What prevents re-hospitalization? The patents or psychopathology: Patient-centric management of psychopathology

Authors: Amresh Shrivastava, Coralee Belmont, Miky Kaushal, Avinash DeSouza, and Robble Campbell

Background Re-hospitalization is one of the priority areas of research. About 30 – 50% patients are re-hospitalized within one year of discharge. Inability to identify vulnerable candidates for repeated admissions limits our options for strategic treatment. Hospitalization occurs despite best possible community care. It is likely that untreated clinical or psychopathological may be responsible for re-admission which have not been addressed. Early initiation of effective post discharge treatment, prior to discharge may offer good benefit however indicators to select such treatments are undetermined We believe that such factors can be identified and adequately addressed to facilitate their early and safe transition to community In this study we examine clinical and psychopathological factors during the transition for developing effective, patient-centric and comprehensive treatments Method

The study was carried out in an assessment program for acutely ill patients. Consenting patients were recruited between the ages of 18-60, with established psychiatric diagnosis and assessed within 2 days prior to discharge. These patients were assessed on clinical and psychopathological variables using standard tools for psychosis (BPRS), depression (HDRS), resilience (CD-RISK), suicidality (SIS-MAP bsc), clinical outcome (CGIS), current level of stress (HRSS) and fife events (LES)

Results We assessed 101 subjects. 51 females with mean age of 42 yrs, mean number of hospitalization being 6 and duration of illness being 5.4 yrs. The study shows that 45% were repeatedly hospitalized with mean hospitalization of 7.2, where the latest was within 6 months. 60% of these patients were admitted due to a suicide attempt, with higher risk of repeated suicide indicated by risk index of SISMAP, which were 9.1 (cutoff is 8).

These patients had very low level of resilience and >70% were still with suicidal ideation and moderate level of depression at the time of discharge. 40% patients were living alone and a quarter of them had problems with law. In both the groups, the commonest diagnosis was found to be depression followed by psychosis, personality disorder and anxiety.

Conclusion The study shows that hospitalized patients had severe psychopathology at the time of discharge, more so for those who were repeatedly hospitalized. They have moderate suicidality, depression, current stressors life events and poor ability to adapt to stressful conditions adaptation

They appeared to have resolving symptoms, which were in transition for resolution and therefore such patients, have high need for specialized care with strict monitoring. Treatments for enhancing individual patients coping and capacity to adapt. Patients with history of hospitalization are more vulnerable for an admission and therefore hospitalization patients require a treatment program keeping their vulnerability in mind.