Factors Associated with Readmission Among Individuals with One Previous Episode of Schizophrenia in Southern Thailand: A University Hospital-based Retrospective Study
DOI:
https://doi.org/10.31584/jhsmr.2022877Keywords:
factor, prevention, readmission, relapse, schizophreniaAbstract
Objective: Schizophrenia is a chronic disease that has residual symptoms and relapse. The study aims to explore factors associated with readmission from symptom relapse among individuals with schizophrenia.
Material and Methods: Medical records of patients who had their first schizophrenia diagnosis, in the Songklanagarind hospital’s inpatient psychiatric unit, were retrospectively reviewed for the period from January 2007 to December 2019. This yielded data outlining demographic information, profiles of schizophrenia, and treatment. Descriptive statistical analysis was utilized to process all data, and factors associated with readmission were investigated using bivariate and multivariate analyses.
Results: Reviewed medical records identified a sample size of 156 individuals with schizophrenia. The majority were male (50.6%), Buddhist (85.9%), unmarried (80.1%), unemployed (50.6%), and living with their families (90.4%). Mean age was 39.2 years. From the 156 patients, they were divided into two groups; the readmission group and the non-readmission group. Readmission was defined as rehospitalization to a psychiatric unit within 5 years after their first schizophrenia diagnosis. Of all of them, 84 (53.8%) featured readmission whereas 72 (46.2%) were non-readmission. The first to fifth readmission rate was 22.4%, 12.8%, 9.6%, 5.1%, 3.8%, respectively. Multivariate analysis indicated that individuals with schizophrenia having stressful life events, non-adherence to medication, prescription changes, and lack of insight were all factors with a statistically significant association to readmission.
Conclusion: Stressful life events, adverse events, non-adherence, change the prescription, and lack of insight were related to readmission. Emphasizing multimodality of treatment could be key to successful readmission prevention for individuals with schizophrenia.
References
Higashi K, Medic G, Littlewood KJ, Diez T, Granstrom O, De Hert M. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Ther Adv Psychopharmacol 2013;3:200-18.
Kazadi NJB, Moosa MYH, Jeenah FY. Factors associated with relapse in schizophrenia. S Afr J Psychiatr 2008;14:52-62.
Kaplan G, Casoy J, Zummo J. Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia. Patient Prefer Adherence 2013;7:1171-80.
Agrasuta T, Pitanupong J. Perceived stigma in patients with schizophrenia and caregivers in Songklanagarind Hospital: cross-sectional study. Songkla Med J 2017;35:37-45.
Pitanupong J, Rueangwiriyanan C. Caregiver burdens in patients with schizophrenia and related factors. J Ment Health Thai 2019;27:95-106.
Hong J, Windmeijer F, Novick D, Haro JM, Brown J. The cost of relapse in patients with schizophrenia in the European SOHO (Schizophrenia Outpatient Health Outcomes) study. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:835-41.
Harrow M, Jobe TH. Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. J Nerv Ment Dis 2007;195:406-14.
Almond S, Knapp M, Francois C, Toumi M, Brugha T. Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry 2004;184:346-51.
Csernansky JG, Schuchart EK. Relapse and rehospitalisation rates in patients with schizophrenia: effects of second generation antipsychotics. CNS Drugs 2002;16:473-84.
Awad AG. Antipsychotic medications: compliance and attitudes towards treatment. Curr Opin Psychiatry 2004;17:75–80.
Suzuki Y, Yasumura S, Fukao A, Otani K. Associated factors of rehospitalization among schizophrenic patients. Psychiatry Clin Neurosci 2003;57:555-61.
Siris SG. Depression in schizophrenia: perspective in the era of "Atypical" antipsychotic agents. Am J Psychiatry 2000;157:1379- 89.
San L, Bernardo M, Gomez A, Pena M. Factors associated with relapse in patients with schizophrenia. Int J Psychiatry Clin Pract 2013;17:2-9.
Chabungbam G, Avasthi A, Sharan P. Sociodemographic and clinical factors associated with relapse in schizophrenia. Psychiatry Clin Neurosci 2007;61:587-93.
Fenton WS. Comorbid conditions in schizophrenia. Curr Opin Psychiatry 2001;14:17-23.
Green AI, Canuso CM, Brenner MJ, Wojcik JD. Detection and management of comorbidity in patients with schizophrenia. Psychiatr Clin North Am 2003;26:115-39.
Berge D, Mane A, Salgado P, Cortizo R, Garnier C, Gomez L, et al. Predictors of relapse and functioning in first-episode psychosis: a two-year follow-up study. Psychiatr Serv 2016;67:227-33.
