Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

Abstract

2019). Hospitalisation and length of hospital stay following first-episode psychosis: Systematic review and metaanalysis of longitudinal studies. Psychological Medicine. https://doi. AbstractBackground: Reducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in hospital during follow-up.Methods: Studies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted. Results: 81 longitudinal studies encompassing data for 23280 FEP patients with an average follow-up length of 7 years were included. 55% (95%CI=50.3-60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95%CI=95.1-138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS. Conclusion: One in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest. Key words: First episode psychosis / schizophrenia / hospitalisation / length of stay / inpatient / follow-up / outcome R.M.M. has received honoraria from Janssen, Astra-Zeneca, Lilly, and BMS. A.S.D. has received honoraria from Janssen and Roche Pharmaceuticals. F.G. has received honoraria for advisory work and lectures from Roche, BMS, Lundbeck, Otsuka and Sunovion and has a family member with professional links to Lilly and GSK. The other authors (O.A., B.S., J.L., E.F.) have no conflict of interest to declare. References Agius M, Hadjinicolaou AV, Ramkisson R, Shah S, Haq SU, Tomenson B, Zaman R. (2010). Does early intervention for psychosis work? An analysis of outcomes of early intervention in psychosis based on the critical period hypothesis, measured by number of admissions and bed days used over a period of six years, the first three in an early intervention service, the second three in a community mental health team. Psychiatria Danubina 22, s72-84. (2017) Patterns of illness and care over the 5 years following onset of psychosis in different ethnic groups; the gap-5 s...

Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data

“…Our finding that 38% of people with early psychosis had an admission within 2 years of first diagnosis is lower than a recent meta-analysis of international estimates, reporting that 55% of patients were hospitalized at least once over any length of follow-up (Ajnakina et al, 2019). This difference may be partially explained by study region, given that subgroup analyses from this review revealed a lower proportion of hospitalized patients in studies from North America (48%; Ajnakina et al, 2019). Comparison with earlier time periods in Ontario health administrative data suggests that differences could also be due to declining hospitalization rates over timewe previously observed that 38% of first-episode cases were hospitalized at first diagnosis between 1999 and 2008 ), compared to 10% in the current study.…”

“…Our finding that 38% of people with early psychosis had an admission within 2 years of first diagnosis is lower than a recent meta‐analysis of international estimates, reporting that 55% of patients were hospitalized at least once over any length of follow‐up (Ajnakina et al, ). This difference may be partially explained by study region, given that subgroup analyses from this review revealed a lower proportion of hospitalized patients in studies from North America (48%; Ajnakina et al, ).…”

“…The youngest age group (16-20 years) had higher hospitalization rates compared to older age groups. Recent meta-analytic results similarly observed older age of onset to be associated with a lower proportion of hospitalizations (Ajnakina et al, 2019). Adolescent onset is associated with more severe expression of illness, lower premorbid social/emotional adjustment, cognitive impairments, bizarre behaviour, and negative symptoms compared to adult onset, which may increase the likelihood of hospitalization (Ballageer, Malla, Manchanda, Takhar, & Haricharan, 2005;Joa et al, 2009).…”

“…Substance and alcohol use were identified through contact with services, therefore we misclassified people who use substances or alcohol but have not presented to services. We were unable to examine some factors previously shown to impact hospitalization risk, including symptom severity (Lee et al, 2016;Robinson et al, 2019;Sipos, Harrison, Gunnell, Amin, & Singh, 2001), behavioural/functional disturbance (Turner et al, 2013;Wade, Harrigan, Harris, Edwards, & McGorry, 2006), enrollment in early psychosis intervention services (Randall et al, 2015), and being in a stable relationship (Ajnakina et al, 2019).…”

A multivariate neuromonitoring approach to neuroplasticity-based computerized cognitive training in recent onset psychosis

“…First, the current study used a relatively short CCT as we wanted to keep the intervention duration comparable to the duration of clinical treatment. Our intention was to provide greater resemblance to the real-world clinical setting that appears common in many other health centers across Europe [78], and provides a strong clinical care framework due to the initial stay of the patients at the ward or frequent clinical checks. However, we cannot claim that ROP patients who did not respond with an improvement of rsFC pattern and did not show efficient SPC learning would not achieve neural 'recovery' associated with enhancement of cognition with a slightly different form of intervention, longer duration, or implementing more diverse protocols [7].…”