Bernard Rosen

THE PREDICTION OF REHOSPITALIZATION: THE RELATIONSHIP BETWEEN AGE OF FIRST PSYCHIATRIC TREATMENT CONTACT, MARITAL STATUS AND PREMORBID ASOCIAL ADJUSTMENT

The 3-year incidence of rehospitalization of a group of 81 previously hospitalized schizophrenic patients was determined. A significant relationship was found between their incidence of rehospitalization and age of first psychiatric treatment contact (p<.001), premorbid asocial adjustment (p<.001) and marital status (<.025) The three predictor variables were all significantly related (p<.05). The results indicate that when one controls for either age of first psychiatric treatment contact or premorbid asocial adjustment marital status has no prognostic utility. The results also indicate that the presence of premorbid asocial adjustment is an almost certain indicator of rehospitalization (87.2 per cent), regardless of the patients age at first psychiatric treatment contact. However, among patients who do not have a premorbid asocial history, early age of first psychiatric treatment contact effectively predicts rehospitalization. Only 15.0 per cent of the nonasocial patients whose first psychiatric treatment contact occurred at the age of 23 or older were rehospitalized.

Comparison of the clinical effectiveness of "short" versus "long" stay psychiatric hospitalization. III. Further results of a 3-year posthospital follow-up.

One hundred seventy-three patients were randomly assigned to long term (LT: unlimited length of stay, mean = 179 days) or short term (ST: stay limited to 90 days, mean = 89 days) hospitalization in an intensive treatment psychiatric hospital. In-hospital data and partial 3-year posthospital follow-u

Comparison of the clinical effectiveness of "short" versus "long" stay psychiatric hospitalization. IV. Predictors of differential benefit.

One hundred seventy-three patients were randomly assigned to LT (long term, unlimited length of stay, mean 179 days) vs. ST (short term, 90-day limit) psychiatric hospitalization. Three-year follow-up results showed few between-group differences, although LT patients tended to be rehospitalized more and had superior relative ratings of psychopathology. Demographic and clinical data did not predict differential benefit from LT or ST hospitalization. Diagnosis did not generally predict differential benefit either, except that clinically diagnosed personality disorders, given LT as opposed to St hospitalization, had poorer role functioning and less psychiatric treatments after discharge. Patients with a history of drug abuse did worse if given LT hospitalization in terms of role functioning and rehospitatalization. Overall, this study agrees with other relevant studies in indicating that hospitalization should be kept as short as feasiole.

The hospitalization proneness scale as a predictor of response to phenothiazine treatment. II. Delay of psychiatric hospitalization.

To further explore the influence of personality factors on response to phenothiazine treatment, we examined the relationship between the hospitalization proneness scale (HPS) and the effectiveness of phenothiazine treatment in delaying hospitalization for those patients hospitalized during the course of their clinic treatment. The 129 hospitalized patients were part of a larger cohort of 446 chronic schizophrenic outpatients randomly assigned to placebo, promazine, and chlorpromazine and treated under double blind conditions. The patients in this sample were hospitalized after from 1 to 114 months of continuous outpatient treatment. The patients were divided into hospitalization prone and nonprone groups on the basis of the HPS. The HPS consists of measures of the patients effectiveness in social interactions, cognitive performance, and social attainment assessed at intake. The findings indicate that the number of months the patient was able to remain in outpatient treatment prior to hospitalization is the result of an interaction between the specific drug received and level of HPS score (p < .01). A multiple range test indicated that among prone patients, those treated with either chlorpromazine or promazine remained in treatment for a significantly longer period of time than comparable placebo-treated patients (p < .05). On the other hand, nonprone patients treated with chlorpromazine were hospitalized after a significantly shorter period of time than nonprone patients treated with either placebo or promazine (p < .05). In addition, chlorpromazine-treated nonprone patients were hospitalized significantly earlier than chlorpromazine-treated prone patients (p < .01). The results were discussed in terms of the relationship between the personality attributes measured and the sedative characteristics of the drugs employed. The implications of the findings to drug treatment and future research were also discussed.

Sex differences in the relationship between premorbid asociality and posthospital outcome.

To clarify the influence of the patients sex on the relationship between level of premorbid social functioning and posthospital outcome, the premorbid asocial adjustment during preadolescence and adolescence and the 3-year posthospital outcome of a group of 163 previously hospitalized psychiatric patients were determined. A significant relationship was found between premorbid asocial adjustment and both incidence of rehospitalization and sex (p < .005). The data indicate that a premorbid asocial adjustment scale (PAAS) score associated with good posthospital outcome among male patients was indicative of poor outcome for female patients. Thus the mean PAAS score for nonhospitalized males (4.97) is statistically similar to the mean PAAS score of rehospitalized females (5.30). Further, the relationship between PAAS and rehospitalization was limited to schizophrenic patients, indicating that the meaning of premorbid asocial adjustment is a function of diagnosis rather than a panpathological index. The findings were discussed in terms of differences in childrearing practices and social expectations for each sex group. The importance of comparing individuals on measures of premorbid social competence only within their own sex and diagnostic group was emphasized.