Does the Ranking Matter? A Retrospective Cohort Study Investigating the Impact of the 2018 CANMAT and ISBD Guidelines for the Management of Patients with Bipolar Disorder Treatment Recommendations for Acute Mania on Rehospitalization Rates.

OBJECTIVE: There is limited data about the impact of mood disorders treatment guidelines on clinical outcomes. The objective of this study was to investigate the impact of prescribers' adherence to the 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) treatment guidelines recommendations on the readmission rates of patients hospitalized for mania. METHOD: A retrospective cohort of all individuals admitted due to acute mania to Kingston General Hospital, Kingston, ON, from January 2018 to July 2021 was included in this study. Patient variables and data regarding index admission and subsequent hospitalizations were extracted from medical records up to December 31, 2021. Treatment regimens were classified as first-line, second-line, noncompliant, or no treatment. We explored the associations between treatment regimens and the risk of readmissions using univariate, multivariate, and survival analysis. RESULTS: We identified 211 hospitalizations related to 165 patients. The mean time-to-readmission was 211.8 days (standard deviation [SD] = 247.1); the 30-day rehospitalization rate was 13.7%, and any rehospitalization rate was 40.3%. Compared to no treatment, only first-line treatments were associated with a statistically significant decreased risk of 30-day readmission (odds ratio [OR] = 0.209; 95% CI, 0.058 to 0.670). The risk of any readmission was reduced by first-line (OR = 0.387; 95% CI, 0.173 to 0.848) and noncompliant regimens (OR = 0.414; 95% CI, 0.174 to 0.982) compared to no treatment. On survival analysis, no treatment group was associated with shorter time-to-readmission (log-rank test, p = 0.014) and increased risk of readmission (hazard ratio = 2.27; 95% CI, 1.30 to 3.96) when compared to first-line medications. CONCLUSIONS: Treatment with first-line medications was associated with lower 30-day rehospitalization rates and longer time-to-readmission. Physicians' adherence to treatments with higher-ranked evidence for efficacy, safety, and tolerability may improve bipolar disorder outcomes.

Cessation of dangerousness status in Brasília, Brazil: An analysis of 144 reports from Federal District Medical Examiner's Office in the last 10 years.

The aim of this study is to evaluate factors related to cessation of dangerousness of individuals under safety measures, through the study of psychiatric reports. This is a cross-sectional study, conducted through a retrospective analysis of expert psychiatric dangerousness cessation reports issued by the Federal District Coroner's Office, Brasília, Brazil. By examining official files, information was extracted from the reports (socio-demographic data, clinical characteristics, type of crime, historical characteristics and the search for items related to risk assessment present in instruments such as Historical, Clinical and Risk Management [HCR-20], Psychopathy Checklist - Revised [PCL-R], Two-Tiered Violence Risk Scale [TTV], Short-Term Assessment of Risk and Treatability [START] and others) and submitted to statistical analysis and then compared to other studies on the subject. The items most considered by the experts were those referring to PCL-R, START and the "non static" part of HCR-20 and TTV. For the non-cessation of dangerousness, we've found: absence of remorse, fragile behavioral control, early behavioral problems, juvenile delinquency. For the cessation of dangerousness, we've found: presence of social skills, balanced emotional state, presence of social support, adherence to rules, good coping strategies, involvement with treatment and adherence. The systematization and standardization of forensic psychiatric reports needs to be established and the use of risk assessment instruments are essential to support better decisions by the experts.