Hospitalization For Psychosis Research Articles

Recollected experiences of first hospitalisation for acute psychosis among persons diagnosed with schizophrenia in South Africa

<p>First-time admission to a psychiatric hospital for acute psychosis has been reported to be extremely traumatic, and this has not been adequately researched in the South African context. This study approached persons diagnosed with schizophrenia and explores their recollected, subjective experiences of their first admission to a South African psychiatric hospital ward for acute psychosis. Semi-structured individual interviews were conducted with seven participants diagnosed with schizophrenia. These were analysed using thematic content analysis. While some participants had positive experiences, the majority reported frightening, distressing, emotionally painful or traumatic experiences during their first hospitalisation. The first hospital admission was also described as having serious long-term implications for the person’s wellbeing, particularly as the diagnosis of schizophrenia made them feel isolated and stigmatised, which further hinders them from recovering from their symptoms and reintegrating into society. This study therefore draws attention to aspects of the process of first admission to psychiatric wards in South Africa, which may benefit from proactive intervention and closer research attention.</p>

Recollected experiences of first hospitalisation for acute psychosis among persons diagnosed with schizophrenia in South Africa

First-time admission to a psychiatric hospital for acute psychosis has been reported to be extremely traumatic, and this has not been adequately researched in the South African context. This study approached persons diagnosed with schizophrenia and explores their recollected, subjective experiences of their first admission to a South African psychiatric hospital ward for acute psychosis. Semi-structured individual interviews were conducted with seven participants diagnosed with schizophrenia. These were analysed using thematic content analysis. While some participants had positive experiences, the majority reported frightening, distressing, emotionally painful or traumatic experiences during their first hospitalisation. The first hospital admission was also described as having serious long-term implications for the person’s wellbeing, particularly as the diagnosis of schizophrenia made them feel isolated and stigmatised, which further hinders them from recovering from their symptoms and reintegrating into society. This study therefore draws attention to aspects of the process of first admission to psychiatric wards in South Africa, which may benefit from proactive intervention and closer research attention.

Better attitudes and mental health for our future

Two issues of the South African Journal of Psychiatry applaud a future in which South Africa pursues both better mental health and better attitudes towards psychiatric difficulties and illnesses. The first, a Special Issue of the SAJP, features the Treatment Guidelines of the South African Society of Psychiatrists, [1] which is published by the SAJP without being subsidised by advertisements from the pharmaceutical industry. This is the first publication of its kind in South Africa, resulting from peer consultation and refinement by psychiatrists and carefully compiled and edited by Professors Soraya Seedat and Robin Emsley. It aims to cater to both the public and private sectors of psychiatric practice. Our 'ordinary' issue of the SAJP, the third of 2013 (Vol. 19), has similar concerns to the Special Issue, i.e. advocating better mental health. But it is not 'ordinary' for at least two reasons: it contains the abstracts of the Biological Psychiatry Conference; and the papers published within collectively call for better attitudes towards, and understanding of mental health difficulties. Moosa and Jeenah [2] consider the ethics of provider-initiated HIV counselling and testing among people with mental illness, working against the double stigmatisation attached to both mental illness and HIV status. Also working against stigmatisation, Vijayalakshmi et al. [3] and Pretorius and Broodryk [4] consider misconceptions about mental illness and traumatic brain injuries, respectively, held in educational settings. Both papers propose educational interventions that foster more accurate understanding of, and better attitudes towards mental health difficulties. In their paper on recollected experiences of first hospitalisation for acute psychosis, Zubi and Connolly [5] have found a profound growth point for the furtherance of better attitudes, as well as better mental health practice: progressive efforts to account for the experiences of people who are mentally ill. The paper explores the qualitative properties of these experiences, which may inform how services and practices may be improved for people who are admitted for the first time for an acute psychotic episode. It is noteworthy that the subjects' experience is being taken seriously in spite of their psychiatric illness --psychiatric illness, even of a psychotic kind, does not necessarily preclude a potentially worthy contribution to the improvement of services and practices. This contribution remains modest, however, considering how much scope and need there is for developing ways in which the experiences of people suffering from psychosis and other mental illnesses may be incorporated into mental health service, practice and research. The emerging byword of this growth point is 'co-production. [6] Co-production brings together experts-by-training and experts-by-experience in efforts to construct jointly not only personalised treatment plans, but also diagnostic processes, as well as an approach to mental health research that extends from conceptualisation to publication. …

