RESUMEN
BACKGROUND: The aim of the study was to examine the differences between former involuntary and voluntary patients with a schizophrenic disorder with regard to time to and frequency of rehospitalization. METHODS: In this prospective observational study, 374 patients with a diagnosis of schizophrenia or schizoaffective disorder were included. At the time of inclusion, 290 (77.5 %) were hospitalized voluntarily and 84 (22.5 %) involuntarily. Follow-up assessments were conducted half-yearly over a 2-year period with measures of PANSS, GAF, sociodemographic data and cognitive functioning. These data served as covariates for adjustment in statistical models that included a Cox regression model, a random-effect logit model and a random-effect tobit model. RESULTS: After adjustment for other relevant covariates, the Cox regression showed that involuntary treatment is a significant risk factor of subsequent rehospitalization (HR = 1.53; CI = 1.06, 2.19; p = 0.02). The involuntary group had higher half-year incidence rates of rehospitalization, and in case of rehospitalization the duration of hospital stay was longer. CONCLUSIONS: Involuntary hospitalization seems to be associated with a higher risk of rehospitalization and longer subsequent hospital stays in patients with schizophrenia and schizoaffective disorders. Further studies are needed to examine in detail the processes and interventions that are suitable for interrupting circles of repeated hospitalizations, especially in former involuntary patients.
Asunto(s)
Readmisión del Paciente/estadística & datos numéricos , Trastornos Psicóticos/terapia , Esquizofrenia/terapia , Adulto , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
PURPOSE: The purpose of the study was to examine the long-term influence of involuntary hospitalization on medication adherence, engagement in out-patient treatment and perceived coercion to treatment participation. METHODS: In a naturalistic observational multi-centre study, 290 voluntarily and 84 involuntarily hospitalized patients with schizophrenia or schizoaffective disorder had been followed up over a period of 2 years with half-yearly assessments. Assessments included self-rated medication adherence, externally judged medication adherence by blood levels, engagement in treatment and perceived coercion. The statistical analyses were based on multilevel hierarchical modelling of longitudinal data. Level and development of the outcome was controlled for involuntariness, for sociodemographic characteristics and clinical history. RESULTS: Involuntariness of the index-hospitalization did not have an effect on the development of treatment engagement or medication adherence judged by blood levels in the course of the follow-up period when the models were controlled for sociodemographic variables and clinical history. It was associated, though, with a continuously lower self-rated medication adherence. Moreover, former involuntarily hospitalized patients more often felt coerced in several treatment aspects at the follow-up assessments. Yet, there was no difference between the voluntary and involuntary group with regard to the development of the levels of adherence or coercion experiences over time. CONCLUSIONS: Involuntary hospitalization does not seem to impair future treatment engagement in patients with schizophrenia, but formerly involuntarily hospitalized patients continue to be more sensitive to subjective or real coercion in their treatment and more vulnerable to medication non-adherence. Hereby, their risk of future involuntary hospitalization might be increased.
Asunto(s)
Antipsicóticos/uso terapéutico , Coerción , Internamiento Obligatorio del Enfermo Mental , Hospitalización/estadística & datos numéricos , Cumplimiento de la Medicación/psicología , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Adulto , Femenino , Hospitales Psiquiátricos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multinivel , Percepción , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , Factores Socioeconómicos , Encuestas y Cuestionarios , Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Objective of this observational trial is to examine the effects of quetiapine in comparison with olanzapine and risperidone on clinical outcomes and quality of life in patients with schizophrenia and schizoaffective disorder in routine care. 374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine, or risperidone at discharge from inpatient treatment were included. Clinical and psychosocial outcomes were assessed before discharge and at 6, 12, 18, and 24 months. Statistical analyses were conducted by mixed-effects regression models for longitudinal data. The propensity score method was used to control for selection bias. Patients discharged on olanzapine had significantly lower hospital readmissions than those receiving quetiapine or risperidone. The average chlorpromazine equivalent dose of quetiapine was higher than in patients treated with olanzapine or risperidone. No further significant differences between treatment groups were found. Quetiapine and risperidone are less effective in preventing the need for psychiatric inpatient care than olanzapine, and higher chlorpromazine equivalent doses of quetiapine are needed to obtain clinical effects similar to those of olanzapine and risperidone.
Asunto(s)
Antipsicóticos/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Adulto , Benzodiazepinas/uso terapéutico , Dibenzotiazepinas/uso terapéutico , Femenino , Administración Hospitalaria/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Olanzapina , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/mortalidad , Fumarato de Quetiapina , Risperidona/uso terapéutico , Esquizofrenia/mortalidad , Sesgo de Selección , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose of this study was to examine patients' response profiles to the Medication Adherence Rating Scale (MARS) and to evaluate the potential of response styles as predictors of the future course of psychotic disorders in terms of rehospitalisation and maintenance of medication. A total of 371 psychiatric in-patients with schizophrenia or schizoaffective disorder who were taking part in a naturalistic long-term study completed a German version of the MARS. A Latent Class Analysis (LCA) was performed. Five latent classes of response styles could be identified: "moderately adherent", "critical discontinuers", "good compliers", "careless and forgetful", and "compliant sceptics". Class membership was found to be related to the severity of symptoms, level of functioning, insight into illness, insight into necessity of treatment, treatment satisfaction and medication side effects. At a six-month follow-up appointment, significant differences between the classes persisted. Participants showing a "good compliers" response pattern had a significantly better prognosis in terms of rehospitalisation rate and maintenance of the original medication than "critical discontinuers". Evaluation of the MARS by studying response profiles provides informative results that reach beyond the results obtained by an evaluation by scores. Patients can be classified into adherence groups that are of predictive value for long-term patient outcome.