Poor prognosis for schizophrenia patients leaving hospital against medical advice
MedWire News: Schizophrenia patients discharged from hospital against medical advice (AMA) are more likely to be readmitted and die from suicide attempts and accidents than are patients discharged on physician recommendation, study findings from Israel indicate.
It is more common for psychiatric patients to be discharged AMA than it is for general medical or surgical patients, and rates of discharges AMA among psychiatric patients have been increasing steadily over recent decades.
To examine the prognosis of psychiatric patients discharged AMA, Avi Valevski, from Geha Medical Center in Petach Tikva, and colleagues reviewed the records of 12,937 admissions of 8052 schizophrenia patients between 1984 and 2005.
The team compared 673 schizophrenia patients identified as having left hospital AMA with 1345 control patients who were discharged based on a physician recommendation.
Of the patients who left hospital AMA, 50% did so during the first 2 weeks of admission, 3% left on the first day of admission, and 49% left during their first admission to hospital, the team notes in the journal European Psychiatry.
Patients who left hospital AMA were more likely than control patients to be male and single. In addition, they were younger at their first admission and had a shorter duration of illness. This group also had significantly more prior admissions during the study period than the control group, were more likely to have involuntary admission, less likely to have a physical comorbidity, and more likely to be using alcohol or drugs.
AMA-discharged patients were readmitted to hospital significantly more often than control patients. Other predictors of readmission were male gender and duration of illness. Although study patients were significantly less likely than controls to die during follow-up, at 9.8% versus 16.6%, they were more likely to commit suicide and die from accidents, at 27.7% versus 11.4% and 13.8% versus 5.5%, respectively.
The team writes: "In view of the fact that 49% of the study patients left the hospital AMA during their first admission and 50% left the hospital within the first 2 weeks of hospitalization, special attention should to be addressed to schizophrenia inpatients at the beginning of their first hospitalization in an attempt to prevent further recurrent admissions and increased mortality rate."
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By Liam Davenport