Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis

Yang, Yuan; Li, Wen; Lok, Ka In; Zhang, Qinge; Liu, Hong; Ungvári, Gábor S.; Bressington, Daniel; Cheung, Teris; Xiang, Yu Tao

doi:10.1016/j.ajp.2019.101902

Cited by 7 publications

(5 citation statements)

References 56 publications

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“…While long-term antipsychotic treatments prevent the relapse of the disorder both after a first episode and in the case of a chronic course [49,50], delaying time to hospitalization, especially in the early phases of the disorder [51], the management of the acute phase of schizophrenia should consider an adequate antipsychotic therapy [46] and, if recommended, a hospital admission, thus avoiding involuntary hospitalization where possible [46,52]. However, the patient's journey usually begins with an acute crisis that, especially in the case of FEP, is generally followed by immediate hospitalization.…”

Section: Acute Phase Managementmentioning

confidence: 99%

The Patient Journey of Schizophrenia in Mental Health Services: Results from a Co-Designed Survey by Clinicians, Expert Patients and Caregivers

Percudani

Iardino²,

Porcellana

et al. 2023

Brain Sciences

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Background: The Patient Journey Project aims to collect real-world experiences on schizophrenia management in clinical practice throughout all the phases of the disorder, highlighting virtuous paths, challenges and unmet needs. Methods: A 60-item survey was co-designed with all the stakeholders (clinicians, expert patients and caregivers) involved in the patient’s journey, focusing on three areas: early detection and management, acute phase management and long-term management/continuity of care. For each statement, the respondents expressed their consensus on the importance and the degree of implementation in clinical practice. The respondents included heads of the Mental Health Services (MHSs) in the Lombardy region, Italy. Results: For early diagnosis and management, a strong consensus was found; however, the implementation degree was moderate-to-good. For acute phase management, a strong consensus and a good level of implementation were found. For long-term management/continuity of care, a strong consensus was found, but the implementation level was slightly above the cut-off, with 44.4% of the statements being rated as only moderately implemented. Overall, the survey showed a strong consensus and a good level of implementation. Conclusions: The survey offered an updated evaluation of the priority intervention areas for MHSs and highlighted the current limitations. Particularly, early phases and chronicity management should be further implemented to improve the patient journey of schizophrenia patients.

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Section: Acute Phase Managementmentioning

confidence: 99%

The Patient Journey of Schizophrenia in Mental Health Services: Results from a Co-Designed Survey by Clinicians, Expert Patients and Caregivers

Percudani

Iardino²,

Porcellana

et al. 2023

Brain Sciences

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“…Results from this study are consistent with previous literature in that there remains a relatively high admission rate among people presenting with FEP [ 1 , 3 ]. However, the rate is lower than that demonstrated in a recent systematic review comprising 134,100 patients with established schizophrenia, where overall voluntary and involuntary admission rates were 61.9% and 43.0%, respectively [ 13 ].…”

Section: Discussionmentioning

confidence: 83%

Prevalence and predictors of admission at the time of presentation in first episode psychosis

Gannon,

Mullen,

McGorry

et al. 2023

Soc Psychiatry Psychiatr Epidemiol

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Background Individuals presenting with first episode psychosis (FEP) constitute a population with high admission rates. Across psychiatric services, community based treatment is aimed for where appropriate. Therefore, further knowledge on predictors of admission is required. Purpose The objectives were to: (i) determine the proportion of individuals with FEP admitted at time of presentation (voluntarily and involuntarily) (ii) identify associated demographic and clinical factors. Methods This study included all young people (aged 15–24) who presented with FEP to the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia from 01.01.11 to 31.12.16. Binary logistic regression was used to determine unadjusted and adjusted odds ratios. Results Of 1208 participants, 58.6% were male and the median age was 20 years (I.Q.R.17–22). At time of presentation, 50.2% were admitted. On multivariate analysis, the following factors predicted admission: being a migrant (OR = 1.75, 95% CI [1.17, 2.62]), aggression (OR = 1.42, 95% CI [1.02, 1.99]), and more severe psychotic symptoms. Longer duration of untreated psychosis was associated with lower admission rates. 70.1% of admissions were involuntary (33.7% of the cohort). Risk factors for involuntary admission were consistent with any admission, other than aggression, and with the addition of older age and male sex. Conclusion There remains a high admission rate for FEP, even in an established early intervention service, with severity of psychopathology being the strongest predictive factor. There is an independent association between migrancy and admission. Potential reasons for these findings are discussed, and initiatives to reduce admission rates including (i) interventions to prevent admission and (ii) alternative care pathways.

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“…The WHO estimates that for schizophrenia the cost of hospital-based mental health care is 33–55% higher when compared to a community-based service model [ 2 , 122 , 123 ]. People with psychoses are among those most likely to be admitted for inpatient psychiatric care—often involuntarily [ 124 ] and to be readmitted after leaving inpatient care [ 125 , 126 ]. For example, at Uganda’s only psychiatric referral hospital, nearly two-thirds (62.7%) of patients are diagnosed with a psychotic disorder at first contact [ 127 ].…”

Section: Resultsmentioning

confidence: 99%

Reprioritising global mental health: psychoses in sub-Saharan Africa

Omigbodun

Ryan

Fasoranti

et al. 2023

Int J Ment Health Syst

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Arthur Kleinman’s 2009 Lancet commentary described global mental health as a “moral failure of humanity”, asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman’s appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly—especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised.

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Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis

Cited by 7 publications

References 56 publications

The Patient Journey of Schizophrenia in Mental Health Services: Results from a Co-Designed Survey by Clinicians, Expert Patients and Caregivers

The Patient Journey of Schizophrenia in Mental Health Services: Results from a Co-Designed Survey by Clinicians, Expert Patients and Caregivers

Prevalence and predictors of admission at the time of presentation in first episode psychosis

Reprioritising global mental health: psychoses in sub-Saharan Africa

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