Introduction
Methods
Inclusion and exclusion criteria
Data collection
Data analysis
Results
Baseline characteristics of the study participants
Variable | All participants in 2018 n (%) | Participants with readmission | t/ χ2 (p-value) | |
---|---|---|---|---|
No n (%) 157 (76.2) | Yes n (%) 49 (23.8) | |||
Age (mean, S.E)
| 31.2 (0.9) | 31.7 (1.0) | 29.5 (1.6) | 1.09 (0.277) |
Gender
| ||||
Female | 104 (50.5) | 77 (49.0) | 27 (55.1) | 0.75 (0.386) |
Male | 102 (49.5) | 80 (51.0) | 22 (44.9) | |
Level of education*
| ||||
None | 37 (18.0) | 28 (17.8) | 9 (18.4) | 7.32 (0.119) |
Primary | 32 (15.5) | 29 (18.5) | 3 (6.1) | |
Secondary | 50 (24.3) | 34 (21.7) | 16 (32.6) | |
Tertiary | 22 (10.7) | 19 (12.1) | 3 (6.1) | |
Missing | 65 (31.5) | 47 (30.0) | 18 (36.7) | |
Marital status*
| ||||
Divorced | 1 (0.5) | 1 (0.6) | 0 (0.0) | 4.69 (0.455) |
Married/cohabiting | 78 (37.9) | 57(36.3) | 21 (42.9) | |
Separated | 14 (6.8) | 9 (5.7) | 5 (10.2) | |
Single | 85 (41.3) | 65 (41.4) | 20 (40.8) | |
Widowed | 3 (1.5) | 3 (1.9) | 0 (0.0) | |
Missing | 25 (12.1) | 22 (14.0) | 3 (6.1) | |
Positive family history of mental illness*
| ||||
No | 166 (80.6) | 128 (81.5) | 38 (77.5) | 0.38 (0.539) |
Yes | 40 (19.4) | 29 (18.5) | 11 (22.5) | |
Occupation*
| ||||
Unemployed | 142 (68.9) | 107 (68.1) | 35 (17.4) | 0.19 (0.911) |
Employed | 23 (11.2) | 18 (11.5) | 5 (10.2) | |
Missing | 41 (19.9) | 32 (20.4) | 9 (18.4) |
Clinical characteristics of study participants and readmissions during the years of follow up
Variables | T0 (First admission in 2018 n (%) (n = 206) | R1 (Re-admitted) n (%) (n = 49) | R2 (Second re-admission) n (%) (n = 23) | R3 (Third and/or more re-admissions) n (%) (n = 14) | χ2 / F (p-value) |
---|---|---|---|---|---|
Duration with symptoms before admission (in days) (mean, S.E)
| 56 (14.8) | 7 (1.2) | 5 (10.9) | 10 (3.1) | 1.26 (0.288) |
Days of admission (mean, S.E)
| 11 (1.0) | 12 (4.1) | 10 (1.8) | 8 (2.2) | 0.24 (0.870) |
Psychotherapy treatment given
| |||||
No | 146 (70.8) | 25 (51.0) | 7 (30.4) | 6 (42.9) |
20.28 (< 0.001)
|
Yes | 60 (29.2) | 24 (49.0) | 16 (69.6) | 8 (57.1) | |
SYMPTOMS AT PRESENTATION IN HOSPITAL
| |||||
Hallucinations
| |||||
No | 159 (77.2) | 45 (91.8) | 21 (91.3) | 12 (85.7) | 7.52 (0.057) |
Yes | 47 (22.8) | 4 (8.16) | 2 (8.7) | 2 (14.3) | |
Delusions
| |||||
No | 173 (84.0) | 44 (89.8) | 20 (87.0) | 12 (85.7) | 1.13 (0.771) |
Yes | 33 (16.0) | 5 (10.2) | 5 (13.0) | 2 (14.3) | |
Uncoordinated speech
| |||||
No | 143 (69.4) | 44 (89.8) | 19 (82.6) | 13 (92.9) |
12.24 (0.007)
|
Yes | 63 (30.6) | 5 (10.2) | 4 (17.4) | 4 (7.1) | |
Suspiciousness
| |||||
No | 194 (94.2) | 47 (95.9) | 23 (100) | 14 (100) | 2.40 (0.494) |
Yes | 12 (5.8) | 2 (4.1) | - | - | |
Poor sleep
| |||||
No | 74 (35.9) | 16 (32.6) | 5 (21.7) | 1 (7.1) | 6.36 (0.095) |