Relationship Between Relapse and Hospitalization in First-Episode Psychosis

Relapse is a frequently used outcome measure in schizophrenia research. However, difficulties in reliably measuring relapse diminish its usefulness. Hospitalization is a potential alternative, but its relationship to relapse has not been assessed. This study used data from a two-year, prospective study to examine associations between relapse and hospitalization in a cohort of 200 Canadian patients with first-episode psychosis. First, the relationship between relapse and hospitalization was assessed by cross-tabulating relapse and hospitalization. Next, survival curves of time to first relapse or hospitalization were compared. Finally, to examine the convergent validity of relapse and hospitalization, the predictive capacity of three predictors were examined: a substance use disorder diagnosis, prior hospitalization, and medication adherence. Rates of both relapse and hospitalization were similar. During the two-year follow-up, 37% of the patients experienced a relapse, and 26% were hospitalized. As an indicator of relapse, hospitalization had a low sensitivity (47%) and high specificity (87%). A higher risk of hospitalization and relapse was associated with prior hospitalization, a substance use disorder diagnosis, and medication nonadherence. Results indicated that relapse and hospitalization are separate but related outcome measures. They had similar frequencies and were found to have similar relationships with some predictors. Relapse is a more useful outcome measure in smaller clinical studies in which routine standardized clinical measures can be used. Hospitalization is more relevant in larger studies or as a quality indicator for studies using administrative databases, and it serves as a good measure for quality management in health systems.

Are prenatal, obstetric, and infant complications associated with postpartum psychosis among women with pre‐conception psychiatric hospitalisations?

To examine the associations of maternal and infant complications with postpartum hospitalisation for psychosis in women with a pre-conception history of psychiatric hospitalisation. Population-based study. Swedish medical birth register. Primiparous women who gave birth between 1January1987 and 31December2001, and who had a pre-conception history of psychiatric hospitalisation but who were not hospitalised during pregnancy (n=1842). International Classification of Diseases (ICD) codes were used to identify prenatal, obstetric, postpartum maternal complications, and newborn health conditions. We used multivariable logistic regression to describe the associations between maternal and infant health conditions and the odds for postpartum hospitalisation for psychosis. Psychiatric hospitalisation within 90days of delivery. Compared with women who did not have a postpartum psychiatric hospitalisation, hospitalised women were at 2.3 times higher odds (95%CI 1.0-4.9) of having non-psychiatric puerperium complications (e.g. infection, lactation problems or venous complications). No other maternal complications were associated with postpartum psychiatric hospitalisation. Although their infants were at no higher odds for health complications, the offspring of women who had a postpartum psychiatric hospitalisation were at 4.1 times higher odds (95%CI 1.3-12.6) of death within the first 365days of life than those of women who were not hospitalised. We found no prenatal indicators of postpartum risk for psychiatric hospitalisation among high-risk women, but they had higher odds of postpartum pregnancy-related medical problems and, rarely, offspring death.

Neurologist-associated reduction in PD-related hospitalizations and health care expenditures

To investigate the impact of neurologist care on Parkinson disease (PD)-related hospitalizations. Recent data indicate that neurologist treatment in PD may be associated with improved survival, yet is underutilized. Factors contributing to this improved survival remain unknown, but may be due in part to optimal disease treatment or avoidance of disease-related complications. This was a retrospective cohort study of Medicare beneficiaries diagnosed with PD in 2002 and still living in 2006. Hospitalization for PD-related (neurodegenerative disease, psychosis, depression, urinary tract infection, and traumatic injury) and general medical (hypertension, diabetes, congestive heart failure, angina, and gastrointestinal obstruction) illnesses was compared by PD treating physician specialty using Cox proportional hazard models, adjusting for confounders. Secondary analyses included PD-related rehospitalization and cost stratified by frequency of neurologist care. We identified 24,929 eligible incident PD cases; 13,489 had neurologist care. There were 9,112 PD-related hospitalizations, and these occurred and recurred less often among neurologist-treated patients. Neurologist PD care was associated with lower adjusted odds of both initial and repeat hospitalization for psychosis (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.59-0.86), urinary tract infection (HR 0.74, 0.63-0.87), and traumatic injury (HR 0.56, 0.40-0.78). PD-related outcomes improved with frequency of neurologist care in a stepwise manner. Odds of general illness hospitalization or hospitalization did not differ by neurologist involvement. Regular neurologist care in PD is specifically associated with lower risk of hospitalization and rehospitalization for several PD-related illnesses. This may reflect an improved ability of neurologists to prevent, recognize, or treat PD complications.

