Is it Possible To Identify Patients After Their First Hospitalization for a Psychotic Disorder Who Do Not Use...

Area of Science:

• Psychiatry and Mental Health
• Clinical Epidemiology

Background:

• Professional guidelines recommend maintenance antipsychotic treatment for patients with psychotic disorders and multiple relapses.
• However, some patients discontinue antipsychotics without subsequent relapse, prompting investigation into predictive factors.

Purpose of the Study:

• To characterize patients with psychotic disorders who, early in their disease and not on maintenance antipsychotics, do not experience re-hospitalization.
• To identify sociodemographic and clinical factors associated with re-hospitalization or death in this patient group.

Main Methods:

• A population-based cohort study utilizing registry data from Sweden and Israel, including patients diagnosed with their first psychotic episode (ICD 10 codes F20-29).
• Follow-up for up to 7 years for re-hospitalization or death.
• Multivariate analyses and meta-analysis of results from both countries to assess risk factors in patients with one hospitalization who did not fill antipsychotic prescriptions.

Main Results:

• The main analysis included 1611 patients from Sweden and 1607 from Israel.
• Male gender (aHR 1.57) and a diagnosis of narrowly defined schizophrenia (aHR 1.85) were associated with an increased risk of a second hospitalization or death in patients not using antipsychotics.
• No sociodemographic or clinical characteristics were found to be associated with a decreased risk of re-hospitalization or death.

Conclusions:

• Registry data did not allow for clinically meaningful characterization of patients who could safely discontinue antipsychotic medications without risk of re-hospitalization or death.
• Male gender and narrowly defined schizophrenia diagnoses are associated with an increased risk of later relapse in patients not on antipsychotics.