Predictors of psychiatric readmission among patients with bipolar disorder at an academic safety-net hospital

Hamilton, Jane; Passos, Ives Cavalcante; Cardoso, Taiane de Azevedo; Jansen, Karen; Allen, Melissa; Begley, Charles E.; Soares, Jair C.; Kapczinski, Flávio

doi:10.1177/0004867415605171

Cited by 45 publications

(39 citation statements)

References 49 publications

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“…Analysis of factors other than drugs of interest showed that the inpatient meta‐visit had an RR of 1.68 over the outpatient meta‐visit for psychiatric hospitalization ( P < 2.23 × 10 −308 ), supporting the evidence that previous hospitalization is a strong predictor of subsequent hospital admission in patients with BD . Consistent with our data, baseline substance use disorder, psychosis, and use of anticonvulsants and anxiolytics were previously reported to be risk factors for hospitalization in BD .…”

Section: Discussionsupporting

confidence: 88%

“…Analysis of factors other than drugs of interest showed that the inpatient meta-visit had an RR of 1.68 over the outpatient metavisit for psychiatric hospitalization (P < 2.23 × 10 −308 ), supporting the evidence that previous hospitalization is a strong predictor of subsequent hospital admission in patients with BD. [29][30][31][32][33] Consistent with our data, baseline substance use disorder, psychosis, and use of anticonvulsants and anxiolytics were previously reported to be risk factors for hospitalization in BD. 30 The findings on the reduced risk of psychiatric hospitalizations for patients on antibiotics and non-steroidal anti-inflammatory drugs contribute to the evidence suggesting the importance of immune alterations, inflammation, and the microbiome in BDs.…”

Section: × 10 −12supporting

confidence: 90%

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Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

Nestsiarovich

Mazurie²,

Hurwitz³

et al. 2018

Bipolar Disorders

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This largest reported retrospective observational study on bipolar disorders pharmacotherapy to date demonstrates that the majority of patients end monotherapy within 2 months after treatment start. The risk of psychiatric hospitalization varied almost two-fold across individual medications. The data add to the evidence favoring lithium and mood stabilizer use in short-term bipolar disorder management. The findings that the dopaminergic drugs aripiprazole and bupropion had better outcomes than other members of their respective classes and that antidepressant outcomes may vary by baseline mood polarity merit further investigation.

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Section: Discussionsupporting

confidence: 88%

Section: × 10 −12supporting

confidence: 90%

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

Nestsiarovich

Mazurie²,

Hurwitz³

et al. 2018

Bipolar Disorders

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show abstract

“…Kraepelin reported that the recurrence of episodes tended to accelerate over time, which leads to shortening of inter‐episodic intervals . In this same vein, some studies using the nationwide registration of all psychiatric hospitalizations from Denmark and others showed that the rate of relapse leading to hospitalization increased with the number of previous episodes . However, it has been argued that some of these studies, and also Kraeplin's observations, may be due to a computational artifact .…”

Section: Resultsmentioning

confidence: 99%

Areas of controversy in neuroprogression in bipolar disorder

Passos

Mwangi

Vieta

et al. 2016

Acta Psychiatr Scand

184

103

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Illness trajectories are largely variable, and illness progression is not a general rule in BD. The number of manic episodes seems to be the clinical marker more robustly associated with neuroprogression in BD. However, the majority of the evidence came from cross-sectional studies that are prone to bias. Longitudinal studies may help to identify signatures of neuroprogression and integrate findings from the field of neuroimaging, neurocognition, and biomarkers.

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“…31 The length of stay of the patient was not found to be significant in this study, even though some studies have showed that a shorter length of stay during the index hospital admission led to a higher risk of readmission. 3,41,45 This has become an important finding as many countries have pressed for a shorter length of stay and some psychiatrists may discharge a patient prematurely before recovery in an attempt to hasten the patient's reintegration into society in the community. 46 This may be because of the relatively long length of stay of patients in Hong Kong compared with other countries, with less pressure for early discharge, and data being partly skewed by the discharge episodes of certain patients who have lived in psychiatric institutions for years.…”

Section: Main Findingsmentioning

confidence: 99%

Clinical risk model to predict 28-day unplanned readmission via the accident and emergency department after discharge from acute psychiatric units for patients with psychotic spectrum disorders

et al. 2020

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Background Unplanned readmissions rates are an important indicator of the quality of care provided in a psychiatric unit. However, there is no validated risk model to predict this outcome in patients with psychotic spectrum disorders. Aims This paper aims to establish a clinical risk prediction model to predict 28-day unplanned readmission via the accident and emergency department after discharge from acute psychiatric units for patients with psychotic spectrum disorders. Method Adult patients with psychotic spectrum disorders discharged within a 5-year period from all psychiatric units in Hong Kong were included in this study. Information on the socioeconomic background, past medical and psychiatric history, current discharge episode and Health of the Nation Outcome Scales (HoNOS) scores were used in a logistic regression to derive the risk model and the predictive variables. The sample was randomly split into two to derive (n = 10 219) and validate (n = 10 643) the model. Results The rate of unplanned readmission was 7.09%. The risk factors for unplanned readmission include higher number of previous admissions, comorbid substance misuse, history of violence and a score of one or more in the discharge HoNOS overactivity or aggression item. Protective factors include older age, prescribing clozapine, living with family and relatives after discharge and imposition of conditional discharge. The model had moderate discriminative power with a c-statistic of 0.705 and 0.684 on the derivation and validation data-set. Conclusions The risk of readmission for each patient can be identified and adjustments in the treatment for those with a high risk may be implemented to prevent this undesirable outcome.

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Predictors of psychiatric readmission among patients with bipolar disorder at an academic safety-net hospital

Cited by 45 publications

References 49 publications

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

Areas of controversy in neuroprogression in bipolar disorder

Clinical risk model to predict 28-day unplanned readmission via the accident and emergency department after discharge from acute psychiatric units for patients with psychotic spectrum disorders

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