Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T18:15:49.344Z Has data issue: false hasContentIssue false
  • English
  • Français

Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia

Published online by Cambridge University Press:  15 April 2020

R.A. Kroken ,
L.S. Mellesdal ,
T. Wentzel-Larsen ,
H.A. Jørgensen  and
E. Johnsen
R.A. Kroken*
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Pb 23, 5812Bergen, Norway
L.S. Mellesdal
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Pb 23, 5812Bergen, Norway
T. Wentzel-Larsen
Affiliation:
Centre for Clinical Research, Haukeland University Hospital, Pb 23, 5812Bergen, Norway Norwegian Centre for Violence and Traumatic Stress Studies, Kirkeveien 166, building 48, 0407Oslo, Norway Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Kirkeveien 166, building 48, 0407Oslo, Norway
H.A. Jørgensen
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Pb 23, 5812Bergen, Norway
E. Johnsen
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Pb 23, 5812Bergen, Norway
*
*Corresponding author. Tel.: +47 55 95 84 00; fax: +47 55 95 84 36. E-mail address:[email protected]
Get access

Abstract

Objective

Evidence based treatment of schizophrenia as well as antipsychotic drug utility patterns have changed considerably in recent years and the present study aims to investigate the current level of unplanned hospital readmissions in a cohort of patients with schizophrenia, and to determine the risk-reducing effects of current antipsychotic drug treatment.

Method

An open cohort study included all consecutively discharged patients with schizophrenia in a 3-year period (n = 277). The treatment-dependent variables were entered in a multivariate Cox survival analyses with time to unplanned readmission as the dependent variable.

Results

11.2% of patients were readmitted within 30days of discharge, and 44.8% were readmitted within 12months. Antipsychotic monotherapy reduced the risk of readmission by 74.9%. Treatment in CMHC also had a risk-reducing effect. The prescription rate of clozapine in this sample was 10.1%.

Discussion

The over-all level of unplanned readmissions was in correspondence with the findings of others. Current antipsychotic drug treatment independently offers strong protection against unplanned readmissions. There may be a potential for further optimalizing antipsychotic drug treatment according to treatment guidelines.

Conclusions

Unplanned readmissions are very common for patients with schizophrenia but antipsychotic drug treatment is associated with a strong risk-reducing effect in this regard.