Yes | 132 (64.1) | 33 (67.4) | 18 (78.3) | 13 (92.9) | |
Physical aggression
| |||||
No | 88 (42.7) | 22 (44.9) | 19 (82.6) | 9 (64.3) |
14.97 (0.002)
|
Yes | 118 (57.3) | 27 (55.1) | 4 (17.4) | 4 (35.7) | |
Food refusal
| |||||
No | 194 (94.2) | 47 (95.9) | 20 (87.0) | 12 (85.7) | 3.64 (0.303) |
Yes | 12 (5.8) | 2 (4.1) | 3 (13.0) | 2 (14.3) | |
Affective lability
| |||||
No | 179 (86.9) | 43 (87.8) | 18 (78.3) | 13 (92.9) | 1.93 (0.588) |
Yes | 27 (13.1) | 6 (12.2) | 5 (21.7) | 1 (7.1) | |
Talking to self
| |||||
No | 189 (91.7) | 45 (91.8) | 21 (91.3) | 13 (92.9) | 0.03 (0.999) |
Yes | 17 (8.3) | 4 (8.2) | 2 (8.7) | 1 (7.1) | |
Restlessness
| |||||
No | 129 (62.6) | 27 (55.1) | 11 (47.8) | 9 (64.3) | 2.61 (0.457) |
Yes | 77 (37.4) | 22 (44.9) | 12 (52.2) | 5 (35.7) | |
Self-neglect
| |||||
No | 180 (87.38) | 44 (89.8) | 22 (95.7) | 13 (92.9) | 1.77 (0.622) |
Yes | 26 (12.6) | 5 (10.2) | 5 (10.2) | 1 (7.1) | |
Destructiveness
| |||||
No | 171 (83.0) | 39 (79.6) | 22 (95.7) | 13 (92.9) | 3.98 (0.264) |
Yes | 35 (17.0) | 10 (20.4) | 1 (4.4) | 1 (7.4) | |
Singing
| |||||
No | 188 (91.3) | 46 (93.9) | 20 (86.9) | 13 (92.9) | 1.01 (0.800) |
Yes | 18 (8.7) | 3 (6.1) | 3 (13.1) | 1 (7.1) | |
Increased religiosity
| |||||
No | 192 (93.2) | 46 (93.9) | 22 (95.7) | 14 (100) | 1.19 (0.755) |
Yes | 14 (6.8) | 3 (6.1) | 1 (4.3) | - | |
High energy levels
| |||||
No | 150 (72.8) | 34 (69.4) | 18 (78.3) | 11 (78.6) | 0.87 (0.833) |
Yes | 56 (27.2) | 15 (30.6) | 5 (21.7) | 3 (21.4) | |
Wandering away from home
| |||||
No | 132 (64.1) | 43 (87.8) | 19 (82.6) | 13 (92.9) |
16.19 (0.001)
|
Yes | 74 (35.9) | 6 (12.2) | 4 (17.4) | 1 (7.1) | |
Talkativeness
| |||||
No | 81 (39.3) | 22 (44.9) | 8 (34.8) | 6 (42.9) | 0.84 (0.841) |
Yes | 125 (60.7) | 27 (55.1) | 15 (65.2) | 8 (57.1) | |
Social withdrawal
| |||||
No | 198 (96.1) | 47 (95.9) | 22 (95.6) | 14 (100) | 0.59 (0.899) |
Yes | 8 (3.9) | 2 (4.1) | 1 (4.4) | - | |
Suicidality
| |||||
No | 200 (97.1) | 49 (100) | 23 (100) | 13 (100) | 3.35 (0.341) |
Yes | 6 (2.9) | - | - | - | |
Grandiosity
| |||||
No | 186 (92.3) | 45 (91.8) | 22 (95.7) | 14 (100) | 2.19 (0.534) |
Yes | 20 (9.7) | 4 (8.2) | 1 (4.4) | - | |
Thoughtlessness
| |||||
No | 206 (100) | 48 (98.0) | 23 (100) | 14 (100) | 4.98 (0.174) |
Yes | - | 1 (2.0) | - | - | |
Poor appetite
| |||||
No | 191 (92.7) | 45 (92.0) | 22 (95.6) | 12 (85.7) | 1.30 (0.730) |
Yes | 15 (7.3) | 4 (8.0) | 1 (4.4) | 2 (14.3) | |
Undressing in public
| |||||
No | 186 (90.3) | 44 (89.8) | 23 (100) | 14 (100) | 4.00 (0.264) |
Yes | 20 (9.7) | 5 (10.2) | - | - | |
Irritability
| |||||
No | 191 (92.7) | 45 (91.8) | 20 (87.0) | 10 (71.4) |
7.86 (0.049)
|
Yes | 15 (7.3) | 4 (8.2) | 3 (13.0) | 4 (28.6) | |
Disorganized speech
| |||||
No | 196 (95.2) | 21 (91.3) | 21 (91.3) | 14 (100) | 1.53 (0.766) |
