Lay Barbara, Kawohl Wolfram, Rössler Wulf
Klinik für Psychiatrie und Psychotherapie, Psychiatrische Dienste Aargau AG, Windisch, Switzerland.
Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
Front Psychiatry. 2019 Mar 21;10:120. doi: 10.3389/fpsyt.2019.00120. eCollection 2019.
This prospective study addresses risk factors of compulsory re-admission focusing on the role of the patient's subjective symptom distress and perceived social support, based on comprehensive patient and external (clinicians, study staff) assessments. Of the baseline sample, 168 (71%) patients with serious mental disorders, who had been compulsorily admitted to psychiatric inpatient care, were followed over 24 months after discharge within the framework of a RCT. During this time 36% had compulsory re-admissions; risk was highest immediately after discharge. Regression models identified a history of previous compulsory hospitalisations and compulsory admission due to endangerment of others as the predictors most strongly associated with the outcome. Patients diagnosed with a psychotic disorder or an emotionally instable or combined personality disorder were most likely to experience compulsory re-hospitalisation, with poor response to treatment further significantly increasing the risk. The patient ratings of subjective symptom distress or perceived social support had no predictive value for compulsory re-admission, and this study did not provide evidence for a significant prognostic relevance of sociodemographic background factors. The present findings suggest that within individual-level variables disease-related factors are essentially the strongest predictors, but including the patients' subjective perspective does not enhance the prediction of compulsory re-hospitalisation. The psychiatric treatment of patients with recurrent and often challenging behavioural problems, at the more severe end of the spectrum of mental disorders, deserves closer attention if the use of compulsory hospitalisation is to be reduced.
这项前瞻性研究基于对患者和外部人员（临床医生、研究人员）的全面评估，探讨了强制再入院的风险因素，重点关注患者主观症状困扰和感知到的社会支持的作用。在基线样本中，168名（71%）患有严重精神障碍且被强制收治到精神科住院治疗的患者，在一项随机对照试验的框架内，于出院后接受了24个月的随访。在此期间，36%的患者有强制再入院情况；出院后立即风险最高。回归模型确定，既往强制住院史以及因对他人构成危险而被强制入院是与该结果关联最紧密的预测因素。被诊断患有精神障碍或情绪不稳定或复合型人格障碍的患者最有可能经历强制再次住院，治疗反应不佳会进一步显著增加风险。患者对主观症状困扰或感知到的社会支持的评分对强制再入院没有预测价值，并且本研究没有为社会人口学背景因素的显著预后相关性提供证据。目前的研究结果表明，在个体层面变量中，与疾病相关的因素本质上是最强的预测因素，但纳入患者的主观视角并不能增强对强制再次住院的预测。如果要减少强制住院的使用，对于患有复发性且往往具有挑战性的行为问题、处于精神障碍谱系较严重一端的患者的精神科治疗，值得给予更密切的关注。