O Serviço Psiquiátrico de Diagnóstico e Tratamento no Hospital Geral: usuários e novas urgências

The Servizio di Psichiatrico Diagnosi and Healing (SPDC), born as a representation of the territory within the hospital reality. Objectives. The objective of the research is to show what new emergencies in SPDC and how these situations have changed in the past. Three different studies were planned. The first study analyzed the principle of schizophrenic disorders in the first contact with psychiatric services, to evaluate a possible correlation between the onset of schizophrenia and substance abuse of 136 patients admitted to the SPDC, in the period from 2001 to 2007. The second study evaluated retrospectively from 1985 to 1998, comparing them with the triennium 2007-2009. And finally, the third study measured the rate of burnout of almost all operators almost all SPDC Piedmontese. In all reported studies, psychopathological scales were used and recognized tests. In 130 schizophrenic episodes, 46.1% have a positive anamnesis for substance abuse. These patients show a greater resistance to initial treatment with longer hospitalizations. The analysis showed disorders, through the years, a reduction in hospitalizations for schizophrenic psychosis, contrasting with an increase in hospitalizations for personality disorders and psychomotor agitation. Analyzing rates of burnout, most operators have values medium-high emotional exhaustion and depersonalization, while 47% have low personal accomplishment. These psychopathological conditions are almost always associated with a greater burden on the social assistance that is reflected operators with the same risk of burnout.

Total and differential white blood cell counts, high-sensitivity C-reactive protein, and the metabolic syndrome in non-affective psychoses

The metabolic syndrome is highly prevalent in patients with schizophrenia, and is associated with a state of chronic, low-grade inflammation. Schizophrenia is also associated with increased inflammation, including aberrant blood levels of pro-inflammatory cytokines and high-sensitivity C-reactive protein (hsCRP). The purpose of this study is to investigate the relationship between total and differential white blood cell (WBC) counts, hsCRP, and the metabolic syndrome in patients with schizophrenia and related non-affective psychoses. Fifty-nine inpatients and outpatients age 18-70 with non-affective psychotic disorders and 22 controls participated in this cross-sectional study. Subjects had a fasting blood draw between 8 and 9 am for glucose, lipids, total and differential WBC counts, and hsCRP. Vital signs and anthropometric measures were obtained. Patients with non-affective psychosis and the metabolic syndrome had significantly higher total WBC counts, monocytes, and hsCRP levels than patients without the metabolic syndrome (p≤0.04 for each). In binary logistic regression analyses, after controlling for potential confounding effects of age, race, sex, age at first hospitalization for psychosis, parental history of diabetes, smoking, and psychotropic medications, total WBC count, monocytes, and hsCRP were significant predictors of metabolic syndrome in patients (p≤0.04 for each). hsCRP was also a significant predictor of increased waist circumference and triglycerides in patients (p≤0.05 for each). Our findings suggest that measurement of total and differential WBC counts and hsCRP blood levels may be germane to the clinical care of patients with schizophrenia and related disorders, and support an association between inflammation and metabolic disturbance in these patients.

Compassionate allowance for people with schizophrenia?

Disability is common in schizophrenia, perhaps ubiquitous. Affecting roughly 1% of the population, with onset in adolescence or early adulthood, schizophrenia leads to cognitive and functional impairment during the critically productive phases of life. As a result, many people with schizophrenia become chronically disabled and eventually receive disability benefits from the Social Security Administration. In the current configuration of US health services, health insurance coverage is often closely linked to a determination of disability and in many individuals being determined to be disabled (by the SSA or the VA) is the only way that health insurance coverage can be guaranteed. One of the features of schizophrenia is a deficit in cognitive function, including problems with executive function tasks such as planning or responding to complex demands. As a result, the illness often precludes or significantly delays application for disability benefits, with attendant personal and societal cost. It is well known that access to treatment early in the course of illness leads to a better outcome. Thus, a delay in benefits and/or health care can begin a tragic cycle of events that include untreated psychosis, homelessness, and repeat hospitalization. In August 2007, the leadership of the Social Security Administration (SSA) approached the National Institutes of Health (NIH)with a request for assistance in improving SSA's procedures for processing applications to SSA's disability insurance programs (Social Security Disability Insurance and Supplemental Security Income). In particular, SSA described new procedures for “compassionate allowances,...a new method of triaging disability claims for decision. (SSA's) hope is that...the process for identifying compassionate allowances will help SSA to identify manymore individuals who should be allowed quickly and efficiently.” Compassionate allowance means, quite simply, that the definitive diagnosis of a condition, generally without additional exacerbating features, qualifies an applicant for disability benefits. Obvious compassionate

