Rehabilitation Service, Royal Edinburgh Hospital, Edinburgh, UK.
BMC Psychiatry. 2011 Sep 16;11:149. doi: 10.1186/1471-244X-11-149.
At any time, about 1% of people with severe and enduring mental illness such as schizophrenia require in-patient psychiatric rehabilitation. In-patient rehabilitation enables individuals with the most challenging difficulties to be discharged to successful and stable community living. However, the length of rehabilitation admission that is required is highly variable and the reasons for this are poorly understood. There are very few case-control studies of predictors of outcome following hospitalisation. None have been carried out for in-patient rehabilitation. We aimed to identify the factors that are associated with achieving discharge from in-patient rehabilitation by carrying out a case-control study.
We compared two groups: 34 people who were admitted to the Rehabilitation Service at the Royal Edinburgh Hospital and discharged within a six year study period, and 31 people who were admitted in the same period, but not discharged. We compared the groups on demographic, illness, treatment and risk variables that were present at the point of their admission to rehabilitation. We used independent t tests and Pearson Chi-Square tests to compare the two groups.
We found that serious self harm and suicide attempts, treatment with high dose antipsychotics, antipsychotic polypharmacy and previous care in forensic psychiatric services were all significantly associated with non-discharge. The non-discharged group were admitted significantly later in the six year study period and had already spent significantly longer in hospital. People who were admitted to rehabilitation within the first ten years of developing psychosis were more likely to have achieved discharge.
People admitted later in the study period required longer rehabilitation admissions and had higher rates of serious self harm and treatment resistant illness. They were also more likely to have had previous contact with forensic services. This change over time is likely to be due to the drive in Scotland to manage mentally disordered offenders in conditions of lower security. There is a growing need for secure longer-term in-patient rehabilitation, particularly for people previously treated in forensic services. Admission to rehabilitation earlier in a person's illness may improve their outcome.
在任何时候，大约有 1%的严重和持久的精神疾病患者，如精神分裂症，需要住院精神康复。住院康复使个人面临最具挑战性的困难得以成功和稳定的社区生活。然而，所需的康复住院时间是高度可变的，其原因还不太清楚。对于住院治疗后的结果预测因素，很少有病例对照研究。没有针对住院康复的研究。我们的目的是通过进行病例对照研究，确定与从住院康复中出院相关的因素。
我们比较了两组：34 人被收入爱丁堡皇家医院康复服务，并在六年的研究期间出院，31 人在同一时期被收入，但未出院。我们比较了两组在入院时的人口统计学、疾病、治疗和风险变量。我们使用独立 t 检验和 Pearson Chi-Square 检验来比较两组。
我们发现，严重的自我伤害和自杀企图、高剂量抗精神病药物治疗、抗精神病药物联合用药和以前在法医精神病服务机构的治疗都与未出院显著相关。未出院组在六年研究期间的入院时间明显较晚，并且已经在医院住院时间明显延长。在发病后十年内被收入康复治疗的人更有可能出院。
在研究期间较晚入院的人需要更长的康复住院时间，且严重自我伤害和治疗抵抗性疾病的发生率更高。他们也更有可能与法医服务部门有过接触。这种随时间的变化可能是由于苏格兰在较低安全条件下管理精神障碍罪犯的努力。对安全的长期住院康复的需求不断增加，特别是对以前在法医服务机构治疗的人。在一个人的疾病早期入院进行康复治疗可能会改善他们的预后。
