Miettunen Jouko, Lauronen Erika, Veijola Juha, Koponen Hannu, Saarento Outi, Isohanni Matti
Department of Psychiatry, University of Oulu, PO Box 5000, FIN-90014, Finland.
Nord J Psychiatry. 2006;60(4):286-93. doi: 10.1080/08039480600790168.
We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia (n=88) and other schizophrenia spectrum cases (n=27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1-14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00-20.41) and familial risk of psychosis (OR 3.36; 1.09-10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92-48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response.
我们报告了一个基于人群的纵向队列中34岁前精神分裂症性精神病的住院模式。我们测试了各种人口统计学和疾病相关变量对住院模式的预测能力,特别关注首次精神科住院的时长。芬兰医院出院登记册中记录了1966年出生的芬兰北部队列中所有在世的、符合DSM-III-R精神分裂症标准的患者(n = 88)以及其他精神分裂症谱系病例(n = 27),截至1997年,对他们平均随访了10.5年。精神科住院的衡量指标包括再次住院时间(连续时间以及2年内再次住院情况)和住院次数。首次住院时长、其他疾病相关因素以及各种社会人口统计学预测因素被用于预测住院模式。在对性别、首次入院年龄和住院天数进行调整后,首次住院时间较短(1 - 14天)(参照组>30天;调整后的优势比为6.39;95%置信区间为2.00 - 20.41)以及精神病家族风险(优势比为3.36;1.09 - 10.39)可预测2年内再次住院。首次住院时间较短还可预测频繁的精神科入院,定义为3年内的前三次入院(优势比为13.77;3.92 - 48.36)。首次住院时间较短与再次住院风险增加有关。尽管多项指南推荐缩短住院时间,但可能存在一组精神分裂症性精神病患者,住院时间过短可能导致治疗反应不足。