Developing a Risk-Model of Time to First-Relapse for Children and Adolescents With a Psychotic Disorder

Abstract

Individuals treated for psychotic disorders and mood disorders with psychotic features have a high likelihood of relapse across the life course. This study examines the relapse rate and its associated predictors for children and adolescents experiencing a first-episode and develops a statistical risk-model for prediction of time to first-relapse. A multiyear, retrospective cohort design was used to track youth, under the age of 18 years, who experienced a first-episode of psychosis, and were admitted to 1 of 6 inpatient hospital psychiatric units (N = 87). Participants were followed for at least 2 years (M = 3.9, SD = 1.3) using survival analysis. Approximately 60% of subjects experienced relapse requiring hospital readmission by the end of follow-up, with 33% readmitted within the first year and 44% within 2 years. Median survival time was 34 months. Cox proportional hazards regression identified 4 key risk factors for relapse: medication nonadherence, female gender, receiving clinical treatment, and a decline in social support before first admission.

READMIT: A clinical risk index to predict 30-day readmission after discharge from acute psychiatric units

“…While many studies have identified risk factors for early psychiatric readmission (Hendryx et al, 2003), few have focused on methods to quantify risk of psychiatric readmission for individuals in a clinical setting. Existing studies focus on specific populations (Gearing et al, 2009) such that their findings are not applicable to the majority of general adult inpatient settings that provide treatment to individuals with a range of diagnoses and needs.…”

Social Value of Supported Employment for Psychosocial Program Participants

“…Isolation also engenders distrust and paranoia [5,6] and, for all these reasons, loneliness and social rejection are particularly adverse for anyone with a severe psychiatric illness [7,8]. Conversely, positive social support is very therapeutic [9,10]. Nevertheless, most adults with a severe mental illness are socially isolated [11][12][13][14][15][16], and many are so lonely that even negative relationships seem preferable to being alone [17,18].…”

Modeling Determinants of Medication Attitudes and Poor Adherence in Early Nonaffective Psychosis: Implications for Intervention

“…11 Individuals' adherence fluctuates: one group 12 found 33%-44% were nonadherent sometime in any 6-month period and 53% sometime in the first 2 years, while another 13 found 63% nonadherent for at least a week over a year. Another study 14 estimated 45% took under 75% of antipsychotics in the first 6 months, while 42%-60% were rated as nonadherent at some point in first episode psychosis cohorts followed up for at least 1 year, 12,13,[15][16][17] particularly if the samples were juvenile or all had schizophrenia. Poor adherence predicts total discontinuation.…”