Psychiatric Morbidity, Violent Crime, and Suicide Among Children and Adolescents Exposed to Parental Death

This retrospective cohort study examined the risk for suicide, psychiatric hospitalization, and violent criminal convictions among offspring of parents who died from suicide, accidents, and other causes. Population-based data from multiple Swedish national registers were linked from 1969 to 2004. Participants were 44,397 offspring of suicide decedents, 41,467 offspring of accident decedents, 417,365 offspring of parents who died by other causes, and 3,807,867 offspring of alive parents. We estimated risk by mode of parental death (suicide, accident, other) and offspring age at parental death (childhood, adolescence, young adulthood). Offspring of suicide decedents were at greater risk for suicide than offspring of alive parents (incidence rate ratio [IRR] = 1.9; 95% confidence interval [CI] = 1.4 to 2.5), whereas offspring of accident decedents and other parental death were not at increased risk (p < .001). The risk for offspring suicide differed by the developmental period during which parental suicide occurred. Child and adolescent offspring of suicide decedents were at threefold greater risk for suicide (IRR = 3.0; 95% CI = 1.7 to 5.3; IRR = 3.1, 95% CI = 2.1 to 4.6, respectively). Young adults were not at increased risk for suicide (IRR = 1.3; 95% CI = 0.9 to 1.9). Offspring of suicide decedents had an especially high risk of hospitalization for suicide attempt, depressive, psychotic, and personality disorders. Child survivors of parental suicide were at particularly high risk for hospitalization for drug disorders and psychosis. All offspring who experienced parental death, regardless of mode or age, were at increased risk for violent criminal convictions. Mode of parental death and offspring age at parental death are associated with offspring long-term risk for suicide and hospitalization for specific psychiatric disorders.

Oral versus injectable antipsychotic treatment in early psychosis: Post hoc comparison of two studies

Background: Few studies have compared long-acting injectable second-generation antipsychotics with oral antipsychotics. Long-acting injectable antipsychotics—developed specifically to address the problem of adherence—might have an important role to play in treating early psychosis. Objective: The effects of oral antipsychotics versus risperidone long-acting injection (RLAI) were compared between 2 similar studies lasting 2 years each that were conducted at our site in South Africa. Methods: Results of an open-label study in which patients were treated with flexible doses of RLAI were compared with the results of a randomized controlled trial of flexible doses of oral risperidone or haloperidol. Inclusion criteria for both studies were age 16 to 45 years; confirmed diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder; ≤2 hospitalizations for psychosis; and lifetime exposure to ≤12 weeks of antipsychotic medication. The dose of RLAI was 25 mg every 2 weeks, which could be increased to 50 mg. Doses of oral risperidone or haloperidol began at 1 mg/d and were increased if necessary up to a maximum dose of 4 mg/d (8 mg/d in exceptional cases). Study assessments included the Positive and Negative Syndrome Scale (PANSS), the Extrapyramidal Symptom Rating Scale (ESRS), and body mass index (BMI). Results: The RLAI group included 50 patients (32 men and 18 women; mean [SD] age, 25.4 [7.4] years; BMI, 20.6 [4.6] kg/m 2). The oral risperidone or haloperidol group included 47 patients (27 men and 20 women; mean [SD] age, 25.9 [5.8] years; BMI, 20.1 [3.4] kg/m 2). Compared with patients treated with oral risperidone or haloperidol, RLAI-treated patients had significantly fewer all-cause discontinuations (26.0% [13/50] vs 70.2% [33/47] at 24 months; P < 0.005), greater reduction on the PANSS total score (-39.7 vs -25.7; P = 0.009), higher remission rate (64.0% [32/50] vs 40.4% [19/47]; P = 0.028), and lower relapse rate (9.3% [4/43] vs 42.1% [16/38]; P = 0.001) among the responders. Extrapyramidal symptoms were significantly lower in the RLAI group than in patients treated with oral risperidone or haloperidol, as measured by the maximum change in the mean [SD] ESRS total score (1.40 [2.60] vs 5.61 [5.21] vs 9.04 [6.21], respectively; P ≤ 0.001). The increase in BMI after 6 months was significantly greater in the RLAI group than in oral haloperidol-treated patients (mean [SD], 3.9 [1.9] vs 2.2 [1.3] kg/m 2; P = 0.001) but not significantly different from oral risperidone (3.4 [2.0] kg/m 2; P = NS). Four patients in the RLAI group had adverse events that were possibly related to prolactin, compared with 1 each in the oral risperidone and haloperidol groups. Conclusions: The findings of this post hoc analysis suggest that there were advantages in terms of efficacy, fewer extrapyramidal symptoms, and more weight gain with long-acting injectable second-generation antipsychotics as compared with oral antipsychotic treatment in early-episode psychosis.

