Predicting involuntary hospitalization in psychiatry: A machine learning investigation

Silva, Benedetta; Gholam, Mehdi; Golay, Philippe; Bonsack, Charles; Morandi, Stéphane

doi:10.1192/j.eurpsy.2021.2220

Cited by 10 publications

(8 citation statements)

References 64 publications

(104 reference statements)

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“…Beyond patient characteristics, as diagnosis and clinical profile, these results can be explained by differences in legislation and mental health service availability. We could interpret these admissions as in-hospital crisis interventions due to the lack of alternatives on the weekend ( 38 , 39 , 49 ).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

et al. 2022

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IntroductionDay and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes.MethodsDemographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn).ResultsDuring the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates.DiscussionThe main finding of our study is the relationship between “daytime hours” and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.

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Section: Discussionmentioning

confidence: 99%

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

et al. 2022

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“…Involuntary admission is appropriate when impaired judgment adversely affects the capacity to consent. Patients who are aggressive or with psychosis are more likely to need involuntary admission during manic episodes …”

Section: Methodsmentioning

confidence: 99%

Diagnosis and Treatment of Bipolar Disorder

Nierenberg,

Agustini,

Köhler-Forsberg

et al. 2023

JAMA

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ImportanceBipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide.ObservationsBipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide.Conclusions and RelevanceBipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.

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“…Vísbendingar eru um að þvinguð meðferð eins og nauðungarlyfjagjöf tengist þáttum eins og tíma dags, vikudegi eða árstíð auk sjúkdómsgreininga og lýðfraeðilegra breyta. 9,10 Þeir sjúklingar sem eru í áhaettuhópi fyrir því að fá nauðungarlyfja gjöf virðast vera ungir karlmenn með geðrofssjúkdóm (F20-F29) og hafa sögu um vímuefnavanda og ofbeldi gagnvart öðrum 5,6,11,12 og þeir sem hafa dvalið oftar og lengur á geðdeildum en aðrir sjúklingar. 6 Nefnd Evrópuráðs um varnir gegn pyndingum og ómannúðlegri eða vanvirðandi meðferð eða refsingum gerði úttekt á stöðu þvingaðrar meðferðar á Íslandi árið 2012.…”

Section: Nauðungarlyfjagjafir á Geðdeildum Landspítala áRin 2014-2018unclassified

Involuntary medication in psychiatric units at Landspitali University Hospital in the years 2014-2018

Thorstenson¹,

Jónsson²,

Bragadóttir³

2023

LBL

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INTRODUCTION: Coercion is considered controversial and is criticized around the world. Involuntary medication is one type of coercion, but the extent of its use in Iceland is not well known. The aim of this study is to shed light on the extent and time of involuntary medication in Landspitali University Hospital in Iceland, when it is most often used and whether there is a difference between patients who receive involuntary medication and those who do not receive such treatment. MATERIAL AND METHODS: This study is a quantitative descriptive retrospective study using data obtained from medical records. The sample consisted of all patients admitted to the psychiatric inpatient wards at Landspitali University Hospital in Iceland in the years 2014-2018 (N=4053). The sample was divided into two groups, group 1 with patients who received involuntary medication n=400 (9.9%) and group 2 with patients who did not receive such treatment n=3653 (90.1%). RESULTS: The total number of involuntary medications was 2438 and about 1% of the total sample received about half of all involuntary medication. Involuntary medications were most frequent during the daytime during weekdays and late at night, but no notable difference was seen between months of the year. When comparing the groups, it appears that proportionally more men and patients with foreign citizenship are in group 1 than in group 2, but no notable difference is seen in age between groups. Patients in group 1 had more visits to the emergency services at Landspitali, more admissions, and patient days per patient at psychiatric wards in Landspitali than those in group 2. The most common medical diagnosis in group 1 were within the schizophrenia spectrum (F20-F29) and mood disorders (F30-39) but in group 2 the most common medical diagnosis were mental and behavioral disorders due to psychoactive substance use (F10-19) and mood disorders (F30-F39). CONCLUSION: Findings indicate certain risk factors for involuntary medication regarding demographic, medical diagnosis, use of services as well as external factors such as timing of involuntary medication. A more detailed analysis could be used to reduce the use of coercive treatment. Further research is needed on the use of coercion in psychiatric wards in Iceland.

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Predicting involuntary hospitalization in psychiatry: A machine learning investigation

Abstract: Predicting involuntary hospitalisation in psychiatry: a machine learning investigation

Cited by 10 publications

References 64 publications

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

Diagnosis and Treatment of Bipolar Disorder

Involuntary medication in psychiatric units at Landspitali University Hospital in the years 2014-2018

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