Risk Factors Associated with Readmissions of Patients with Severe Mental Disorders Under Treatment with Antipsychotics

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2022 Mar 18

PMID 35300649

Authors

Ronaldo Portela

Milton Leonard Wainberg

Saulo Castel

Helian Nunes de Oliveira

Cristina Mariano Ruas

Affiliations

Soon will be listed here.

Abstract

Background: The aim of this study was to assess the risk of readmission in patients with severe mental disorders, compare it between patients using different types of antipsychotics and determine risk factors for psychiatric readmission.

Methods: Medical records of a non-concurrent cohort of 625 patients with severe mental disorders (such as psychoses and severe mood disorders) who were first discharged from January to December 2012 (entry into the cohort), with longitudinal follow-up until December 2017 constitute the sample. Descriptive statistical analysis of characteristics of study sample was performed. The risk factors for readmission were assessed using Cox regression.

Results: Males represented 51.5% of the cohort, and 75.6% of the patients had no partner. Most patients (89.9%) lived with relatives, and 64.7% did not complete elementary school. Only 17.1% used more than one antipsychotic, 34.2% did not adhere to the treatment, and 13.9% discontinued the medication due to unavailability in public pharmacies. There was a need to change the antipsychotic due to the lack of therapeutic response (11.2% of the patients) and adverse reactions to the antipsychotic (5.3% of the patients). Cox regression showed that the risk of readmission was increased by 25.0% (RR, 1.25; 95% CI, 1.03-1.52) when used typical antipsychotics, compared to those who used atypical ones, and by 92.0% (RR, 1.92; 95% CI, 1.63-2.27) when patients did not adhere to maintenance treatment compared to those who adhered.

Conclusions: Use of atypical antipsychotics and adherence to treatment were associated with a lower risk of psychiatric readmissions.

Citing Articles

Predictors of Readmission in Young Adults with First-Episode Psychosis: A Multicentric Retrospective Study with a 12-Month Follow-Up.

Besana F, Civardi S, Mazzoni F, Carnevale Miacca G, Arienti V, Rocchetti M Clin Pract. 2024; 14(4):1234-1244.

PMID: 39051293 PMC: 11270315. DOI: 10.3390/clinpract14040099.

Comparative effectiveness of clozapine and non-clozapine atypical antipsychotics provided by the Brazilian National Health System in adults with schizophrenia.

Vieira J, Reis E, Guerra Jr A, de Oliveira H, Ruas C Front Psychiatry. 2024; 15:1421501.

PMID: 38962057 PMC: 11220267. DOI: 10.3389/fpsyt.2024.1421501.

Influencing factors of medication adherence in schizophrenic patients: a meta-analysis.

Guo J, Lv X, Liu Y, Kong L, Qu H, Yue W Schizophrenia (Heidelb). 2023; 9(1):31.

PMID: 37188714 PMC: 10185672. DOI: 10.1038/s41537-023-00356-x.

References

Nuernberg G, Baeza F, Fleck M, Rocha N . Outcomes of inpatients with severe mental illness: a naturalistic descriptive study. Braz J Psychiatry. 2016; 38(2):141-7. PMC: 7111368. DOI: 10.1590/1516-4446-2014-1643. View

McGrath J, Saha S, Chant D, Welham J . Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008; 30:67-76. DOI: 10.1093/epirev/mxn001. View

Morken G, Widen J, Grawe R . Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry. 2008; 8:32. PMC: 2390550. DOI: 10.1186/1471-244X-8-32. View

Tiihonen J, Haukka J, Taylor M, Haddad P, Patel M, Korhonen P . A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011; 168(6):603-9. DOI: 10.1176/appi.ajp.2011.10081224. View

Miyamoto S, Miyake N, Jarskog L, Fleischhacker W, Lieberman J . Pharmacological treatment of schizophrenia: a critical review of the pharmacology and clinical effects of current and future therapeutic agents. Mol Psychiatry. 2012; 17(12):1206-27. DOI: 10.1038/mp.2012.47. View

