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[Prognosis of short-term outcome in the first admission for psychosis]
H Verdoux1, F Liraud, B Gonzales
1CHS Charles Perrens, Service Universitaire de Psychiatrie, Centre Carreire, Bordeaux.
Insights
Family history of psychiatric hospitalization may predict longer first hospital stays for psychosis. Schizophrenia diagnosis and poor functioning predict symptom persistence, while low education and poor functioning predict antipsychotic prescription at discharge.
Area of Science:
- Psychiatry
- Clinical Psychology
- Epidemiology
Context:
- First-episode psychosis requires understanding predictors of clinical and therapeutic outcomes.
- Population-based studies are crucial for generalizable findings on psychotic symptom management.
- Assessing outcomes at discharge informs treatment strategies and patient recovery trajectories.
Purpose:
- To identify factors predicting the duration of the first hospitalization for patients with psychotic symptoms.
- To determine predictors of psychotic symptom persistence at discharge.
- To examine factors associated with antipsychotic medication prescription at discharge.
Summary:
- A family history of psychiatric hospitalization was a trend-level predictor of longer first hospital stays (HR = 0.54).
- Persistence of psychotic symptoms was strongly associated with schizophrenia diagnosis (OR = 23.9) and lower Global Assessment of Functioning (GAF) scores (OR = 0.93).
- Antipsychotic prescription at discharge was predicted by low educational level (OR = 5.5) and low GAF scores (OR = 0.94).
Impact:
- Findings highlight the role of family history in hospitalization duration for first-episode psychosis.
- Identifying predictors of symptom persistence and medication use can guide targeted interventions.
- Understanding socioeconomic and functional factors influencing treatment is essential for optimizing care in psychotic disorders.
Abstract:
The aim of the study was to assess the factors predicting the clinical and therapeutic outcome at discharge of first hospitalization in a population-based sample of patients presenting with psychotic symptoms. Factors predicting duration of the first hospital stay were examined using Cox proportional hazard regression. A family history of psychiatric hospitalization was the only variable independently predicting at trend level a longer hospitalization (HR = 0.54, 95% CI 0.28-1.07, p = 0.08). Since most subjects (92.5%) returned to an independent place of residence in the community after the hospital stay, factors predicting residential outcome were not assessed. Factors associated with persistence of psychotic symptoms, or prescription of antipsychotic drugs, at discharge, were examined using logistic regression models. Persistence of psychotic symptoms (whatever their intensity) was associated with a diagnosis of schizophrenia broadly defined (OR = 23.9, 95% CI 2.8-201.7, p = 0.003), with poor adjustment in the preceding year as measured by the Global Assessment of Functioning (GAF) scale (OR = 0.93, 95% CI 0.87-0.99, p = 0.04), and, at trend level, with older age at admission (OR = 1.1, 95% CI 0.99-1.21, p = 0.07). Prescription of antipsychotic drugs at discharge was independently predicted by low educational level (OR = 5.5, 95% CI 1.2-25.4, p = 0.03), low GAF score (OR = 0.94, 95% CI 0.90-0.99, p = 0.05), and, at trend level, by a diagnosis of schizophrenia broadly defined (OR = 4.1, 95% CI 0.80-23.4, p = 0.09). Univariate analyses showed that duration of psychosis before first admission was strongly associated with persistence of psychotic symptoms and with prescription of antipsychotic drugs at discharge. However, no association was found between duration of psychosis and outcome after adjustment.