Keywords

Schizophrenia and psychosisAntipsychoticsPsychiatry in Europe
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 7 , October 2012 , pp. 489 - 495
Copyright
Copyright © European Psychiatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Global Assessment of Function (GAF). 1994Google Scholar
Bridge, J.A.Barbe, R.P.Reducing hospital readmission in depression and schizophrenia: current evidence. Curr Opin Psychiatry. 2004; 17: 505–511.CrossRefGoogle Scholar
Dixon, L.B.Dickerson, F.Bellack, A.S.Bennett, M.Dickinson, D.Goldberg, R.W.et al.Schizophrenia Patient Outcomes Research Team (PORT). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull. 2010; 36: 48–70.CrossRefGoogle ScholarPubMed
Drake, R.E.Osher, F.C.Noordsy, D.L.Hurlbut, S.C.Teague, G.B.Beaudett, M.S.Diagnosis of alcohol use disorders in schizophrenia. Schizophr Bull. 1990; 16: 57–67.CrossRefGoogle Scholar
Edlinger, M.Hausmann, A.Kemmler, G.Kurz, M.Kurzthaler, I.Walch, T.et al.Trends in the pharmacological treatment of patients with schizophrenia over a 12 year observation period. Schizophr Res. 2005; 77: 25–34.CrossRefGoogle Scholar
Elm, E.Altman, D.G.Egger, M.Pocock, S.J.Gøtzsche, P.C.Vandenbroucke, J.P.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiolog. 2008; 61: 344–349.CrossRefGoogle Scholar
Fleischacker, W.W.Oehl, M.A.Hummer, M.Factors influencing compliance in schizophrenia patients. J Clin Psychiatry. 64 suppl 16 2003 10–13.Google Scholar
Harrell, F.E.Regression modelling strategies. New York: Springer; 2001.CrossRefGoogle Scholar
Hermann, R.C.Mattke, S.Somekh, D.Silfverhielm, H.Goldner, E.Glover, G.et al.Quality indicators for international benchmarking of mental health care. Int J Qual Health Care. 18 suppl 1 2006 31–38.CrossRefGoogle ScholarPubMed
Ingram, G.Muirhead, D.Harvey, C.Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: changes in problem behaviours and social functioning. Aust NZ J Psychiatry. 2009; 43: 1077–1083.CrossRefGoogle ScholarPubMed
Johnsen, E.Jørgensen, H.A.Effectiveness of second generation antipsychotics: A systematic review of randomized trials. BMC Psychiatry. 2008; 8: 31.CrossRefGoogle ScholarPubMed
Jónsdóttir, H.Opjordsmoen, S.Birkenaes, A.B.Engh, J.A.Ringen, P.A.Vaskinn, A.et al.Medication adherence in outpatients with severe mental disorders: relation between self-reports and serum level. J Clin Psychopharmacol. 2010; 30: 169–175.CrossRefGoogle ScholarPubMed
Kisely, S.R.Campbell, L.A.Preston, N.J.Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews. 2005 3.Google ScholarPubMed
Kroken, R.A.Johnsen, E.Ruud, T.Wentzel-Larsen, T.Jørgensen, H.A.Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study. BMC Psychiatry. 2009; 9: 24.CrossRefGoogle ScholarPubMed
Leucht, S.Heres, S.Epidemiology, clinical consequences, and psychosocial treatment of non-adherence in schizophrenia. J Clin Psychiatry. 67 suppl 5 2006 3–8.Google Scholar
Lieberman, J.A.Stroup, T.S.McEvoy, J.P.Swartz, M.S.Rosenheck, R.A.Perkins, D.O.et al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005; 355: 1209–1223.CrossRefGoogle Scholar
Madi, N.Zhao, H.Li, J.F.Hospital readmissions for patients with mental illness in Canada. Healthcare Quarterly. 2007; 10: 30–32.CrossRefGoogle ScholarPubMed
Mellesdal, L.Mehlum, L.Wentzel-Larsen, T.Kroken, R.Jørgensen, H.A.Suicide risk and acute psychiatric readmissions: a prospective cohort study. Psychiatr Serv. 2010; 61: 25–31.CrossRefGoogle ScholarPubMed
Mullins, C.D.Obeidat, N.A.Cuffel, B.J.Naradzay, J.Loebel, A.D.Risk of discontinuation of atypical antipsychotic agents in the treatment of schizophrenia. Schizophr Res. 2008; 98: 8–15.CrossRefGoogle ScholarPubMed
Olfson, M.Marcus, S.C.Doshi, J.A.Continuity of care after in-patient discharge of patients with schizophrenia in the Medicaid program: a retrospective longitudinal cohort analysis. J Clin Psychiatry. 2010; 71: 831–838.CrossRefGoogle Scholar
Organization for Economic Co-operation and Development (OECD). OECD Health Care Quality Indicators 2009. http://www.oecd.org/dataoecd/32/4/43947738.xls#’Schizophrenia data’!A1Google Scholar
Rabinowitz, J.Levine, S.Z.Haim, R.Häfner, H.The course of schizophrenia: Progressive deterioration, amelioration or both?. Schizophr Res. 2007; 91: 254–258.CrossRefGoogle ScholarPubMed
Sikka, R.Xia, F.Aubert, R.E.Estimating persistency using administrative claims data. Am J Manag Care. 2005; 11: 449–457.Google ScholarPubMed
Stahl, S.M.Grady, M.M.A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation. Curr Med Chem. 2004; 11: 313–327.CrossRefGoogle ScholarPubMed
Tandon, R.Belmaker, R.H.Gattaz, W.F.Lopez-Ibor, J.J. Jr.Okasha, A.Singh, B.et al.World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophr Res. 2008; 100: 20–38.CrossRefGoogle ScholarPubMed
Therneau, T.M.Grambsch, P.M.Modelling survival data: extending the Cox model. Verlag: Springer; 2000.CrossRefGoogle Scholar
Weiden, P.J.Olfson, M.Cost of relapse in schizophrenia. Schiz Bull. 1995; 21: 419–429.CrossRefGoogle Scholar
Collaborating Centre for Drug Statistics WHO Methodology ATC classification index with DDDs 2008. 2008 WHO.Google Scholar
Wing, J.K.Beevor, A.S.Curtis, R.H.Park, S.B.G.Hadden, S.Burns, A.Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry. 1998; 172: 11–18.CrossRefGoogle ScholarPubMed
World Health Organization Policies and practices for mental health in Europe – meeting the challenges. 2008 WHO http://www.euro.who.int/__data/assets/pdf_file/0006/96450/E91732.pdf.Google Scholar
World Health Organization The ICD-10 classification of mental and behavioural disorders, clinical description and diagnostic guidelines. 1992 WHO.Google Scholar
Øiesvold, T.Saarento, O.Sytema, S.Vinding, H.Gøstas, G.Lønnerberg, O.et al.Predictors for readmission risk of new patients: the Nordic comparative study on sectorized psychiatry. Acta Psychiatr Scand. 2000; 101: 367–373.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.