FACTORS ASSOCIATED WITH RELAPSE OF PERSONS WITH SCHIZOPHRENIA AFTER DISCHARGE FROM PSYCHIATRIC INPATIENT CARE
DOI:
https://doi.org/10.55766/sujst-2024-03-e02808Keywords:
Schizophrenia, Relapse, Hospitalization, Exacerbation, AdmissionAbstract
Background and Hypothesis: Schizophrenia is a chronic condition with high risk of relapse, affecting the lives and careers of those afflicted along with their carers. In the context of Surin hospital, 4.6% of patients with schizophrenia experience relapses within 6 months after discharge from hospital inpatient care. The knowledge regarding factors associated with relapses after discharge from inpatient admissions can prove useful for monitoring and management to reduce the risk of relapses in such patients.
Purpose: To explore the factors associated with relapse of persons with schizophrenia after discharge from psychiatric inpatient care.
Study Design: An etiological study using retrospective matched data case-controls at Surin hospital. Patients with schizophrenia exhibiting relapse within 6 months after discharge from the psychiatric ward between the year 2020-2021 were selected from our database with a ratio of 5 controls to 1 case. The analysis for this etiology study was performed using logistic regression, expressing values in odds ratio, 95% confidence intervals and P values.
Study Results: Of the 817 schizophrenic patients in this study, 263 patients suffered from relapses while 554 patients did not. The factors associated with relapses include the average duration of inpatient admission and duration of illness, the number of psychiatric admissions, discontinuity of medication intake, and the presence of psychiatric comorbidities.
References
Adebiyi M.O., Mosaku S.K., Irinoye O.O., and Oyelade O.O. (2018). Socio-demographic and clinical factors associated with relapse in mental illness. International Journal of Africa Nursing Sciences, 8:149-153. https://doi.org/10.1016/j.ijans.2018.05.007
Almond S., Knapp M., Francois C., Toumi M., and Brugha T. (2004). Relapse in schizophrenia: costs, clinical outcomes and quality of life. The British Journal of Psychiatry, 184:346-351. https://doi.org/10.1192/bjp.184.4.346
Alvarez-Jimenez, M., Priede, A., Hetrick, S.E., Bendall, S., Killackey, E., Parker, A.G., McGorry, P.D. and Gleeson, J.F. (2012). Risk factors for relapse following treatment for first episode psychosis:a systematic review and meta-analysis of longitudinal studies. Schizophrenia Research, 139(1):116-128. https://doi.org/10.1016/j.schres.2012.05.007
Awad A.G. and Voruganti L.N., (2008). The burden of schizophrenia on caregivers: a review. Pharmacoeconomics. 26:149-162. https://doi.org/10.2165/00019053-200826020-00005
Bergé D., Mané A., Salgado P., Cortizo R., Garnier C., Gomez L., Diez-Aja, C., Bulbena, A., Pérez, V. (2016) Predictors of relapse and functioning in frst-episode psychosis: a two-year followup study. Psychiatric Services, 67(2):227-233. https://doi.org/10.1176/appi.ps.201400316
Burns, T., Fiander, M., and Audini, B., (2000). A Delphi approach to characterizing relaps as used in UK clinical practice. International Journal of Social Psychiatry, 46(3):220-230. https://doi.org/10.1177/002076400004600308
Emsley, R., Oosthuizen, P.P., Koen, L., Niehaus, D.J.H., and Martinez, G. (2012). Symptom Recurrence Following Intermittent Treatment in First Episode Schizophrenia Successfully Treated for Two Years. Journal of Clinical Psychiatry, 73(4):e541-7. https://doi.org/10.4088/JCP.11m07138
Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W.F., and Möller, H.J. (2005). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 1: acute treatment of schizophrenia. The World Journal of Biological Psychiatry, 6(3):132-191. https://doi.org/10.1080/15622970510030090
Funk M. (2008). Integrating mental health into primary care: a global perspective. Geneva: World Health Organization, 2008.
