Predictors for readmission risk in schizophrenia

Mortensen, Preben Bo; Eaton, William W.

doi:10.1017/s0033291700026982

Cited by 102 publications

(82 citation statements)

References 19 publications

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“…12,14,15,20 The ability to maintain a partnership may indicate less severe illness, or it may be that a cohabiting partnership in this community confers a more protective effect by virtue of support and help from extended family structures.…”

Section: Discussionmentioning

confidence: 99%

“…Although three studies 1,4,14 reviewed supported this notion, three others did not. 10,15,16 The influence of length of hospital stay on relapse rates remains a disputed area.…”

Section: S Afrmentioning

confidence: 99%

“…14,15,24 The positive interpretation is that patients are being given adequate attention for the severity of their illness and that patients are being admitted for the duration they require, despite the pressure on bed occupancy.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

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Patterns and determinants of acute psychiatric readmissions

Behr

Christie

Söderlund³

et al. 2002

S. Afr. J. Psych.

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International trends have seen a policy shift from chronic psychiatric institutions and long hospital admissions towards acute, short hospital stays and community-based care. Following this process a dramatic increase in relapse rates has been noted among a particular subgroup of psychiatric patients. The general decline in number of hospital beds and mental hospital population size seems to have directly paralleled the increasing rate of readmissions for certain patients. Design. A retrospective cohort of 180 admissions was followed up for 12 months, after an index discharge, by means of multiple hospital and community-based record reviews.Each readmission was analysed as an event using a survival analysis model. Setting. Chris Hani Baragwanath Hospital, Gauteng.Subjects. A random sample of patients admitted during a 6-month period in 1996.Outcome measures. Time to readmission.Results. Two hundred and eighty-four admissions were analysed. The only factor that provided a significant protective effect was being married or cohabiting (P = 0.015). Clinic attendance showed a slight protective effect early on but conferred a significantly higher risk of readmission on those who had been out of hospital for a long period (P = 0.001). Only 21% of discharged patients ever attended a clinic. The overall risk of readmission was significantly higher in the first 90 days post discharge. Conclusions.The lack of impact of length of hospital stay and use of depot neuroleptics on time to readmission may indicate that patients are being kept for appropriate duration and that the most ill patients are receiving depot medication.Several sampling and statistical artefacts may explain some of our findings. These results confirm the worldwide difficulty in finding consistent and accurate predictors of readmission. Low rates of successful referral to community aftercare need to be addressed before their effectiveness can be reasonably assessed. The inherent instability of the post-discharge period is a potential area for further investigation and intensive management. The influence of length of hospital stay on relapse rates remains a disputed area. S AfrWith regard to aftercare variables, poor treatment compliance was found to predict relapse, 9,13,17 but one study 9 found that use of outpatient services, number of clinic visits and access to carewere not significant factors.Quality of life indicators seem poorly predictive of the 'revolving door' syndrome. 9 In this category family criticism of the patient 9 and unsatisfactory family relations 11,16 are the only variables that have been associated with high relapse rates.Finally, it has been suggested that the inconsistent and contradictory findings in much of the research may be accounted for by variables that are significant only when they interact with other variables, for example employment and age with living status. 10The above studies 1 17 were done in developed countries and a review of the literature in Medline over the last 10 years reveals a paucity of research on risk fa...

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Section: Discussionmentioning

confidence: 99%

“…Although three studies 1,4,14 reviewed supported this notion, three others did not. 10,15,16 The influence of length of hospital stay on relapse rates remains a disputed area.…”

Section: S Afrmentioning

confidence: 99%

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Patterns and determinants of acute psychiatric readmissions

Behr

Christie

Söderlund³

et al. 2002

S. Afr. J. Psych.

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“…Gender was adjusted on the basis of the gender distribution of schizophrenia patients in the general population. An average prevalence RR in the general population of 1.14 for gender (male/female) was used, based on figures reported by McGrath et al, 15 Saha et al, 16 and Perälä et al 17 The effect of gender on time to relapse was based on Robinson et al, 18 risk of hospitalization by gender was based on Mortensen and Eaton, 19 and time to all-cause discontinuation by gender was based on Tiihonen et al 8 and Ciudad et al 20 For age, Kozma and Weiden 21 report a 26.1% decline in risk of rehospitalization per 10-year increase in age. This effect was assumed to hold for relapse and discontinuation as well.…”

