The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders

Jae Hoon Jeong; Min Jeong Kang; Min Young Kwon; Sang Min Lee; Kyu Young Lee

doi:10.16946/kjsr.2019.22.2.66

Journal List > Korean J Schizophr Res > v.22(2) > 1136570

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jeong, Kang, Kwon, Lee, and Lee: The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders

Original Article

Korean Journal of Schizophrenia Research 2019; 22(2): 66-73.

Published online: 31 October 2019

DOI: https://doi.org/10.16946/kjsr.2019.22.2.66

The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders

Jae Hoon Jeong, MD^1,², Min Jeong Kang³, Min Young Kwon³, Sang Min Lee³, Kyu Young Lee, MD, PhD^1,^2,³

¹Department of Psychiatry, Eulji University School of Medicine, Daegeon, Korea.

²Department of Psychiatry, Eulji University Eulji Hospital, Seoul, Korea.

³Dobonggu Mental Health and Welfare Center, Seoul, Korea.

Address for correspondence: Kyu Young Lee, Department of Psychiatry, Eulji University Eulji Hospital, 327 Gongneung-ro, Nowon-gu, Seoul 01830, Korea. Tel: 02-970-8303, Fax: 02-949-2356, lky@eulji.ac.kr

Received 4 June 2019 Revised 29 July 2019 Accepted 3 September 2019

Korean Society for Schizophrenia Research

Abstract

Objectives

This study aimed to elucidate the effectiveness of long-term psychosocial intervention in reducing the disabling period of patients with major psychiatric disorders by their rehospitalization rate.

Methods

Of the 210 patients with major psychiatric disorders received psychosocial interventions in a Mental Health and Welfare Center, 192 patients (147 with schizophrenia spectrum disorders, 45 with mood disorders) who received interventions more than 6 months were selected. Review of case management records was conducted to obtain information.

Results

The number and length of hospitalization and the hospital days per year significantly decreased after psychosocial intervention. Additional analysis of 102 patients followed up for more than 5 years suggested that the effectiveness of the intervention persisted for a sufficient period. However, no significant difference was observed in the number of rehospitalization in 45 patients with mood disorders, though the length of hospitalization significantly decreased. In addition, the hospital days per year of 21 patients with mood disorder followed up for more than 5 years also showed no significant decrease.

Conclusion

Long-term psychosocial intervention had a significant effect on reducing the number and length of hospitalization for patients with major psychiatric disorder and the effectiveness maintained for more than 5 years.

Keywords: Major psychiatric disorder, Mental health center, Psychosocial intervention, Rehospitalization

Figures and Tables

Table 1

Demographic characteristics of the patients with major psychiatric disorder (N=192)

^*: Visit once every 2 weeks, if any of the items in Individual Service Plan (ISP) have a severity of 3 or more checked. ^†: Visit once every 1 month, if any of the items in Individual Service Plan (ISP) have a severity of 2 or more checked

Table 2

Demographic comparison between patients with schizophrenia spectrum disorder and patients with mood disorder

^*: Visit once every 2 weeks, if any of the items in Individual Service Plan (ISP) have a severity of 3 or more checked, ^†: Visit once every 1 month, if any of the items in Individual Service Plan (ISP) have a severity of 2 or more checked

Table 3

Changes in psychiatric hospitalization status of patients before and after psychosocial intervention

Table 4

Changes in psychiatric hospitalization status of patients with 5 years and more psychosocial intervention

References

1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3:e442.

2. Castle DJ, Galletly CA, Dark F, Humberstone V, Morgan VA, Killackey E, et al. The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders. Med J Aust. 2017; 206:501–505.

3. Hjorthoj C, Sturup AE, McGrath JJ, Nordentoft M. Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry. 2017; 4:295–301.

4. Bustillo J, Lauriello J, Horan W, Keith S. The psychosocial treatment of schizophrenia: an update. Am J Psychiatry. 2001; 158:163–175.

5. Kim SW. Psychosocial intervention for patients with schizophrenia. J Korean Neuropsychiatr Assoc. 2018; 57:235–243.

6. Lee DE, Choi YS. The history and achievement of psychosocial treatment for patients with schizophrenia. J Korean Neuropsychiatr Assoc. 2009; 48:411–422.

7. Penn DL, Mueser KT. Research update on the psychosocial treatment of schizophrenia. Am J Psychiatry. 1996; 153:607–617.

8. Bellack AS, Turner SM, Hersen M, Luber RF. An examination of the efficacy of social skills training for chronic schizophrenic patients. Hosp Community Psychiatry. 1984; 35:1023–1028.

9. Hogarty GE, Anderson CM, Reiss DJ, Kornblith SJ, Greenwald DP, Javna CD, et al. Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia I One-year effects of a controlled study on relapse and expressed emotion. Arch Gen Psychiatry. 1986; 43:633–642.

10. Marder SR. Integrating pharmacological and psychosocial treatments for schizophrenia. Acta Psychiatr Scand Suppl. 2000; 87–90.

11. Thornicroft G, Tansella M. The balanced care model for global mental health. Psychol Med. 2013; 43:849–863.

12. Hengartner MP, Klauser M, Heim G, Passalacqua S, Andreae A, Rossler W, et al. Introduction of a psychosocial post-discharge intervention program aimed at reducing psychiatric rehospitalization rates and at improving mental health and functioning. Perspect Psychiatr Care. 2017; 53:10–15.