Tandon R, Belmaker R, Gattaz W, Lopez-Ibor Jr J, Okasha A, Singh B . World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophr Res. 2008; 100(1-3):20-38. DOI: 10.1016/j.schres.2007.11.033. View

Lin C, Chen F, Chan H, Hsu C . Time to Rehospitalization in Patients With Schizophrenia Receiving Long-Acting Injectable Antipsychotics or Oral Antipsychotics. Int J Neuropsychopharmacol. 2019; 22(9):541-547. PMC: 6754732. DOI: 10.1093/ijnp/pyz035. View

Randall J, Chateau D, Bolton J, Smith M, Katz L, Burland E . Increasing medication adherence and income assistance access for first-episode psychosis patients. PLoS One. 2017; 12(6):e0179089. PMC: 5462428. DOI: 10.1371/journal.pone.0179089. View

Grimaldi-Bensouda L, Rouillon F, Astruc B, Rossignol M, Benichou J, Falissard B . Does long-acting injectable risperidone make a difference to the real-life treatment of schizophrenia? Results of the Cohort for the General study of Schizophrenia (CGS). Schizophr Res. 2011; 134(2-3):187-94. DOI: 10.1016/j.schres.2011.10.022. View

10.

Rosenheck R, Krystal J, Lew R, Barnett P, Fiore L, Valley D . Long-acting risperidone and oral antipsychotics in unstable schizophrenia. N Engl J Med. 2011; 364(9):842-51. DOI: 10.1056/NEJMoa1005987. View

11.

Lin C, Lin S, Chen M, Wang S . Comparison of time to rehospitalization among schizophrenic patients discharged on typical antipsychotics, clozapine or risperidone. J Chin Med Assoc. 2006; 69(6):264-9. DOI: 10.1016/S1726-4901(09)70254-0. View

12.

Zipursky R, Menezes N, Streiner D . Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophr Res. 2013; 152(2-3):408-14. DOI: 10.1016/j.schres.2013.08.001. View

13.

Abdel-Baki A, Thibault D, Medrano S, Stip E, Ladouceur M, Tahir R . Long-acting antipsychotic medication as first-line treatment of first-episode psychosis with comorbid substance use disorder. Early Interv Psychiatry. 2019; 14(1):69-79. DOI: 10.1111/eip.12826. View

14.

Galling B, Roldan A, Hagi K, Rietschel L, Walyzada F, Zheng W . Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World Psychiatry. 2017; 16(1):77-89. PMC: 5269492. DOI: 10.1002/wps.20387. View

15.

Marcus S, Zummo J, Pettit A, Stoddard J, Doshi J . Antipsychotic Adherence and Rehospitalization in Schizophrenia Patients Receiving Oral Versus Long-Acting Injectable Antipsychotics Following Hospital Discharge. J Manag Care Spec Pharm. 2015; 21(9):754-68. PMC: 10398026. DOI: 10.18553/jmcp.2015.21.9.754. View

16.

Kaplan G, Casoy J, Zummo J . Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia. Patient Prefer Adherence. 2013; 7:1171-80. PMC: 3833623. DOI: 10.2147/PPA.S53795. View

17.

Loch A . Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system. Braz J Psychiatry. 2012; 34(2):185-92. DOI: 10.1590/s1516-44462012000200011. View

18.

Kim E, Gupta S, Bolge S, Chen C, Whitehead R, Bates J . Adherence and outcomes associated with copayment burden in schizophrenia: a cross-sectional survey. J Med Econ. 2010; 13(2):185-92. DOI: 10.3111/13696991003723023. View

19.

Malmgren H, Radovic S, Thoren H, Haglund B . A philosophical view on concepts in psychiatry. Int J Law Psychiatry. 2010; 33(2):66-72. DOI: 10.1016/j.ijlp.2009.12.006. View

20.

Lozano M, Manyes L, Peiro J, Iftimi A, Ramada J . Strategic procedure in three stages for the selection of variables to obtain balanced results in public health research. Cad Saude Publica. 2018; 34(7):e00174017. DOI: 10.1590/0102-311X00174017. View