Factors Associated With Premature Discharge of Patients With Psychosis Against Medical Advice
AbstractObjective: This study was conducted to identify the characteristics of patients with psychosis who had escaped from hospital or were discharged prematurely and against medical advice. Method: We carried out this retrospective study on 72 patients with psychosis who were discharged prematurely over a 38-month period and compared them to 76 patients with psychosis who were discharged according to the physician’s order, as the control group. In addition to the demographic factors, we assessed the following: the patient’s and their care giver’s level of education, in hospital stay, suicidal idea and attempt, smoking, substance abuse, psychiatric diagnosis, arrest record, imprisonment, positive history of psychiatric disorder in the first degree family members, first episode of psychosis, admission with police assistance, unemployment, and escape history (from hospital, school, military service, home, work and prison). Results: The two groups of patients were comparable in regard to two factors: the in hospital stay, and a positive history of escape. The latter was defined as leaving home, quitting work, escaping from school and military service, and a positive history of escape from hospital.Conclusion: Irregular discharge of patients with psychosis seems to be predictable by their positive escape history, and therefore preventable. Irregular discharge is more likely in the first few days of hospital admission. There is also a great tendency towards irregular discharge when in hospital stay gets long.
Duffy A. Towards early intervention and prevention strategies for major affective disorders: a review of antecedent and risk factors. Can J psychiatry 2000; 45: 340-8 .
McGorry PD, Edwards J, Mihalopoulos C, Harrigan SM, Jackson HJ. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996;22: 305-26 .
Loebel AD, Lieberman JA, Alvir JM, Mayerhoff DI, Geisler SH, Szymanski SR. Duration of psychosis and outcome in first episode schizophrenia. Am J psychiatry 1992; 149: 1183-8.
Chandrasena R. Premature discharges: A comparative study. Can J of Psychiatry 1987; 32: 259- 63 .
Gillis K, Russell VR, Busby K. Factors associated with unplanned discharge from psychiatric day treatment programs, a multi center study. General hospital psychiatry 1997; 19:355-61.
Glick ID, Braff DL, Johnson G, Showstack JA.Outcome of irregularly discharged psychiatric patients. Am J psychiatry 1981; 138: 1472-6.
Senior N ,Kibbee P .Can we predict the patient who leaves against medical advice :The_search for a method .Psychiatr Hosp 1986 ; 17 :33-36.
Phillips MS, Ali H .Psychiatric patients who discharge themselves against medical_advice. Can J of Psychiatry 1983 ; 28:202-5
Ferber JS, Oswald M, Rubin M, Ungemack J, Schane M, .The day hospital as entry point to a network of long-term services: a program evaluation. Hosp Community Psychiatry1985; 36: 1297-301.
Thompson CM. characteristics associated with outcome in a community mental health partial hospitalization program. Community mental health J 1985; 21: 179-88.
Smith HH Jr. Discharge against medical advice (AMA) from an acute care private psychiatric hospital. J Clin Psychol 1982; 38: 550-4.
Vander stoep A, Bohn P, Melville E .A model for predicting discharge against medical advice from adolescent residential treatment. Hosp community psychiatry 1991; 42: 725-8.
Jeremiah J, O'Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med 1995; 10: 403-5.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Washington DC: American Psychiatric Association; 1994.
Armitage P, Berry G, Mathews JNS. Statistical methods in medical research, 4th edition. Massachusetts: Blackwell; 2002.
Akhtar S, Helfrich J, Mestayer RF. AMA discharge from a psychiatric inpatient uniting J soc Psychiatry 1981; 27: 143-50
Bosch G, Steinhart I. [Treatment conditions and discharge from the viewpoint of the therapist and patient--on the follow-up of former patients of a social psychiatric model institution]. Psychiatry Prax 1985; 12: 55-62. (article in German)