Hong J., Windmeijer F., Novick D., Haro J.M., and Brown J. (2009). The cost of relapse in patients with schizophrenia in the European SOHO (Schizophrenia Outpatient Health Outcomes) study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 33(5):835-841. https://doi.org/10.1016/j.pnpbp.2009.03.034
Jablensky A., Sartorius N., Ernberg G., Anker M., Korten A., Cooper J.E., Day R., and Bertelsen A. (2009). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine Monograph Supplement, 1992(20):1-97. https://doi.org/10.1017/S0264180100000904
Jørgensen, K.T., Bøg, M., Kabra, M., Simonsen, J., Adair, M., and Jönsson, L. (2020). Predicting time to relapse in patients with schizophrenia according to patients’ relapse history: a historical cohort study using real-world data in Sweden. BMC Psychiatry, 1-12. https://doi.org/10.1186/s12888-021-03634-z
José, M.O., Jan, S., Michiel, H., Andreas, S. (2013). Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review. Annals of General Psychiatry, 1-11. https://doi.org/10.1186/1744-859X-12-32
Kane J.M. (2007). Treatment strategies to prevent relapse and encourage remission. Journal of Clinical Psychiatry, 68(14):27-30.
Kazadi N.J.B., Moosa M.Y.H., and Jeenah F.Y. (2008). Factors associated with relapse in schizophrenia. South African Journal of Psychiatry, 14(2):52-62. https://doi.org/10.4102/sajpsychiatry.v14i2.158
Kazadi, N.J.B., Moosa, M.Y.H., and Jeenah, F.Y. (2008). Factors associated with relapse in Schizophrenia. South Asia Journalism Fellowship, 14(2):a158. https://doi.org/10.4102/sajpsychiatry.v14i2.158
Moges, S., Belete, T., Mekonen, T., and Menberu M. (2021). Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study. International Journal of Mental Health Systems, 2-12. https://doi.org/10.1186/s13033-021-00464-0
Morken, G., Widen, J.H., Grawe, R.W. (2008). Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry, 1-7. https://doi.org/10.1186/1471-244X-8-32
Pigott, T.A., Carson, W.H., Saha, A.R., Torbeyns, A.R., Stock, E.G., Ingenito, G.G. (2003). Aripiprazole for the prevention of relapse in stabilized patients with chronic schizophrenia: a placebo-controlled 26-week study. Journal of Clinical Psychiatry, 64(9):1,048-56. https://doi.org/10.4088/JCP.v64n0910
Pompili M., Amador X.F., Girardi P., Harkavy-Friedman J., Harrow M., Kaplan K., Krausz, M., Lester, D., Meltzer, H.Y., Modestin, J., Montross, L.P., Mortensen, P.B., Munk-Jørgensen, P., Nielsen, J., Nordentoft, M., Saarinen P.L. Zisook, S. Wilson, S.T., and Tatarelli, R. (2007). Suicide risk in schizophrenia: learning from the past to change the future. Annals of General Psychiatry, 1-22. https://doi.org/10.1186/1744-859X-6-10
Rabinowitz, J., Lichtenberg, P., Kaplan, Z., Mark, M., Nahon, D., Davidson, M. (2001). Rehospitalization rates of chronically ill schizophrenic patients discharged on a regimen of risperidone, olanzapine, or conventional antipsychotics. American Journal of Psychiatry, 158:266-269. https://doi.org/10.1176/appi.ajp.158.2.266
Robinson D., Woerner M.G., Alvir J.M., Bilder R., Goldman R., Geisler S., Koreen, A., Sheitman, B., Chakos, M., Mayerhoff, D., and Lieberman, J.A. (1999). Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry, 56(3):241-247. https://doi.org/10.1001/archpsyc.56.3.241
Suzuki Y., Yasumura S., Fukao S., Otani, k. (2003). Associated factors of rehospitalization among schizophrenic patients. Psychiatry and Clinical Neurosciences, 57(6):555-561. https://doi.org/10.1046/j.1440-1819.2003.01167.x
Taishiro K., Vishesh A., Taro K., Stefan L., John M.K., and Christoph U.C. (2013). Relapse prevention in schizophrenia: a systematic review and meta-analysis of second-generation antipsychotics versus first-generation antipsychotics. molecular psychiatry, 18(1):53-66. https://doi.org/10.1038/mp.2011.143
Uçok, A., Polat, A., Cakir, S., and Genç, A. (2006). One year outcome in first episode schizophrenia. Predictors of relapse. European Archives of Psychiatry and Clinical Neuroscience, 256:37-43. https://doi.org/10.1007/s00406-005-0598-2
Wiersma D., Nienhuis F.J., Sloof C.J., and Giel R. (1998). Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull. 24(1):75-85. https://doi.org/10.1093/oxfordjournals.schbul.a033315