Presentations of psychosis with violence: variations in different jurisdictions. A comparison of patients with psychosis in the high security hospitals of Scotland and England

International literature is consistent on there being a significant relationship between psychosis and violence, less so on its extent and nature, but two main presentational types are increasingly recognized. In one, people are unremarkable before onset of illness and psychotic symptoms commonly drive violence; in the other, psychosis is preceded by childhood conduct problems, associated with personality disorder, and psychotic symptoms seem less relevant. To explore the extent to which variations in aspects of social and service context in different jurisdictions affect presentational type among people admitted to high security hospitals. There will be differences between jurisdictions in proportions of patients with pure psychosis or with psychosis and antecedent personality disorder, but symptom drive to violence will be more common in the pure psychosis group regardless of social, legal and service context. Independently conducted record studies were used to compare high security hospital patients with psychosis in Scotland and England, all resident between 25 August 1992 and 13 August 1993. The cohorts were similar in offence histories, predominance of schizophrenia, age at first hospitalization for psychosis and first high security hospitalization. More Scottish patients had co-morbid substance misuse diagnoses and/or personality disorder than patients in England. Psychotic symptom drive to the index offence was, however, four times more likely in the pure psychosis groups, regardless of sex, ethnic group or country. Scottish patients spent less time in high security after the index act. Our hypotheses were sustained. Knowledge about lifestyle before onset of psychosis is important for interpreting literature on how psychotic symptoms relate to violence. This may also influence longer term outcome, although the shorter length of secure hospital stay in Scotland was perhaps affected more by greater availability of open 'step-down' beds.

A Cross-Sectional and Longitudinal Magnetic Resonance Imaging Study of Cingulate Gyrus Gray Matter Volume Abnormalities in First-Episode Schizophrenia and First-Episode Affective Psychosis

Previous magnetic resonance imaging (MRI) findings have demonstrated psychopathological symptom-related smaller gray matter volumes in various cingulate gyrus subregions in schizophrenia and bipolar disorder. However, it is unclear whether these gray matter abnormalities show a subregional specificity to either disorder and whether they show postonset progression. To determine whether there are initial and progressive gray matter volume deficits in cingulate gyrus subregions in patients with first-episode schizophrenia (FESZ) and patients with first-episode affective psychosis (FEAFF, mainly manic) and their specificity to FESZ or FEAFF. A naturalistic cross-sectional study at first hospitalization for psychosis and a longitudinal follow-up approximately 1(1/2) years later. Patients were from a private psychiatric hospital. Thirty-nine patients with FESZ and 41 with FEAFF at first hospitalization for psychosis and 40 healthy control subjects (HCs) recruited from the community underwent high-spatial-resolution MRI, with follow-up scans in 17 FESZ patients, 18 FEAFF patients, and 18 HCs. Individual subjects were matched for age, sex, parental socioeconomic status, and handedness. Cingulate gyrus gray matter volumes in 3 anterior subregions (subgenual, affective, and cognitive) and 1 posterior subregion, and whether there was a paracingulate sulcus. At first hospitalization, patients with FESZ showed significantly smaller left subgenual (P = .03), left (P = .03) and right (P = .005) affective, right cognitive (P = .04), and right posterior (P = .003) cingulate gyrus gray matter subregions compared with HCs. Moreover, at the 1(1/2)-year follow-up, patients with FESZ showed progressive gray matter volume decreases in the subgenual (P = .002), affective (P < .001), cognitive (P < .001), and posterior (P = .02) cingulate subregions compared with HCs. In contrast, patients with FEAFF showed only initial (left, P < .001; right, P = .002) and progressive subgenual subregion abnormalities (P < .001). Finally, patients with FESZ showed a less asymmetric paracingulate pattern than HCs (P = .02). Patients with FEAFF and FESZ showed differences in initial gray matter volumes and in their progression. Initial and progressive changes in patients with FEAFF were confined to the subgenual cingulate, a region strongly associated with affective disorder, whereas patients with FESZ evinced widespread initial and progressively smaller volumes.