13. Cloutier M, Aigbogun MS, Guerin A, Nitulescu R, Ramanakumar AV, Kamat SA, et al. The economic burden of schizophrenia in the United States in 2013. J Clin Psychiatry. 2016; 77:764–771.

14. Nicholl D, Akhras KS, Diels J, Schadrack J. Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective. Curr Med Res Opin. 2010; 26:943–955.

15. Weiden PJ, Olfson M. Cost of relapse in schizophrenia. Schizophr Bull. 1995; 21:419–429.

16. Almond S, Knapp M, Francois C, Toumi M, Brugha T. Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry. 2004; 184:346–351.

17. Hong J, Windmeijer F, Novick D, Haro JM, Brown J. The cost of relapse in patients with schizophrenia in the European SOHO (Schizophrenia Outpatient Health Outcomes) study. Prog Neuropsychopharmacol Biol Psychiatry. 2009; 33:835–841.

18. Olivares JM, Sermon J, Hemels M, Schreiner A. Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review. Ann Gen Psychiatry. 2013; 12:32.

19. Burns T. Evolution of outcome measures in schizophrenia. Br J Psychiatry Suppl. 2007; 50:s1–s6.

20. Burns T. Hospitalisation as an outcome measure in schizophrenia. Br J Psychiatry Suppl. 2007; 50:s37–s41.

21. Vigod SN, Kurdyak PA, Dennis CL, Leszcz T, Taylor VH, Blumberger DM, et al. Transitional interventions to reduce early psychiatric readmissions in adults: systematic review. Br J Psychiatry. 2013; 202:187–194.

22. Hengartner MP, Passalacqua S, Heim G, Andreae A, Rossler W, von Wyl A. The post-discharge network coordination programme: a randomized controlled trial to evaluate the efficacy of an intervention aimed at reducing rehospitalizations and improving mental health. Front Psychiatry. 2016; 7:27.

23. Seoul Mental Heath Welfare Center. Seoul Mental Health Information System user manual version 1.0. 2017.

24. Corrigan PW, Mueser KT, Bond GR, Drake RE, Solomon P. Principles and practice of psychiatric rehabilitation: an empirical approach. New York: Guilford press;2012.

25. Colom F, Vieta E, Sanchez-Moreno J, Martinez-Aran A, Reinares M, Goikolea JM, et al. Stabilizing the stabilizer: group psychoeducation enhances the stability of serum lithium levels. Bipolar Disord. 2005; 7 Suppl 5:32–36.

26. Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry. 2005; 62:996–1004.

27. Ball JR, Mitchell PB, Corry JC, Skillecorn A, Smith M, Malhi GS. A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change. J Clin Psychiatry. 2006; 67:277–286.

28. Perry A, Tarrier N, Morriss R, McCarthy E, Limb K. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ. 1999; 318:149–153.

29. Lucksted A, McFarlane W, Downing D, Dixon L. Recent developments in family psychoeducation as an evidence-based practice. J Marital Fam Ther. 2012; 38:101–121.

30. Mayoral F, Berrozpe A, de la Higuera J, Martinez-Jambrina JJ, de Dios Luna J, Torres-Gonzalez F. Efficacy of a family intervention program for prevention of hospitalization in patients with schizophrenia. A naturalistic multicenter controlled and randomized study in Spain. Rev Psiquiatr Salud Ment. 2015; 8:83–91.

31. Steffen S, Kosters M, Becker T, Puschner B. Discharge planning in mental health care: a systematic review of the recent literature. Acta Psychiatr Scand. 2009; 120:1–9.

32. Stein LI, Test MA. Alternative to mental hospital treatment I Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980; 37:392–397.

33. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. 2010; Cd000088.

34. Correll CU, Galling B, Pawar A, Krivko A, Bonetto C, Ruggeri M, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry. 2018; 75:555–565.

35. Lambert M, Schottle D, Ruppelt F, Rohenkohl A, Sengutta M, Luedecke D, et al. Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study. Acta Psychiatr Scand. 2017; 136:188–200.

36. Chan SK, So HC, Hui CL, Chang WC, Lee EH, Chung DW, et al. 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychol Med. 2015; 45:1181–1193.

37. Hengartner MP, Passalacqua S, Heim G, Andreae A, Rossler W, von Wyl A. Factors influencing patients’ recovery and the efficacy of a psychosocial post-discharge intervention: post hoc analysis of a randomized controlled trial. Soc Psychiatry Psychiatr Epidemiol. 2016; 51:1667–1677.

38. Hooley JM. Expressed emotion and relapse of psychopathology. Annu Rev Clin Psychol. 2007; 3:329–352.

39. Chatterton ML, Stockings E, Berk M, Barendregt JJ, Carter R, Mihalopoulos C. Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: network meta-analysis. Br J Psychiatry. 2017; 210:333–341.

40. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013; 15:1–44.

41. National Collaborating Centre for Mental Health. Bipolar disorder: the NICE guideline on the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. Leicester (UK): British Psychological Society;2018.

42. Miklowitz D, Yatham L, Kusumakar V. Psychosocial interventions for bipolar disorder: a critical review of evidence for efficacy. In : Yatham LN, Kusumakar V, editors. Bipolar disorder: a clinician's guide to treatment management. 2nd edition. New York: Routledge;2009. p. 90.

TOOLS

Similar articles