Schizophrenia patients discharged against medical advice at a mental hospital in Taiwan.
OBJECTIVE
The purpose of the present study was to evaluate the risk factors associated with discharge against medical advice (AMA) and compare the time to rehospitalization between patients with AMA discharges and those with regular discharges.


METHODS
All schizophrenia inpatients discharged from a psychiatric hospital between 1 January 2006 and 31 December 2006 were monitored. The clinical variables were compared between the patients discharged AMA and those with regular discharges. Logistic regression was used to determine the best predictor for AMA discharge. Times to rehospitalizaton within 15 and 60 days after discharge were measured using the Kaplan-Meier method.


RESULTS
Compared to patients with regular discharges, patients discharged AMA were significantly more likely to be male (P = 0.007), to have comorbid alcohol abuse/dependence (P = 0.007), to take typical antipsychotic agents (P = 0.005) and to have shorter lengths of hospital stay (P < 0.001). Logistic regression demonstrated that male gender (odds ratio [OR], 1.631; 95% confidence interval [CI]: 1.067- 2.493)] and prescription of typical antipsychotic agents (OR, 1.729; 95%CI: 1.098-2.723) were the most influential predictors for discharge AMA. There were significant differences in time to rehospitalization between these two groups during the 15-day (P = 0.009) and 60-day (P = 0.038) follow-up periods.


CONCLUSIONS
Male gender and prescription of typical antipsychotic agents increased the likelihood of AMA discharge. The consequence for patients with AMA discharges was earlier rehospitalization. Future studies are needed in many different mental health systems to better generalize the findings.
Wung
Yu-Ting
YT
Department of Adult Psychiatry, Kai-Suan Psychiatric Hospital, Taiwan.
Chen
Cheng-Chung
CC
Chen
Feng-Chuan
FC
Lin
Ching-Hua
CH
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D055815:Young Adult
D014150:Antipsychotic Agents