Harris MG, Henry LP, Harrigan SM, Purcell R, Schwartz OS, Farrelly SE, et al. The relationship between duration of untreated psychosis and outcome: an eight-year prospective study. Schizophr Res 2005;79:85-93.
Dolder CR, Lacro JP, Jeste DV. Adherence to antipsychotic and nonpsychiatric medications in middle-aged and older patients with psychotic disorders. Psychosom Med 2003;65:156-62.
Hudson TJ, Owen RR, Thrush CR, Han X, Pyne JM, Thapa P, et al. A pilot study of barriers to medication adherence in schizophrenia. J Clin Psychiatry 2004;65:211-6.
Valenstein M, Blow FC, Copeland LA, McCarthy JF, Zeber JE, Gillon L, et al. Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors. Schizophr Bull 2004;30:255-64.
Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 2002;63:892-909.
Suzuki T, Uchida H, Takeuchi H, Nomura K, Tanabe A, Watanabe K, et al. Simplifying psychotropic medication regimen into a single night dosage and reducing the dose for patients with chronic schizophrenia. Psychopharmacology 2005;181:566-75.
Gaebel W, Schreiner A, Bergmans P, de Arce R, Rouillon F, Cordes J, et al. Relapse prevention in schizophrenia and schizoaffective disorder with risperidone long-acting injectable vs quetiapine: results of a long-term, open-label, randomized clinical trial. Neuropsychopharmacology 2010;35:2367-77.
Talaslahti T, Alanen HM, Hakko H, Isohanni M, Hakkinen U, Leinonen E. Change in antipsychotic usage pattern and risk of relapse in older patients with schizophrenia. Int J Geriatr Psychiatry 2013;28:1305-11.
Jimenez MA, Priede A, Hetrick SE, Bendall S, Killackey E, Parker AG, et al. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res 2012;139:116-28.
Shewangizaw Z, Mukherjee R. Prevalence of relapse and associated factors in patient with schizophrenia at Amanuel mental specialized hospital, Addis Ababa, Ethiopia: institution based cross sectional study. IJIMS 2014;2:184-92.
Taengbunngam S, Chincharoensup D, Vitayanont A. Attitudes toward mental illness of psychiatric patients, relatives of psychiatric patients and homeowners from a homestay family camp. J Psychiatr Assoc Thailand 2015;60:149-54.
Teetharatkul T, Pitanupong J. Meaning in life and medication adherence among Thai schizophrenic patients. J Health Sci Med Res 2022. doi:10.31584/jhsmr.2022864.
Hung YY, Chan HY, Pan YJ. Risk factors for readmission in schizophrenia patients following involuntary admission. PLoS One 2017;12:e0186768.
Wolfe MM, Yang PH, Wong EC, Atkinson DR. Design and development of the European American values scale for Asian Americans. Cultur Divers Ethnic Minor Psychol 2001;7:274-83.
Phanthunane P, Vos T, Whiteford H, Bertram M, Udomratn P. Schizophrenia in Thailand: prevalence and burden of disease. Popul Health Metr 2010;8:1-8.
Anekwit N. Relapse rate of schizophrenia and other psychotic disorders in patients at mahasarakham hospital. J DMS 2018; 43:35-9.
Alvarez-Jimenez M, Priede A, Hetrick SE, Bendall S, Killackey E, Parker AG, et al. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta analysis of longitudinal studies. Schizophr Res 2012;139:116- 28.
Roick C, Heider D, Bebbington PE, Angermeyer MC, Azorin JM, Brugha TS, et al. Burden on caregivers of people with schizophrenia: comparison between Germany and Britain. Br J Psychiatry 2007;190:333-8.
Brown E, Bedi G, McGorry P, O’Donoghue B. Rates and predictors of relapse in first-episode psychosis: an Australian cohort study. Schizophr Bull Open 2020;1. doi:10.1093/ schizbullopen/sgaa017.
Capite SD, Upthegrove R, Mallikarjun P. The relapse rate and predictors of relapse in patients with first-episode psychosis following discontinuation of antipsychotic medication. Early Interv Psychiatry 2018;12:893-9.
Kreyenbuhl J, Buchanan RW, Dickerson FB, Dixon LB. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009. Schizophr Bull 2010;36:94-103.
Masakazu H, Hiroyuki K, Akane S, Shigeki Y, Nakao I. Trend survey on adverse event profiles of antipsychotic long-acting injections and oral agents using the Japanese adverse drug event report database. Psychiatry Res 2020;291:113249.
Pitanupong J, Karakate A, Tepsuan L, Sritrangnant G. Attitudes toward long-acting injectable antipsychotics among schizo phrenic patients in southern Thailand: a multihospital-based cross-sectional survey. Siriraj Med J 2022. doi.10.33192/Smj. 2022.24.
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