Department of Adult Psychiatry, La Colombière Hospital, CHU de Montpellier, University Montpellier 1, 34095 Montpellier Cedex 5, France.
Psychiatry Res. 2013 Sep 30;209(2):160-6. doi: 10.1016/j.psychres.2012.11.013. Epub 2013 Jan 11.
Short periods of hospitalization for first episode psychosis are generally considered preferable, although research evidence is inconsistent. Clinical and social determinants of length of hospital stay (LOS) were examined in 121 admissions for first episode psychosis using standardized assessment measures, in five clinical units of a French psychiatric hospital. LOS varied from 4 to 371 days, and considerably between units. LOS was examined both as a continuous variable and dichotomized comparing short (<31 days) to long (>31 days) stays. In the multivariate analyses, change in antipsychotic medication and the unit head psychiatrist's preference for longer stays were significantly associated with both measures of LOS, indicating effects on LOS per SE and not only with respect to a threshold duration of stay. Of the clinical factors at admission, the only borderline significant association found was between the severity of negative symptoms and LOS on a continuum. Despite some justification for longer stays with respect to discharge conditions, the persisting association with the head psychiatrist's preference for long or short stays strongly suggests a need for greater evidence-based rationalization of practice.
住院治疗首发精神病的时间较短通常被认为是更可取的，尽管研究证据并不一致。本研究使用标准化评估方法，对法国一家精神病院的五个临床科室的 121 例首发精神病住院患者的临床和社会决定因素与住院时间（LOS）进行了研究。LOS 从 4 天到 371 天不等，且各科室间差异较大。LOS 既被作为连续变量，也被划分为<31 天和>31 天的长短住院时间进行分析。多变量分析表明，抗精神病药物的变化和主治精神病医生对长住的偏好与 LOS 的两种测量方法均显著相关，这表明对 LOS 的影响是每 SE，而不仅仅是针对停留时间的阈值。在入院时的临床因素中，唯一具有边缘显著相关性的是阴性症状的严重程度与 LOS 之间的连续关系。尽管在出院条件方面有更长住院时间的理由，但与主治精神病医生对长或短住院时间的偏好之间的持续关联强烈表明，需要更具循证依据来合理化这种做法。
