Risk factors associated with readmissions of patients with severe mental disorders under treatment with antipsychotics

Abstract

Background The aim of this study was to assess the risk of readmission in patients with severe mental disorders, compare it between patients using different types of antipsychotics and determine risk factors for psychiatric readmission. Methods Medical records of a non-concurrent cohort of 625 patients with severe mental disorders (such as psychoses and severe mood disorders) who were first discharged from January to December 2012 (entry into the cohort), with longitudinal follow-up until December 2017 constitute the sample. Descriptive statistical analysis of characteristics of study sample was performed. The risk factors for readmission were assessed using Cox regression. Results Males represented 51.5% of the cohort, and 75.6% of the patients had no partner. Most patients (89.9%) lived with relatives, and 64.7% did not complete elementary school. Only 17.1% used more than one antipsychotic, 34.2% did not adhere to the treatment, and 13.9% discontinued the medication due to unavailability in public pharmacies. There was a need to change the antipsychotic due to the lack of therapeutic response (11.2% of the patients) and adverse reactions to the antipsychotic (5.3% of the patients). Cox regression showed that the risk of readmission was increased by 25.0% (RR, 1.25; 95% CI, 1.03–1.52) when used typical antipsychotics, compared to those who used atypical ones, and by 92.0% (RR, 1.92; 95% CI, 1.63–2.27) when patients did not adhere to maintenance treatment compared to those who adhered. Conclusions Use of atypical antipsychotics and adherence to treatment were associated with a lower risk of psychiatric readmissions.

Influencing factors of medication adherence in schizophrenic patients: a meta-analysis

“…In addition to drug factors, the results of our meta-analysis showed that disease-related factors such as problem behaviors of drug and alcohol abuse (OR = 1.77), duration and severity of illness (OR = 1.14) can also influence medication adherence to a large extent. This is consistent with the findings of several previous studies 41 , 45 , 46 . Also, lower income and quality of life (OR = 1.23), personal attributes including age, gender, and education (OR = 1.21), were all significant in the results of this meta-analysis and were among the risk factors for patient medication adherence.…”

Prevalence of Functional Disability and Associated Factors Among the Patients With Schizophrenia Attending Psychiatry Outpatient Clinics at Muhimbili National Hospital, Dar Es Salaam, Tanzania. Cross-sectional Survey

“…The study of individual antipsychotics speci cally clozapine, a mother atypical antipsychotic has shown functional recovery better than counterparts and lowering refractory schizophrenia states while maintaining clinical symptoms-free states of the patients as reported in an Indian study (50). Schizophrenia refractoriness is associated with poor treatment outcomes such as poor functioning, where controlling relapses aids in modifying the outcomes as reported by Portela and colleagues in Brazil (2017), they found that atypical antipsychotics were a protective factor against readmissions and relapses and so coinciding with the nding of the current study ndings (52). The study participants who did not receive any form of psychotherapy as part of their treatment had higher odds of functional disability compared to those who got psychotherapy as a component of their treatment.…”

Efficacy of Long-Acting Injectable Antipsychotics Versus Oral Antipsychotics in Preventing Psychiatric Rehospitalizations

“…7 One of the greatest contributors to readmissions in patients with schizophrenia is adherence to treatment recommendations as one trial showed a 92% increase in readmissions over a 5-year time frame in nonadherent patients. 8 Continuous treatment with antipsychotic medications is recommended in patients with schizophrenia. Although oral medications are commonly used, long-acting injectable (LAI) antipsychotics offer an alternative that may improve adherence to treatment.…”

“…Adults with serious mental illness have an elevated rate of 30-day readmissions, and patients with schizophrenia have the highest rate, followed by those with bipolar disorder 7 . One of the greatest contributors to readmissions in patients with schizophrenia is adherence to treatment recommendations as one trial showed a 92% increase in readmissions over a 5-year time frame in nonadherent patients 8 …”