Perceived and observed mother–child interaction at time of hospitalization and release in postpartum depression and psychosis

A pilot study was conducted which compared perceived mother-infant bonding in women admitted with postpartum depression or psychosis, with observations of mother-infant interaction by the nursing staff at both the time of hospitalization and that of release. 25 mother-infant pairs admitted to a psychiatric unit were included in this study. The Postpartum Bonding Questionnaire was used to assess the perceived mother-infant bond and the observation of mother-infant interaction was assessed with the Bethlem Mother-Infant Interaction Scale. At the time of both hospitalization and release postpartum depressed women experienced the bond with their child significantly more negative than women with postpartum psychosis. In contrast to women with postpartum psychosis, the experience of postpartum depressed women was significantly correlated with the observations of the nursing staff at time of release. Treatment that focuses on a mother's experience of the bond with her child could be especially beneficial for mothers with postpartum depression.

Self‐report of family functioning and risk for psychotic disorders in male adolescents with behavioural disturbances

Previous studies indicate that a poor family environment might affect vulnerability for the later manifestation of psychotic illness. The current study aims to examine family functioning prior to the onset of psychosis. Subjects were 42,948, 17-year old males with behavioural disturbances who were asked about the functioning of their family by the Israeli Draft Board. Data on later psychiatric hospitalizations were obtained from a National Psychiatric Hospitalization Registry. Poorer self-reported family functioning was associated with greater risk for later hospitalization for psychosis [adjusted hazard ratio (HR) = 1.16, 95% CI = 1.05-1.27], with a trend in the same direction for schizophrenia (adjusted HR = 1.1, 95% CI = 0.98-1.24). In male adolescents with behavioural disturbances, perceived poorer family functioning is associated with increased risk for non-affective psychotic disorders and schizophrenia. These data do not enable us to determine if perceived familial dysfunction increases vulnerability for psychosis, if premorbid behavioural abnormalities disrupt family life, or neither.

Hyperammonemia Due to Valproic Acid in the Psychiatric Setting

Hyperammonemia Due to Valproic Acid in the Psychiatric Setting

Hyperammonemia Due to Valproic Acid in the Psychiatric Setting

In 1980 Coulter and Allen (1) reported the first case of hyperammonemia, to our knowledge, with otherwise normal hepatic function tests in a child with epilepsy treated with valproic acid. Since that time, there have been several additional case reports and studies within the neurology literature that have established hyperammonemia with otherwise normal hepatic function as a potential side effect of valproic acid, especially in children and adolescents (2). Settle (3) published the first case of hyperammonemia, to our knowledge, in a psychiatric setting in 1995. Several additional cases have followed it. Unfortunately, to date, to our knowledge, there has only been one prospective study published within the psychiatric literature (4). We present here a patient’s history that illustrates how the symptoms of a psychiatric disorder might make the diagnosis of hyperammonemic encephalopathy difficult.

Twin Pair Resemblance for Psychiatric Hospitalization in the Swedish Twin Registry: A 32-year Follow-up Study of 29,602 Twin Pairs

Allgulander et al. (Allgulander C, Nowak J, Rice JP (1991) Acta Psychiatr Scand 83, 12) published twin pair analyses of psychiatric hospitalization for like-sex pairs from the Swedish Twin Registry born 1926-1958. As noted in a subsequent letter (Allgulander C, Nowak J, Rice JP (1992) Acta Psychiatr Scand 86, 421), several features of the original study resulted in under-ascertainment of cases and underestimated heritability, particularly for alcoholism. The present report updates the prior results by using 17 additional years of follow-up, including members of opposite-sex twin pairs, and addressing biases arising from cohort effects and from excluding pairs with unknown zygosity. Registry records for 29,602 twin pairs born 1926-1958 were matched against national databases of psychiatric and medical hospitalizations from 1972-2000 to obtain ICD diagnostic codes. Zygosity was known for 10,903 opposite-sex pairs and 15,401 like-sex pairs who participated previously in research. Twin-pair resemblance and genetic and environmental variance proportions were estimated for hospitalization for alcoholism, affective disorders, psychosis, and (in females) anxiety disorders. Hospitalization rates during the ascertainment window were: alcoholism: males = 3.67%, females = 0.94%; affective disorders: males = 1.99%, females = 2.75%; anxiety disorders: males = 0.46%, females = 0.74%; and psychotic disorders: males = 1.70%, females = 1.96%. Twins from like-sex pairs with unknown zygosity had significantly higher prevalences than those with known zygosity. Tetrachoric correlations and heritability estimates were affected by the method used to model unknown zygosity and cohort effects. Inclusion of additional follow-up information, opposite-sex twin pairs, age-adjustment, and use of current ICD definitions yielded higher heritability estimates for alcoholism, anxiety disorders, and psychosis than previously published for this nationally-representative sample of twins from Sweden. The results show that relatively small selection biases can alter twin study results and underscore the importance of addressing under-ascertainment of cases in genetic research based on volunteers.

