Portela et al reported risk factors for readmission of a patient with a severe mental disorder who has been prescribed an antipsychotic medication. These can help to identify a patient who may benefit from more aggressive management. The authors are from UFMG (Belo Horizonte, Brazil), Columbia University, University of Toronto.
Patient selection: severe mental disorder (schizophrenia, bipolar affective disorder)
Typical antipsychotics include chlorpromazine, thioridazine, haloperidol.
Atypical antipsychotics include: clozapine, risperidone, olanzapine, aripiprazole, quetiapine
Risk factors for readmission:
(1) treatment with a typical antipsychotic agent (vs atypical, OR 1.25)
(2) failure to take antipsychotic medication (OR 1.92)
Reasons for failure to take antipsychotic medication:
(1) noncompliance
(2) unable to obtain in public health system
If the patient is readmitted, then the evaluation should include:
(1) severity of the psychotic disorder relative to previous status
(2) ability to tolerate the antipsychotic therapy
(3) noncompliance
(4) social determinants of health
(5) possible contributory factors
(6) other health issues
(7) barriers to obtaining care
