Does the Ranking Matter? A Retrospective Cohort Study Investigating the Impact of the 2018 CANMAT and ISBD Guidelines for the Management of Patients with Bipolar Disorder Treatment Recommendations for Acute Mania on Rehospitalization Rates.

OBJECTIVE: There is limited data about the impact of mood disorders treatment guidelines on clinical outcomes. The objective of this study was to investigate the impact of prescribers' adherence to the 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) treatment guidelines recommendations on the readmission rates of patients hospitalized for mania. METHOD: A retrospective cohort of all individuals admitted due to acute mania to Kingston General Hospital, Kingston, ON, from January 2018 to July 2021 was included in this study. Patient variables and data regarding index admission and subsequent hospitalizations were extracted from medical records up to December 31, 2021. Treatment regimens were classified as first-line, second-line, noncompliant, or no treatment. We explored the associations between treatment regimens and the risk of readmissions using univariate, multivariate, and survival analysis. RESULTS: We identified 211 hospitalizations related to 165 patients. The mean time-to-readmission was 211.8 days (standard deviation [SD] = 247.1); the 30-day rehospitalization rate was 13.7%, and any rehospitalization rate was 40.3%. Compared to no treatment, only first-line treatments were associated with a statistically significant decreased risk of 30-day readmission (odds ratio [OR] = 0.209; 95% CI, 0.058 to 0.670). The risk of any readmission was reduced by first-line (OR = 0.387; 95% CI, 0.173 to 0.848) and noncompliant regimens (OR = 0.414; 95% CI, 0.174 to 0.982) compared to no treatment. On survival analysis, no treatment group was associated with shorter time-to-readmission (log-rank test, p = 0.014) and increased risk of readmission (hazard ratio = 2.27; 95% CI, 1.30 to 3.96) when compared to first-line medications. CONCLUSIONS: Treatment with first-line medications was associated with lower 30-day rehospitalization rates and longer time-to-readmission. Physicians' adherence to treatments with higher-ranked evidence for efficacy, safety, and tolerability may improve bipolar disorder outcomes.

Possible predictors of Covid-19 vaccine hesitancy in the psychiatric population - A scoping review.

Background: The Covid-19 pandemic brought vaccination to the front of the series of measures implemented to address the chain-reaction outbreaks that continue to cause loss and suffering. In spite of its proven efficacy, a considerable percentage of the population remains hesitant or right-out opposed. A need for informing public health strategies not only in regards to the current pandemic but for future similar developments remains of utmost importance for researchers and clinicians alike, especially when it comes to vulnerable categories of population. Identifying risk factors associated with vaccine hesitancy in the psychiatric population is the aim of this scoping review. Methods: We performed a systematic search on the topic of Covid-19 vaccine hesitancy in relation to psychiatric disorders, using three databases: Medline, PubMed and Embase. Inclusion criteria focused on studies looking at individuals with a psychiatric disorder in the context of the Covid-19 vaccine hesitancy where possible determinant factors were discussed. Results: Fifteen articles out of 219 publications on the topic of Covid 19 vaccine hesitancy met our inclusion criteria for this review. The common findings of these studies recognize the following risk factors for Covid 19 hesitancy: diagnosis of severe mental illness such as schizophrenia, lower socioeconomic status, lower educational level, and young age. Conclusions: Our findings may contribute to the proactive development of educational strategies targeting the psychiatric population in the context of cultural, ethnic, age and gender diversity, in order to safeguard the wellbeing of all when facing pandemic events. Overarching future directions include creating vaccination promotion strategies specific for the psychiatric population.