Schizophrenia.

Schizophrenia is the most common psychotic mental disorder, and those affected have two to four times higher mortality than the general population. Genetic and environmental factors increase the risk of developing schizophrenia, and substance use disorder (particularly cannabis) may have the strongest link. Schizophrenia typically develops in young adulthood and is characterized by the presence of positive and negative symptoms. Positive symptoms include hallucinations, delusions, and disorganized speech. Negative symptoms include blunted affect, alogia, avolition, asociality, and anhedonia. Symptoms must be present for at least six months and be severe for at least one month to make a diagnosis. Because schizophrenia is debilitating, it should be treated with antipsychotics, and early treatment decreases long-term disability. Treatment should be individualized, and monitoring for effectiveness and adverse effects is important. Patients with a first episode of psychosis who receive a formal diagnosis of schizophrenia should be treated in a coordinated specialty care program. Second-generation antipsychotics are the preferred first-line treatment because they cause fewer extrapyramidal symptoms. Patients with schizophrenia who are treated with second-generation antipsychotics are at increased risk of cardiovascular disease and should receive at least annual metabolic screening and counseling with interventions to prevent weight gain and encourage smoking cessation. Treatment-resistant schizophrenia should be treated with clozapine. Adjunctive treatments include electroconvulsive therapy, antidepressants, and cognitive behavior therapy for psychosis. Family and social support are keys to improved outcomes.

Early Discharge Does Not Increase Readmission Rates After Minimally Invasive Anatomic Lung Resection.

OBJECTIVE: Enhanced recovery pathways reduce length of stay and costs following lung resection. However, many fear that early discharge may lead to increased hospital readmissions. In this study, we aimed to determine whether early discharge was associated with increased readmission following anatomic lung resection. METHODS: Using the lung resection database approved by our institutional review board, we identified all patients undergoing minimally invasive lobectomy and segmentectomy between January 2010 and March 2017 at our institution, where an enhanced recovery pathway is well established. Thirty-day readmissions were compared between patients with short- and average length of stay, defined as 1 to 2 days and 3 to 5 days, respectively. Multivariable logistic regression analysis of patients matched by propensity scores was performed to determine odds of 30-day readmission for each group. Significance was set at P < 0.05. RESULTS: A total of 296 patients met inclusion criteria. Unadjusted analysis revealed a 3-fold increased rate of readmission in the group with average length of stay (9%, n = 12) versus the group with short length of stay (3%, n = 5; P < 0.01). At baseline, patients with average length of stay had increased rates of preoperative chemotherapy (13%, n = 18 vs. 4%, n = 6; P < 0.01) and radiation (12%, n = 16 vs. 3%, n = 5). Patients with average length of stay also had higher rates of lobectomy (95%, n = 127 vs. 86%, n = 140; P = 0.02) and postoperative complications (31%, n = 41 vs. 4%, n = 7; P < 0.01). On multivariable analysis, patients with average length of stay had a 2.3-fold greater odds of readmission, which was not statistically significant (OR = 2.33; 95% CI, 0.60 to 9.02; P = 0.22). CONCLUSIONS: Early discharge following minimally invasive anatomic lung resection does not increase the risk of hospital readmission in patients treated within an enhanced recovery pathway.