Factors and motives associated with drop-out in an ambulatory service for patients with psychotic disorders

Rates and predictors of disengagement of patients with first-episode psychosis from the early intervention service for sychosis service (EASY) covering 15 to 64 years of age in Hong Kong

AIM

This study aims at assessing the rate and predictors of disengagement of patients with first-episode psychosis (FEP) from the early intervention (EI) service in Hong Kong (EASY) that covers age 15 to 64.

METHODS

All FEP patients aged 15 to 64 years who were newly registered with the EASY programme of Kowloon West Psychiatric Unit from January to December 2012 were included. Data on socio-demographic, clinical characteristics and disengagement over 3 years of the EI service were obtained retrospectively through systematic clinical record review. Predictors of 3 different types of disengagement and their rate of occurrence were identified: complete disengagement (type I), disengaged and re-engaged through hospitalization (type II) and re-engaged as outpatient (type III).

RESULTS

Among the 277 patients included for analysis, 36 patients (13%) had type I disengagement, 17.2% (N = 21) were of age 15 to 25 and 9.7% (N = 15) were of age 25 to 64. Type II and type III disengagements were 4.3% and 13.4%, respectively. Early-stage poor drug compliance significantly predicted type I and type II disengagements. History of substance use, suicidal attempts and poor drug compliance predicted type III disengagement. Younger patients had significant earlier disengagement (χ²  = 5.01, df = 1, P = .025).

CONCLUSION

Results of the current study highlighted the different patterns of disengagement for different age groups and the importance of identifying the high-risk group at early stage of the illness. With the expansion of EI service for wider age group, studies of the differential needs of patient with different ages would be important to guide the future service development.

No-show at a forensic psychiatric outpatient clinic: risk factors and reasons

Nonattendance for and late cancellations of scheduled appointments, that is no-show, is a well-known phenomenon in psychiatric outpatient clinics. Research on the topic of no-show for initial and consecutive appointments in the field of forensic psychiatry is scarce. This study therefore aims to determine the prevalence and causes of no-show and to explore reasons for nonattendance. The study was carried out in an outpatient clinic in northern Netherlands. Telephone interviews were administered to 27 no-show clients, 84 follow-up no-show clients, and 41 attendees of 18 years and older. A no-show rate of 24.9% and a follow-up no-show rate of 9.8% was found. The majority of appointments missed were in the beginning phase of clinic contact. No-show clients were younger than their attending counterparts and more often dropped out from clinic contact. Also, less family social support was experienced by nonattendees. Reasons for nonattendance were having forgotten about appointment and work commitments.

Validity of the BPRS, the BDI and the BAI in dual diagnosis patients

AIM

The psychometric properties of the Brief Psychiatric Rating Scale, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) were tested in a sample of 134 patients with a substance use disorder and a non-substance related psychiatric disorder in a special inpatient dual diagnosis treatment unit.

METHODS

Subjects were assessed at baseline. At discharge on average 6 months post-intake, 78% of patients were re-assessed using the same instruments. All instruments were tested in (1) their ability to discriminate patients with different diagnoses at baseline and follow-up using comparison of area under the curves, and (2) their temporal stability. Moderator regression was used to test whether thought disorder at baseline had any effect on the test-retest rank-order stability of other instruments.

FINDINGS

The BPRS Thought Disorder scale was able to discriminate between patients with and without schizophrenia spectrum diagnoses, and the BDI was able to discriminate between patients with and without mood disorders and schizoaffective disorders at intake to treatment, and each instrument was significantly better than the other at discriminating relevant diagnostic groups. Discriminant correlations between the BDI and the BAI were high and statistically significant. Moderator regression analyses showed no indication that any of the scales were less stable at higher levels of thought disorder.

CONCLUSIONS

It is concluded that dual diagnosis patients can be reliably assessed for symptoms using the BDI and some subscales of the BPRS.

Fatores associados ao abandono de tratamento em saúde mental em uma unidade de nível secundário do Sistema Municipal de Saúde

A ocorrência de abandono de tratamento psiquiátrico de nível secundário é uma relevante questão clínica e econômica. Taxas de abandono em psiquiatria são mais altas que em outras especialidades médicas. Estudos publicados nos últimos 15 anos têm identificado diversos fatores estatisticamente associados ao não-comparecimento às consultas e/ou ao abandono de tratamento em saúde mental. OBJETIVO: Avaliar variáveis demográficas, psicopatológicas, de diagnóstico e tratamento enquanto possíveis preditores de abandono de tratamento em serviço especializado de saúde mental. MÉTODO: Estudo observacional, avaliando 896 pacientes encaminhados, no período de abril de 2004 a março de 2006, por Unidades Básicas de Saúde da área de abrangência do serviço especializado. RESULTADOS: Pacientes solteiros, com idade abaixo da média do grupo (39,2 anos) e desempregados abandonaram significantemente mais o tratamento. Duas variáveis relativas ao exame psicopatológico se associaram significantemente com abandono de tratamento (memória quanto ao passado recente e relação do humor com fatos reais, atuais). Pacientes adultos que receberam diagnóstico psiquiátrico de oligofrenia abandonaram significantemente menos e pacientes com diagnóstico relativo aos transtornos da infância e adolescência (F80-F98 da CID-10) também abandonaram significantemente mais o tratamento. O registro de comorbidade psiquiátrica e tratamento exclusivamente farmacológico se associaram a não abandono do tratamento. CONCLUSÃO: Os resultados confirmam achados de diferentes autores da evidência de características associadas a abandono ao tratamento. Tais achados sugerem que determinados subgrupos de pacientes necessitem de abordagens customizadas, a fim de influenciar positivamente sua adesão final ao tratamento indicado.