Section: Adjusting For Baseline Differences In Gender and Agementioning

confidence: 99%

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Kirson¹,

Weiden²,

Yermakov³

et al. 2013

J. Clin. Psychiatry

165

128

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Objective: Nonadherence is a major challenge in schizophrenia treatment. While long-acting (depot) antipsychotic medications are often recommended to address adherence problems, evidence on the comparative effectiveness of depot versus oral antipsychotics is inconsistent. We hypothesize that this inconsistency could be due to systematic differences in study design. This review evaluates the effect of study design on the comparative effectiveness of antipsychotic formulations. The optimal use of different antipsychotic formulations in a general clinical setting depends on better understanding of the underlying reasons for differences in effectiveness across research designs.Data Sources: A PubMed literature review targeted English-language studies (2000-2011) with information on relapse, hospitalization, or allcause discontinuation for depot and oral antipsychotic treatment arms in schizophrenia. The time frame was chosen to reflect research focused on the newer generation of antipsychotic agents. The search required at least 1 term from each of the following categories: (1) schizophrenia; (2) inject, injection, injectable, injectables, injected, depot, long-acting; and (3) iloperidone, fluphenazine, haloperidol, paliperidone, risperidone, olanzapine, asenapine, flupentixol, flupenthixol, lurasidone, clopenthixol, fluspirilene, zuclopentixol, zuclopenthixol. Study Selection: Thirteen relevant studies were identified by 2 independent reviewers; these studies included information on 19 depot-oral comparisons.Data Extraction: Age-and gender-adjusted risk ratios (RRs) (depot/ oral) were calculated for the identified endpoints and pooled by study design (randomized controlled trial [RCT], prospective observational, and retrospective observational). Meta-analysis with random effects was used to estimate the pooled RRs, by study design. Average conversion factors between study designs were calculated as the ratios of pooled RRs.Results: Meta-analysis of adjusted endpoints showed no apparent benefit of depot over oral formulations in RCTs, with an RR of 0.89 (P = .416). In contrast, there was a significant advantage for depot formulations in other study designs (prospective RR = 0.62 [P < .001]; retrospective RR = 0.56 [P < .001]). These imply conversion factors of 1.43 and 1.59 between RCTs and prospective and retrospective designs, respectively. Conclusions:The comparative effectiveness of antipsychotic formulations is sensitive to research design. Depot formulations displayed significant advantages in nonrandomized observational studies, whereas in RCTs no difference was observed. The estimated conversion factors may facilitate comparison across studies.

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“…[1][2][3][4][5] Rehospitalisation of psychiatric patients is not unusual given the long-term course and prognosis of most psychiatric illnesses. However, we found no study looking into the reasons behind rapid readmission following a discharge, within a specified period of time.…”

mentioning

confidence: 99%

Reasons for rapid readmission to general adult psychiatry wards

Chakraborty¹,

Aryiku²

2008

Prog Neurol Psychiatry

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Rapid readmission to psychiatry wards (the 'revolving doors' scenario) is a common source of frustration to both patients and the teams treating them. However, the reasons behind these rapid readmissions have not been closely studied previously. Here, the authors describe their retrospective study investigating the reasons behind the readmissions that had taken place in the general adult psychiatry wards of a Scottish hospital within 30 days of the last discharge. Nandini Chakraborty MD, DNB (Psych), MRCPsych Charles Aryiku MRCPsych Original research Rapid readmission to psychiatry wardsProgress in Neurology and Psychiatry

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Predictors for readmission risk in schizophrenia

Cited by 102 publications

References 19 publications

Patterns and determinants of acute psychiatric readmissions

Patterns and determinants of acute psychiatric readmissions

Efficacy and Effectiveness of Depot Versus Oral Antipsychotics in Schizophrenia

Reasons for rapid readmission to general adult psychiatry wards

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