Yes | 10 (4.9) | 2 (8.7) | 2 (8.7) | - | |
Substance use
| |||||
No | 188 (91.3) | 46 (93.9) | 21 (91.3) | 14 (100) | 1.64 (0.651) |
Yes | 18 (8.7) | 3 (6.1) | 2 (8.7) | - | |
History of a stressor
| |||||
No | 160 (78.4) | 32 (66.7) | 15 (65.2) | 8 (57.1) | 6.45 (0.091) |
Yes | 44 (21.6) | 16 (33.3) | 8 (34.8) | 6 (42.9) | |
Chlorpromazine
| |||||
No | 23 (11.2) | 4 (8.3) | 1 (4.4) | 2 (14.3) | 1.49 (0.685) |
Yes | 183 (88.8) | 44 (91.7) | 22 (95.6) | 12 (85.7) | |
Haloperidol
| |||||
No | 165 (80.1) | 41 (85.4) | 20 (87.0) | 10 (71.4) | 2.09 (0.554) |
Yes | 41 (19.9) | 7 (14.6) | 3 (13.0) | 4 (28.6) | |
Risperidone
| |||||
No | 2012(98.1) | 48 (100) | 22 (95.6) | 14 (100) | 2.09 (0.555) |
Yes | 4 (1.9) | - | 1 (4.4) | - | |
Stela zine
| |||||
No | 205 (99.5) | 47 (97.9) | 23 (100) | 14 (100) | 1.75 (0.626) |
Yes | 1 (0.5) | 1 (2.1) | - | - | |
Fluphenazine
| |||||
No | 187 (90.8) | 39 (81.3) | 21 (91.3) | 12 (85.7) | 3.88 (0.274) |
Yes | 19 (9.2) | 9 (18.8) | 2 (8.7) | 2 (14.3) | |
Quetiapine
| |||||
No | 205 (99.5) | 48 (100) | 23 (100) | 14 (100) | 0.41 (0.937) |
Yes | 1 (0.5) | - | - | - | |
Mood stabilizers
| |||||
Carbamazepine
| |||||
No | 47(22.8) | 11 (22.5) | 1 (4.4) | 2(14.3) | 4.71 (0.194) |
Yes | 159 (77.2) | 38 (77.6) | 22 (95.6) | 12 (85.7) | |
Sodium valproate
| |||||
No | 194 (94.2) | 44 (89.8) | 21 (91.3) | 14 (100) | 2.12 (0.547) |
Yes | 12 (7.1) | 5 (10.2) | 2 (8.7) | - | |
Antidepressants
| |||||
Amitriptyline
| |||||
No | 194 (94.2) | 47 (95.9) | 22 (95.7) | 13 (92.9) | 0.36 (0.948) |
Yes | 12 (5.8) | 2 (4.1) | 1 (4.3) | 1 (7.1) | |
Fluoxetine
| |||||
No | 205 (99.5) | 48 (98.0) | 23 (100) | 13 (92.9) | 6.48 (0.0915) |
Yes | 1 (0.5) | 1 (2.0) | - | 1 (7.14) |
Annual rates of re-admissions among study participants stratified by the number of episodes of re-admission
First readmission (R1)
Second readmission (R2)
Three or more readmissions (R3)
Variable | Total number of readmissions | Mean time to readmission during study period. (in months) Mean (SD) | 0 to12months n (%) | 13 to 24months n (%) | 25 to 36months n (%) | 37 to 48months n (%) |
---|---|---|---|---|---|---|
R1 | 49 | 10.7 (9.8) | 34 (69.4) | 11 (22.5) | 2 (4.1) | 2 (4.1) |
R2 | 23 | 7.9 (6.4) | 18 (78.3) | 5 (21.7) | - | - |
R3 | 14 | 7 (6.6) | 12 (87.5) | 1 (7.1) | 1 (7.1) | - |
Factors associated with readmission among study participants
Variable | Hazard ratio (95% CI) | P value |
---|---|---|
First readmission (Time from T0 to R1)
| ||
Duration with symptoms before admission (in days) | 0.88 (0.79–0.97) |
0.011
|
High energy levels | 0. 23 (0.06–0.94) |
0.041
|
Mood lability | 0.001 (0.00–0.09) |
0.002
|
Poor appetite | 12.87 (1.36–121.44) |
0.026
|
Undressing in public | 19.65 (2.41–160.45) |
0.005
|
Second readmission (Time from R1 to R2)
| ||
Food refusal | 150.88 (1.50–15206.55) |
0.033
|