Predicting Psychiatric Hospital Admission Among Adults With Schizophrenia

Aim Duration of untreated psychosis in early schizophrenia impacts long‐term outcomes. Because long‐acting injectable (LAI) antipsychotic drugs improve adherence in early‐stage patients, they could reduce additional time in uncontrolled psychosis (TUP) during the critical period of the illness. However, the long‐term benefit of early LAI use over oral formulations has not been quantified. This study explores the potential magnitude of the benefit with a simulation approach. Methods A microsimulation models the effects of 11 treatment pathways reflecting alternative decisions on whether and when LAI agents are used during a “calibration phase” that starts at treatment entry and lasts until the end of the 3‐year critical period. Treatment failure prolongs time in psychosis. Long‐term outcomes are predicted over the ensuing 7‐year period as a function of TUP. Results An “early LAI” pathway where LAI treatment follows the second oral treatment failure is compared to an oral‐only pathway. Under these pathways, 69% and 46% of patients, respectively, are estimated to exit the calibration phase with adequate symptom control (total positive and negative syndrome scale score below 68). Relative to the oral‐only pathway, the early LAI pathway is predicted to increase competitive employment by 39% (25% vs 18%) and independent or family living by 22% (71% vs 58%), and to decrease receipt of disability benefits by 36% (42% vs 66%) and hospital admissions per 1000 patient‐years by 15% (249% vs 294%). Conclusions While these simulation results need to be confirmed empirically, they suggest that earlier use of LAI antipsychotics can meaningfully improve patient outcomes.

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“…Disease severity, based on PANSS total scores: low = up to 67; intermediate = 68‐82; high = 83 and higher (Olfson et al, ).…”

Section: Methodsmentioning

confidence: 99%

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

Horvitz-Lennon

Predmore

Orr

et al. 2018

Early Intervention Psych

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“…The CATIE study also examined the rates of hospitalization for exacerbations of schizophrenia during the 18-month study 91,94. Similar to the findings on medication discontinuation, the risk for hospitalization was lowest for olanzapine-treated patients and highest among the quetiapine-treated patients (Figure 1).…”

Section: Antipsychotics Differ In Effectivenessmentioning

confidence: 68%

Section: Figurementioning

confidence: 99%

The personal, societal, and economic burden of schizophrenia in the People's Republic of China: implications for antipsychotic therapy

Montgomery¹,

Liu²,

Stensland³

et al. 2013

CEOR

Self Cite

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BackgroundThis article describes the personal, societal, and economic burden attributable to schizophrenia in the People’s Republic of China and highlights the potential for effective outpatient treatment to reduce this burden given recent changes in the Chinese health care system. The importance of effective antipsychotic therapy in reducing the burden of schizophrenia is also examined.MethodsPublished research on the burden, disability, management, and economic costs of schizophrenia in the People’s Republic of China was examined in the context of the larger body of global research. Research written in English or Chinese and published before June 2012 was identified using PubMed, CNKI, and Wanfang Med database searches. The contribution of effective antipsychotic therapy in reducing the risk for relapse and hospitalization and improving patients’ functioning is described.ResultsSchizophrenia imposes a substantial burden on Chinese society, with indirect costs accounting for the majority of the total cost. Functional impairment is high, leading to lost wages and work impairment. In the People’s Republic of China, schizophrenia is the most common diagnosis among hospitalized psychiatric patients. Ongoing changes in the Chinese health care system may reduce some barriers to effective relapse prevention in schizophrenia and potentially reduce hospitalizations. The use of antipsychotics for acute episodes and maintenance treatment has been shown to decrease symptom severity and reduce the risk for relapse and hospitalization. However, discontinuing antipsychotic medication appears common and is a strong predictor of relapse. Cost-effectiveness research in the People’s Republic of China is needed to examine the potential gains from improved outpatient antipsychotic treatment.ConclusionSchizophrenia is a very costly mental illness in terms of personal, economic, and societal burden, both in the People’s Republic of China and globally. When treated effectively, patients tend to persist longer with antipsychotic treatment, have fewer costly relapses, and have improved functioning. Further research examining the long-term effects of reducing barriers to effective treatments on the societal burden of schizophrenia in the People’s Republic of China is needed.

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“…); (8) baseline severity of symptoms (CGI) (Olfson et al . ); (9) medication adherence (Valenstein et al . , Lang et al .…”

Section: Methodsmentioning

confidence: 99%

“…); (10) baseline level of functioning (Global Assessment of Functioning) (Olfson et al . ); (11) number of previous hospitalizations (Doering et al . , Olfson et al .…”

Section: Methodsmentioning

confidence: 99%

Psychiatrist's adherence: a new factor in relapse prevention of schizophrenia. A randomized controlled study on relapse control through telemedicine system

Španiel

Novák

Motlová

et al. 2015

Psychiatric Ment Health Nurs

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The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) presents a telemedicine solution for weekly monitoring and management of schizophrenia. This study aims to evaluate the effectiveness of the programme in reducing the number of hospitalizations during the 18-month multi-centre parallel randomized controlled, open label, trial. Outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n = 74) or control group (n = 72). In the active arm, investigators increased the antipsychotic dose upon occurrence of prodrome announced by the system. Intention-to-treat analysis showed no between-group difference in the hospitalization-free survival rate [Kaplan-Meier method; hazard ratio (HR) = 1.21, 95% confidence interval (CI): 0.56-2.61, P = 0.6). In a post hoc multivariate Cox proportional hazards model, out of 13 potential predictors, only ITAREPS-related variables (number of alerts without pharmacological intervention/HR = 1.38, P = 0.042/ and patient non-adherence with ITAREPS /HR = 1.08, P = 0.009/) increased the risk of hospitalization. In this trial ITAREPS was not effective. The results in context with previous ITAREPS studies suggest non-adherence of both psychiatrists and patients as the main reasons for the failure of this preventive strategy. Tertiary prevention in schizophrenia have to be regarded a major challenge, warranting the need for implementation of strategies with more active participation of both patient and treating psychiatrist.

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Predicting Psychiatric Hospital Admission Among Adults With Schizophrenia

Cited by 47 publications

References 48 publications

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

The personal, societal, and economic burden of schizophrenia in the People's Republic of China: implications for antipsychotic therapy

Psychiatrist's adherence: a new factor in relapse prevention of schizophrenia. A randomized controlled study on relapse control through telemedicine system

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Predicting Psychiatric Hospital Admission Among Adults With Schizophrenia

Cited by 47 publications

References 48 publications

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

Simulated long‐term outcomes of early use of long‐acting injectable antipsychotics in early schizophrenia

The personal, societal, and economic burden of schizophrenia in the People&#39;s Republic of China: implications for antipsychotic therapy

Psychiatrist's adherence: a new factor in relapse prevention of schizophrenia. A randomized controlled study on relapse control through telemedicine system

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The personal, societal, and economic burden of schizophrenia in the People's Republic of China: implications for antipsychotic therapy