Incidence of Hospitalization for Postpartum Psychotic and Bipolar Episodes in Women With and Without Prior Prepregnancy or Prenatal Psychiatric Hospitalizations

Postpartum psychosis occurs in 1 to 2 cases per 1000 live births. Most studies have not distinguished postpartum psychosis from bipolar disorder or the proportion of the incidence attributable to prepregnancy psychiatric morbidity. To determine the incidence of postpartum psychosis and bipolar disorder attributable to previous psychiatric hospitalization. Population-based study using linked registry data to determine postpartum onset of psychotic and bipolar episodes within 90 days after the first birth, by women with and without prepregnancy or prenatal psychiatric hospitalization. We assessed the type, number, and recency of previous hospitalizations on the incidence of hospitalization for postpartum psychotic and bipolar episodes. Nationwide Swedish Hospital Discharge and Medical Birth registers. Swedish women delivering a first live infant between January 1, 1987, and December 31, 2001. Postpartum hospitalization for psychosis or bipolar disorder. The cumulative incidences for postpartum psychotic and bipolar episodes (adjusted for age at first birth) were 0.07% and 0.03%, respectively. The incidence of psychiatric hospitalizations for postpartum psychotic or bipolar episodes among women without previous psychiatric hospitalizations was 0.04% and 0.01% of first births, respectively; for women with any psychiatric hospitalization before delivery, the incidence was 9.24% and 4.48%, respectively. For postpartum psychotic and bipolar episodes, the risk increased significantly with the recency of prepregnancy hospitalizations, number of previous hospitalizations, and length of most recent hospitalization. More than 40% of women hospitalized during the prenatal period for a bipolar or a psychotic condition were hospitalized again during the postpartum period. Approximately 90% of all postpartum psychotic and bipolar episodes occurred within the first 4 weeks after delivery. Almost 10% of women hospitalized for psychiatric morbidity before delivery develop postpartum psychosis after their first birth. This underscores the need for obstetricians to assess history of psychiatric symptoms and, with pediatric and psychiatric colleagues, to optimize the treatment of mothers with psychiatric diagnoses through childbirth.

Modifiable Risk Factors for Hospitalization Among People with Psychosis: Evidence from the National Study of Low Prevalence (Psychotic) Disorders

Relatively little has been published on dynamic, that is, modifiable, as opposed to static risk factors for hospitalization in the research literature on risk factors for hospitalization in serious mental illness. The aim of this study was to develop a model to determine modifiable predictors of hospitalization using data from the Australian National Study of Low Prevalence (Psychotic) Disorders. The Study of Low Prevalence Disorders used a two-phase design to estimate the prevalence of psychoses and identify characteristics of people with psychotic illness. This paper compares people hospitalized at the time of census and those using outpatient services. Logistic regression was used to examine the relative impact of dynamic characteristics including service utilization, symptom profile and risky behaviours on a base model for risk of hospitalization. In the base model, course of disorder and age but not type of psychosis were significantly associated with hospitalization. Among symptoms, delusions (but not hallucinations) and negative symptoms significantly increased the odds of hospitalization. Service utilization, especially case management, reduced the odds significantly and substantially. Results for risky behaviours (e.g. substance abuse, offending) were ambiguous. The results highlight the impact of dynamic factors, particularly case management, over and above static factors in reducing the risk of hospitalization in psychosis, and point to a potential for targeted interventions to avert some of the burden, both emotional and financial, associated with the hospitalization of people with psychotic disorders. These findings have important clinical and policy implications.