Predictors of Hospitalization of Individuals With First-Episode Psychosis: Data From a 2-Year Follow-Up of the RAISE-ETP

Abstract

Objective: Despite treatment advances in other domains, inpatient psychiatric hospitalization rates for individuals with first-episode psychosis remain high. Even with early intervention services, a third or more of individuals are hospitalized over the first 2 years of treatment. Reducing hospitalization is desirable from individuals' perspectives and for public health reasons as hospitalization costs are a major component of treatment costs. Method: Univariate and multivariate baseline and time-varying covariate analyses were conducted to identify predictors of hospitalization in the RAISE-ETP study, a two-year cluster randomized trial for participants experiencing a first episode of psychosis who were outpatients at study entry. The trial compared an early intervention treatment model (NAVIGATE) to usual community care at 34 clinics across the United States. Results: 34% of NAVIGATE and 37% of usual care participants were hospitalized during the trial. Risk analyses revealed significant predictors of hospitalization to be: the number of hospitalizations before study entry, duration of untreated psychosis, and time-varying days of substance misuse, presence of Positive and Negative Syndrome Scale positive symptoms, and beliefs about the value of medication. Conclusions: These results indicate that hospital use may be decreased by reducing the duration of untreated psychosis and prior hospitalizations, minimizing residual symptoms, preventing substance misuse and facilitating adherence in medication taking. Addressing these factors could enhance the impact of first-episode early intervention treatment models as well as enhance outcomes of first-episode psychosis treated with other models.

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

“…Prior contact with services for substance use was associated with higher rates of hospitalization, consistent with many prior studies (Patel et al, ; Robinson et al, ; Turner et al, ; Wade, Harrigan, Edwards, et al, ; Wisdom, Manuel, & Drake, ). Substance use is associated with a more complicated clinical picture in psychosis (Wisdom et al, ), and substance use during the early and prodromal stages of illness may mask the onset of psychotic symptoms and delay help seeking, resulting in poorer outcome (Seddon et al, ).…”

“…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).…”

Polyunsaturated Fatty Acids: What is Their Role in Treatment of Psychiatric Disorders?

“…Nine RCTs were performed in patients with stable schizophrenia [30,31,32,33,34,35,36,37,38]. Seven studies showed a positive effect of omega-3 fatty acids on several symptom domains of schizophrenia [30,31,32,34,36,37,38], while two trials [33,35] failed to observe significant advantages with PUFAs supplementation. The majority of studies tested the efficacy of EPA in adjunction to antipsychotics and only three studies [30,37,38] evaluated the effects of combination of EPA and DHA as adjuvant antipsychotic treatment.…”

“…Duration of studies ranged between 8 and 16 weeks. Daily doses of PUFAs were from 0.9 to 4 g. EPA has been found superior than the placebo and also than DHA in reducing positive symptoms [30,31,32,34], negative symptoms [32], depressive symptoms [31,38] and anxious symptoms [38] of schizophrenia. One study indicated that omega-3 fatty acids were useful in reducing violent behaviors in schizophrenia [37].…”

Effects of Omega 3 Fatty Acids on Main Dimensions of Psychopathology

“…These initial promising findings allow us to take into consideration the use of non-pharmacological compounds for early interventions in young people at risk for psychosis [ 42 ]. The results obtained so far about PUFAs as an add-on strategy in the treatment of schizophrenia are controversial; while several studies [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ] produced favorable data, some others [ 58 , 59 , 60 , 61 ] showed no significant differences in clinical outcomes.…”