Abstract
BackgroundThe purpose of this analysis was to evaluate relationships between hospital admission or discharge and scores for symptom or functioning in patients with schizophrenia.MethodsData were from three 52-week open-label extensions of the double-blind pivotal trials of paliperidone extended-release (ER). Symptoms and patient function were measured every 4 weeks using the Personal and Social Performance (PSP) scale and the Positive and Negative Syndrome Scale (PANSS). The intent-to-treat analysis set was defined as open-label patients who had at least one post-baseline PSP and PANSS measurement. Time until first hospitalization was evaluated using the Cox proportional hazard model with categorical time-dependent measures for the PSP (1 to 30, 31 to 70, 71 to 100) or PANSS (< 75, ≥ 75 to < 95, ≥ 95), as well as age, gender, schizophrenia duration, and country. Similar analyses were performed for time to discharge.ResultsOf the 1,077 enrolled patients, 1,028 (95.5%) met study criteria; of these, 382 (37.2%) were hospitalized at open-label baseline. Compared with patients with PSP ≥ 71 group, the hazard for new hospitalization was 8.351 times greater (P = 0.0001) for patients with the poorest functioning (PSP 1 to 30) and 1.977 times greater (P = 0.0295) for patients with PSP of 31-70 compared to the ≥ 71 group. The hazard for new hospitalization was 5.457 times greater (P < 0.0001) for patients PANSS ≥ 95 and 2.316 times greater (P = 0.0027) for the ≥ 75 to < 95 group compared with the < 75 group. For patients hospitalized at baseline, the PANSS ≥ 95 patients had a discharge hazard that was 0.456 times lower than for the < 75 patients (P < 0.0001). The hazard for discharge was 0.646 times lower (P = 0.0012) for the PANSS ≥ 75 to < 95 group compared with the < 75 group. A patient's country was a significant predictor variable, with US patients being admitted and discharged faster.ConclusionsBetter functioning or being less symptomatic is associated with reduced risk for hospitalization and greater chance for early discharge. Treatments or programs that reduce symptoms or improve function decrease the risk of hospitalization in community patients or increase the chance of discharge for hospitalized patients.
Highlights
The purpose of this analysis was to evaluate relationships between hospital admission or discharge and scores for symptom or functioning in patients with schizophrenia
Function scales are fundamentally different than symptom scales in the domain being assessed because they measure behaviors such as self-care or social interaction [4]. These behaviors can exist even if the person is experiencing symptoms such as delusions or hallucinations. (For a discussion of the tools and role of functional assessment in research, see the white paper summarizing the conclusions from a National Institute of Mental Health workshop [5].) The Personal and Social Performance (PSP) scale is an example of a function scale useful in many conditions, including schizophrenia [6]
Pearson correlation coefficient for the association between baseline PSP and Positive and Negative Syndrome Scale (PANSS) total scores was -0.32 for subjects assessed by the same rater and -0.29 for subjects assessed by different raters, suggesting low overlap in measurement constructs between the PANSS and PSP [8]
Summary
The purpose of this analysis was to evaluate relationships between hospital admission or discharge and scores for symptom or functioning in patients with schizophrenia. Given the chronic nature of schizophrenia and Function scales are fundamentally different than symptom scales in the domain being assessed because they measure behaviors such as self-care or social interaction [4] These behaviors can exist even if the person is experiencing symptoms such as delusions or hallucinations. (For a discussion of the tools and role of functional assessment in research, see the white paper summarizing the conclusions from a National Institute of Mental Health workshop [5].) The Personal and Social Performance (PSP) scale is an example of a function scale useful in many conditions, including schizophrenia [6] It and related versions of the instrument have been used for more than a decade in multiple studies [7]. Pearson correlation coefficient for the association between baseline PSP and PANSS total scores was -0.32 for subjects assessed by the same rater and -0.29 for subjects assessed by different raters, suggesting low overlap in measurement constructs between the PANSS and PSP [8]
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