The prediction of discharge from in-patient psychiatric rehabilitation: a case-control study

BMC Psychiatry

Research Article

Stephen M Lawrie¹  Andrew Watson²  Joanna Bredski³  Fiona Clunie³  Debbie A Mountain⁴ 

[1] Division of Psychiatry, University of Edinburgh, Edinburgh, UK;Intensive Psychiatric Care Unit, Royal Edinburgh Hospital, Edinburgh, UK;Rehabilitation Service, Royal Edinburgh Hospital, Edinburgh, UK;Rehabilitation Service, Royal Edinburgh Hospital, Edinburgh, UK;Intensive Psychiatric Care Unit, Royal Edinburgh Hospital, Edinburgh, UK;

关键词: Clozapine;    Suicide Attempt;    Challenging Behaviour;    Borderline Personality Disorder;    Opiate Dependence;   

DOI  :  10.1186/1471-244X-11-149

 received in 2011-04-21, accepted in 2011-09-16,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundAt any time, about 1% of people with severe and enduring mental illness such as schizophrenia require in-patient psychiatric rehabilitation. In-patient rehabilitation enables individuals with the most challenging difficulties to be discharged to successful and stable community living. However, the length of rehabilitation admission that is required is highly variable and the reasons for this are poorly understood. There are very few case-control studies of predictors of outcome following hospitalisation. None have been carried out for in-patient rehabilitation. We aimed to identify the factors that are associated with achieving discharge from in-patient rehabilitation by carrying out a case-control study.MethodsWe compared two groups: 34 people who were admitted to the Rehabilitation Service at the Royal Edinburgh Hospital and discharged within a six year study period, and 31 people who were admitted in the same period, but not discharged. We compared the groups on demographic, illness, treatment and risk variables that were present at the point of their admission to rehabilitation. We used independent t tests and Pearson Chi-Square tests to compare the two groups.ResultsWe found that serious self harm and suicide attempts, treatment with high dose antipsychotics, antipsychotic polypharmacy and previous care in forensic psychiatric services were all significantly associated with non-discharge. The non-discharged group were admitted significantly later in the six year study period and had already spent significantly longer in hospital. People who were admitted to rehabilitation within the first ten years of developing psychosis were more likely to have achieved discharge.ConclusionsPeople admitted later in the study period required longer rehabilitation admissions and had higher rates of serious self harm and treatment resistant illness. They were also more likely to have had previous contact with forensic services. This change over time is likely to be due to the drive in Scotland to manage mentally disordered offenders in conditions of lower security. There is a growing need for secure longer-term in-patient rehabilitation, particularly for people previously treated in forensic services. Admission to rehabilitation earlier in a person's illness may improve their outcome.

【 授权许可】

CC BY   
© Bredski et al; licensee BioMed Central Ltd. 2011