Objectives: This study aimed to determine whether aftercare services reduced the number of rehospitalizations and length of hospital stay among patients with severe mental disorders.Methods: A total of 120 patients with schizophrenia and schizoaffective or bipolar disorder between the ages of 15 and 65 were recruited from 2010 to 2012 for a randomized controlled trial. The participants were followed up for 20 months after discharge from a university-affiliated hospital in Tehran, Iran. The selection procedure was random sampling. Sixty patients received aftercare services, which included treatment follow-up, family psychoeducation, and patient social skills training, and 60 patients received treatment as usual. Number of hospitalizations and length of hospital stay were primary outcome measures, and severity of psychopathology and severity of illness were secondary outcome measures. The quantitative primary and secondary outcomes measures were compared by using repeated-measures analysis.Results: Three members of the control group did not complete the study. The cumulative number of hospitalizations during the follow-up period was 55 for the control group and 26 for the intervention group. Length of stay was significantly greater in the control group compared with the intervention group (rate ratio=2.38, 95% confidence interval=2.17-2.62). Psychopathology was less severe in the intervention group compared with the control group (p,.001).Conclusions: Aftercare services are efficacious for reducing both the need for rehospitalization and the severity of psychopathology.
BackgroundSevere mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country’s urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services.Method/DesignThis is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services.DiscussionThis paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran.Trial registrationIRCT201009052557N2
Kraepelin was the first who recognized the phenomenon of cycling in bipolar disorder in 1913. The term rapid cycling was proposed by Dunner and Fieve in 1974. Later on, Kramlinger and Post defined ultra-rapid cycling and ultradian cycling in 1996. Frequent rapid mood switches are an inherent characteristic of bipolar disorder, and rapid cycling is included as a course specifier for bipolar disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Although the terms cycle and episode are commonly used to delineate discrete periods of mood disorders, literature still suffers from the inconsistent and indistinct definition for them. Therefore, the reported prevalence of rapid cycling bipolar disorder shows a wide variability across studies, which ranges from 15% to 53.6% in adults, and 41.8% to 87.1% in children. Moreover, studies have used different definitions for rapid, ultra-rapid, and ultra-ultra-rapid/ultradian cycling, which has reduced the comparability of data across studies. However, the higher prevalence of rapid, ultra-rapid, and ultra-ultra-rapid/ultradian cycling reported in children with bipolar disorder, compared to adults, may make the pattern of cycling a key criterion in the diagnosis of early-onset bipolar disorder. Obviously, there is a significant need to stabilize a distinct specific definition for each of the terms episode, cycle, rapid cycling, ultra-rapid cycling, and ultra-ultra-rapid/ultradian cycling, based on the consensus of experts in bipolar disorder, in children and adults. In addition to increasing the value of research, using common terminologies and definitions enables comparison between studies and improves diagnostic criteria of rapid cycling bipolar disorder and its therapeutic and management plans in both the early-and adult-onset types.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.