Schizophrenia patients discharged against medical advice at a mental hospital in Taiwan.

AIM: The purpose of the present study was to evaluate the risk factors associated with discharge against medical advice (AMA) and compare the time to rehospitalization between patients with AMA discharges and those with regular discharges. METHODS: All schizophrenia inpatients discharged from a psychiatric hospital between 1 January 2006 and 31 December 2006 were monitored. The clinical variables were compared between the patients discharged AMA and those with regular discharges. Logistic regression was used to determine the best predictor for AMA discharge. Times to rehospitalizaton within 15 and 60 days after discharge were measured using the Kaplan-Meier method. RESULTS: Compared to patients with regular discharges, patients discharged AMA were significantly more likely to be male (P = 0.007), to have comorbid alcohol abuse/dependence (P = 0.007), to take typical antipsychotic agents (P = 0.005) and to have shorter lengths of hospital stay (P < 0.001). Logistic regression demonstrated that male gender (odds ratio [OR], 1.631; 95% confidence interval [CI]: 1.067- 2.493)] and prescription of typical antipsychotic agents (OR, 1.729; 95%CI: 1.098-2.723) were the most influential predictors for discharge AMA. There were significant differences in time to rehospitalization between these two groups during the 15-day (P = 0.009) and 60-day (P = 0.038) follow-up periods. CONCLUSION: Male gender and prescription of typical antipsychotic agents increased the likelihood of AMA discharge. The consequence for patients with AMA discharges was earlier rehospitalization. Future studies are needed in many different mental health systems to better generalize the findings.

Factors predicting transferal after psychiatric emergency management in the elderly.

AIMS: The purpose of this study was to examine the demographic and clinical characteristics that differentiate between elderly and non-elderly visitors in the psychiatric emergency room (ER), and to identify factors predicting transferal after psychiatric emergency management in the elderly. METHODS: Data were collected over four years for patients who visited the psychiatric ER. The elderly were defined as patients older than 65 years old. Demographic and clinical characteristics were analyzed using the chi(2)-test for categorical data and t-tests for continuous data. Multivariate logistic regressions were carried out to find predictive factors associated with being transferred to a general hospital for elderly visitors in the psychiatric ER. RESULTS: Elderly patients made up 3.4% of all included visitors (n = 243) during the four-year period. The mean number of visits for elderly visitors was 1.63 +/- 1.18, ranging from 1 to 7. The chi(2)-test and the t-test indicated that the elderly visitors were different from controls in many demographic and clinical variables. Multivariate logistic regression analysis showed that being transferred to a general hospital for elderly visitors in the psychiatric ER was associated with age (odds ratio = 1.32) and a greater number of previous psychiatric hospitalizations (odds ratio = 1.42). Patients without a thought-form problem also required transferal to a general hospital more often in our study. CONCLUSIONS: The study suggested that elderly visitors in the psychiatric ER were a unique group, and specific considerations should be included in the intervention for these patients.