Factores modificables asociados a hospitalización en pacientes psicóticos

Abstract

Objective: to determine modifiable factors, personal, family, treatment, self-harm and health services associated with hospitalization in psychotic patients. Methods: analytical study of cases (hospitalized) and controls (not hospitalized), matched for psychiatric diagnosis, age, and gender, with a ratio of 1:2 case-control, psychotic patients were taken to the psychiatric care hospital: Clínica de Psiquiatrica in Bogotá during 2008- 2009. Previous informed consent, information was collected through interviews with the patient or caregiver in a questionnaire about modifiable factors for hospitalization of psychotic patients, personal factors, family, treatment, service use and self-injury and checked with the clinical systematized history of the institution and by telephone when necessary. Results: the average age of the group was 41.1 ± 12.2 years, the gender distribution was similar and the most frequent diagnosis was schizophrenia (54.3%), being similar between cases and controls. In the group of personal factors hospitalization (cases) was associated with low socioeconomic status (I-II) (OR = 2.37, 1.48,3.81), low educational level (OR = 1.95, 1.06,3.61), consuming legal and illegal psychoactive substances ( alcohol and cigarettes). Regarding disease variables, association was found with when patient does not recognize mental illness, younger age at diagnosis of mental illness, and when the patient's mother had a mental illness. In regard to access to treatment, protective factors were: to get on time all psychiatric medications delivery of all drugs in the last month and the last year by the mental health service (EPS, Spanish abbreviation), full compliance with prescribed drugs. Adverse events related to non-consumption of psychiatric drugs was significantly associated with hospitalization of psychotic patients. Regarding access to health services the failure of attending the psychiatric appointments in the past year, low frequency of psychiatric appointments in both the last year and in the last three months, and hospitalizations for mental illness were significantly higher in the patient group (7.12 ± 7.0, med = 5) than in the control group (3.9 ± 6.0, med = 2) (p <0.001). In the family and socialization factors, living alone, relationships only with relatives, and accompanying less frequent psychiatric appointments were found significantly associated. The suicide attempt was found significantly associated with hospitalization in psychotic patients (OR = 2.1, 95% CI: 1.28, 3.33, p = 0.003) and number of suicide attempts was significantly higher in the case group than in the controls (p = 0.003). Multiple conditional logistic regression showed associated to hospitalization low socioeconomic status (OR = 2.67, 95% CI: 1.29,5.52), living with relatives who have mental illness (OR = 4.71, 95% CI 1.39,16.07), frequency of previous psychiatric hospitalizations (> = 6 hospitalizations, OR = 7.55, 95% CI 3.03,18.85), high frequency to stop using drugs in the last month (> = 6 days, OR = 13.29, 95% CI 4.30,41.11), relationships only with members of their family (OR = 8.80, 95% CI 1.99,38.95), and some family members accompanying psychiatric consultations ( OR = 4.55, 95% CI 1.63,13.66). In addition frequency of attendance at psychiatric consultations in the past year (> = 11 citations, OR = 0,127 (0.045,0.353) was inversely associated to cases. Conclusions: the modifiable factors of personal (low income, low education, not to recognize his illness, his mother with psychiatric problems), limited access to treatment (not having the medication on time and in full), poor adherence to treatment (incomplete consumption of doses, stop taking drugs, and adverse
events), limited access to psychiatric services by the patient (and Infrequently breach appointments psychiatric care, frequent hospitalizations), family relationship problems and socialization ( living alone, accompanying the patient infrequently, poor relationships with people) and self-harm (suicide attempts) are associated with hospitalization in a psychotic patient.