Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach.

OBJECTIVES: The study examines the clinical determinants of involuntary psychiatric hospitalization. Specifically, it investigates whether distinct clinical profiles of hospitalized patients can be discerned, what other characteristics they are linked with, and which profiles predict involuntary admission. METHODS: In this cross-sectional multicentre population study, data were collected for 1067 consecutive admissions in all public psychiatric clinics of Thessaloniki, Greece, during 12 months. Through Latent Class Analysis distinct patient clinical profiles were established based on Health of the Nation Outcome Scales ratings. The profiles were then correlated with sociodemographic, other clinical, and treatment-related factors as covariates and admission status as a distal outcome. RESULTS: Three profiles emerged. The "Disorganized Psychotic Symptoms" profile, combining positive psychotic symptomatology and disorganization, included mainly men, with previous involuntary hospitalizations and poor contact with mental health services and adherence to medication, indicating a deteriorating condition and chronic course. Τhe "Active Psychotic Symptoms" profile included younger persons with positive psychotic symptomatology in the context of normal functioning. The "Depressive Symptoms" profile, characterized by depressed mood coupled with nonaccidental self-injury, included mainly older women in regular contact with mental health professionals and treatment. The first two profiles were associated with involuntary admission and the third with voluntary admission. CONCLUSIONS: Identifying patient profiles allows the examination of the combined effect of clinical, sociodemographic, and treatment-related characteristics as risk factors for involuntary hospitalization, moving beyond the variable-centered approach mainly adopted to date. The identification of two profiles associated with involuntary admission necessitates the development of interventions tailored to chronic patients and younger persons suffering from psychosis respectively.

Short-term reliability of retrospective childhood trauma reports in schizophrenia spectrum psychosis.

Childhood trauma (CT) refers to severe early life adversities, especially experiences of parental abuse and neglect. Patients with schizophrenia spectrum psychosis (SSP) report higher CT rates than the general population. As CT assessment in SSP samples has been mainly conducted retrospectively through adult recollections of childhood adverse events, reservations about the reliability and validity of these reports have arisen. We sought to explore the short-term reliability of retrospective CT reports in sixty-three patients with SSP, by assessing the concurrent validity and test-retest reliability of the data. Two CT self-report measures, the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and the Parental Bonding Instrument (PBI) were employed for this task. High concurrent validity was detected between CECA.Q antipathy scales and PBI care and overprotection scales; and between CECA.Q neglect scales and PBI care scales. High test-retest reliability was confirmed for all CECA.Q and PBI scales. Our findings indicate that retrospective CT self-report measures are a reliable means of assessing early life adversities in SSP. However, further provisions should be taken to increase the reliability of retrospective reports, especially corroboration of the events through other sources and removal of latent confounders, such as psychopathology, memory fallacies and social desirability biases.