy^ 2,547^ 25– 14,093^ NSW^ 13,154^ Discharge/transfer to an(other) psychiatric hospital^
2, 1952 Computerised tomography of brain^ 2,415^ 35– 9,445^ Vic^ 11,360^ Discharge/transfer to other health care accommodation^
490 1823 Mental, behavioural or psychosocial assessment^ 1,823^ 45– 5,465^ Qld^ 8,911^ Statistical discharge—type change^
1, 1873 Psychological/psychosocial therapies^426 55– 2,702^ WA^ 4,010^ Left against medical advice^
1, 1867 Counselling/education relating to personal care/other activities of daily/indep living^277 65– 1,563^ SA^ 4,512^ Statistical discharge from leave^
1, 2015 Magnetic resonance imaging^188 75– 868 Tas^ 1,024^ Died^
44 1869 Other counselling or education^129 85+^
200 ACT^423 Other^ 32, 1825 Electroencephalography [EEG]^110 Not reported
43,8261,072,3931,131,27025.8 18 NT 432 Not reported^0 (a)^ Schizophrenia includes principal diagnoses for^ Schizophrenia, schizotypal and delusional disorders^
(F20–F29) and for^ Mental and behavioural disorders due to psychoactive substance abuse^ (F10–F19) where the fourthcharacter of the ICD-10-AM principal diagnosis code indicates either 'psychotic disorder' or 'residual and late-onset psychotic disorder' (.5 or .7).
Note:^ Main abbreviations: ALOS—average length of stay, Cat—catastrophic, CC—complication or comorbidity, ECT—electroconvulsive therapy, LOS—length of stay, MHLS—mental health legal status, Sev—severe, W—with,W/O—without. Figure 8.3: Data reported for non-ambulatory-equivalent mental health-related separations with a principal diagnosis of schizophrenia, all hospitals,Australia, 2002–
