A Cross-Sectional Study On Outcomes Of Individuals With First Hospitalization And Psychosis Spectrum Disorder Diagnosis

Abstract Background Acute psychosis is one of the most frequent causes of hospital admission. One of the major challenges is how to manage with negative symptoms. Clinical efficacy of treatment of patients at their first hospitalization has been evaluated in several studies. We carried out a cross sectional study focusing on the different outcomes considering the clinical relevance of positive and negative symptoms. Methods We analyzed all the admissions and discharges of patients at their first psychiatric hospitalization after psychosis onset (diagnosed with ICD-9 criteria) in our inpatient psychiatric acute unit of Policlinico Tor Vergata, (located in a suburb of Rome) considering the period of time between January 2017 and September 2019. We characterized all patients according to age, ethnicity, socioeconomic status, substance use/abuse, violent behaviours, voluntary or compulsory treatment, length of hospitalization and use of long acting injection (LAI). We included 73 patients (out of 626 admissions, 12%) with a diagnosis of spectrum psychosis disorder at first hospitalization. We used items 10–11 and 16–17 from the Brief Psychiatric Rating Scale (BPRS) to obtain two groups of patients with different clinical features. Based on the score of these items, patients were divided into two groups: group One characterized by prevalent positive symptomatology and group Two characterized by negative symptoms. Then, we compared clinical outcomes through BPRS, days of Hospital stay and Clinical Global Impression at the end of the hospitalization. Results In our study we found out that patients with BPRS prevalent negative symptoms had longer hospital stays (mean 17.29 days); patients with BPRS positive prevalent symptoms had a mean stay of 15 days. Group Two patients used LAI treatment less frequently (37% of the times) compared to group One, which was treated with LAI 63% of the cases. At discharge, group Two had still higher scores in the Global Improvement Scale compared to group One. Discussion Our study confirms that the use of antipsychotic therapy does not improve negative symptoms. Moreover, psychosis characterized by negative symptoms has a worse outcomes. Furthermore, considering their first hospitalization, it is interesting to note that our participants’ mean age was 37.98 years old, much higher than the one reported in literature. Since our Hospital is located in a very peripheral area of Rome, where social disadvantage represents a critical issue, we hypothesized different reasons to explain this data such as lower level of education, marginalization and socioeconomic adversity that might increase difficulties to access to health care services. In conclusion, further studies are needed to find more useful and alternative treatments and to deepen relationship between sociodemographic context and the time of their first psychiatric assessment.