Correlates of unscheduled and emergency clinical contact in a cohort of patients treated for psychosis

Abstract

Psychosis has the highest economic burden among mental disorders worldwide. Our retrospective chart-based review aimed to identify factors that predict unscheduled clinical contact for patients with psychosis attending an outpatient psychiatry clinic. Participants consisted of patients with a primary diagnosis of a psychotic disorder being followed for one consistent calendar year at the clinic. The primary outcome was the frequency of unscheduled and emergency clinical contact (phone-based nursing services, visits to the emergency department, or hospitalizations to the inpatient psychiatry ward) as a reflection of psychiatric morbidity and level of care need. The sample consisted of 331 patients, mostly diagnosed with schizophrenia (43.5%) or schizoaffective disorder (30.8%). Logistic regression analyses showed that participants who used any emergency service were significantly more likely to be females, to have comorbid obsessive-compulsive disorder, and to be prescribed two or more antipsychotics. In conclusion, individuals with psychosis following on an outpatient basis might require emergency health services at a point during their treatment. A small minority seems to require unscheduled clinical contact, and an even smaller number will require admission. Early identification of those more likely to require more frequent or intensive care can help organize services more effectively.

Keywords

• Psychosis
• Schizophrenia
• Service development
• Community care
• Lebanon