PurposeTo evaluate the efficacy of a post-discharge intervention for psychiatric inpatients aimed at preventing hospital readmissions and at improving patients’ mental health and psychosocial functioning.MethodsRandomized controlled trial using parallel group block randomization including 151 patients with ≤3 hospitalizations within the last 3 years, a GAF score ≤60, and aged 18–64 years, assessed at two psychiatric hospitals from the canton of Zurich, Switzerland, between September 2011 and February 2014. Primary outcomes were rate and duration of rehospitalization; secondary outcomes were mental health and functioning. Outcome measures were assessed before discharge from the index hospitalization (t0), 3 months after discharge when the intervention terminated (t1), and 12 months after discharge (t2). Participants received either a brief case management post-discharge intervention or treatment as usual.ResultsIn the short-term (i.e., t0–t1), no significant effect emerged in any outcome. In the long term (i.e., t0–t2), the two groups did not differ significantly with respect to the rate and duration of rehospitalization. Also, the intervention did not reduce psychiatric symptoms, did not improve social support, and did not improve quality of life. However, it did slightly increase assessor-rated general (d = 0.30) and social functioning (d = 0.42), although self-reports revealed a deteriorative effect on symptom remission (d = −0.44).ConclusionThis psychosocial post-discharge intervention showed no efficacy in the primary outcome of rehospitalization. With respect to secondary outcomes, in the long term it might lead to slightly increased social functioning but revealed no significant effect on psychopathology, social support, and quality of life. By contrast, with respect to self-reported symptom remission, it was revealed to have a negative effect. In this high-resource catchment area with comprehensive community psychiatric and social services, the intervention thus cannot be recommended for implementation in routine care.

Access to patients' social networks is a challenging task. Based on our preliminary experiences with the program, we suggest that more efforts should be made to enhance patients' social and interpersonal abilities.

BackgroundInadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment. Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment. Additionally, discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization. The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization. Subjects are randomly assigned to either the treatment group or to the control group. The treatment group participates in the Post-Discharge Network Coordination Program. The control group receives treatment as usual with no additional social support. Further outcome variables include: social support, change in psychiatric symptoms, quality of life, and independence in daily functioning.Methods/designThe study is conducted as a randomized controlled trial. Subjects are randomly assigned to either the control group or to the treatment group. Computer generated block randomization is used to assure both groups have the same number of subjects. Stratified block randomization is used for the psychiatric diagnosis of ICD-10, F1. Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur.DiscussionThe proposed post-discharge network coordination program intervenes during the critical post-discharge period. It focuses primarily on promoting the integration of the patients into their social networks, and additionally to coordinating outpatient care and addressing concerns of daily life.Trial registrationISRCTN: ISRCTN58280620

ISRCTN58280620.

Twenty-eight patients, that is 0.8% of all 3,225 patients admitted between 1981 and 1986 in the Free University of Berlin, Department of Psychiatry, had a primary diagnosis of obsessive-compulsive disorder (ICD-9: 300.3). These patients were compared with random samples of equal size (N = 28) of schizophrenic psychoses paranoid type (ICD 295.3), manic depressive psychoses depressed type (ICD 296.1) and neurotic depressions (ICD 300.4) using an AMDP-based multiaxial diagnostic description. It turned out, that although obsessive-compulsive patients were best discriminated from the other clinical groups by their typical symptoms, they were characterized likewise by other psychopathological, especially depressive symptoms. In view of the course of obsessive-compulsive disorder, the findings were compatible with those of other reports. Beyond it, a subgroup of patients with relatively unfavourable course could be described by AMPD-items.