Skip to main content
SpringerLink
Log in

Rehospitalization Risk with Second-Generation and Depot Antipsychotics

  • Published:
Annals of Clinical Psychiatry

Abstract

Decreasing hospital admissions is important for improving outcomes for people with schizophrenia. Second-generation antipsychotics (SGAs) are better tolerated for long-term therapy than traditional medications and may contribute to a lower rehospitalization risk, but have not been compared to depot forms with regard to long-term outcomes. This study evaluates the risk of readmission in patients discharged from six State of Maryland inpatient mental health facilities between Jan. 1, 1997 and Dec. 31, 1997 on clozapine (N = 41), risperidone (N = 149), and olanzapine (N = 103). These patients were compared with those discharged from the two largest state facilities during the same time period on fluphenazine decanoate (N = 59) or haloperidol decanoate (N = 59). One-year readmission risk (measured by Kaplan–Meier survival analysis with Holm's adjustment for multiple comparison on Log Rank tests) were 10% for clozapine, 12% for risperidone, and 13% for olanzapine. These risks were not significantly lower than the readmission risk for fluphenazine decanoate (21%) but were significantly lower than haloperidol decanoate (35%) for all three SGAs. Demographic and clinical variables did not predict readmission for any of the medications. In patients with similar demographic and clinical characteristics, 1-year risk of readmission for patients treated with SGAs were at least comparable to the 1-year risk for patients receiving fluphenazine decanoate and lower than the risk for patients treated with haloperidol decanoate. SGAs may provide better long-term prognoses and outcomes for patients with schizophrenia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Atakan Z, Cliff G, Cooper JE: Can psychiatrists predict the one-year outcome of schizophrenia? Soc Psychiatry Psychiatr Epidemiol 1990; 25(3):117-124

    Google Scholar 

  2. Olfson M, Mechanic D, Boyer CA, Hansell S, Walkup J, Weiden PJ: Assessing clinical predictions of early rehospitalization in schizophrenia. J Nerv Ment Dis 1999; 187(12):721-729

    Google Scholar 

  3. Russo J, Roy-Byrne P, Jaffe C, Ries R, Dagadakis C, Avery D: Psychiatric status, quality of life, and level of care as predictors of outcomes of acute inpatient treatment. Psychiatr Serv 1997; 48(11):1427-1434

    Google Scholar 

  4. Swett C: Symptom severity and number of previous psychiatric admissions as predictors of readmission. Psychiatr Serv 1995; 46(5):482-485

    Google Scholar 

  5. Gupta S, Hendricks S, Kenkel AM, Bhatia SC, Haffke EA: Relapse in schizophrenia: Is there a relationship to substance abuse?. Schizophr Res 1996; 20:153-156

    Google Scholar 

  6. Sullivan G, Wells KB, Morgenstern H, Leake B: Identifying modifiable risk factors for rehospitalization: A case control study of seriously mental ill persons in Mississippi. Am J Psychiatry 1995; 152(12):1749-1756

    Google Scholar 

  7. Neale MS, Rosenheck RA: Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv 1995; 46(7):719-721

    Google Scholar 

  8. Vaughn CE, Leff JP: The influence of family and social factors on the course of psychiatric illness. A comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry 1976; 129:125-137

    Google Scholar 

  9. Weiden P, Aquila R, Standard J: Atypical antipsychotic drugs and long-term outcome in schizophrenia. J Clin Psychiatry 1996; 57(Suppl. 11):53-60

    Google Scholar 

  10. Gerlach J: Depot neuroleptics in relapse prevention: Avantages and disadvantages. Int Clin Psychopharmacol 1995; 9(Suppl 5):17-20

    Google Scholar 

  11. Barnes TR, Curson DA: Long-term depot antipsychotics. A risk–benefit assessment. Drug Saf 1994; 10(6):464-479

    Google Scholar 

  12. Schooler NR, Levine J, Severe JB, Brauzer B, DiMascio A, Klerman GL, Tuason VB: Prevention of relapse in schizophrenia. An evaluation of fluphenazine decanoate. Arch Gen Psychiatry 1980; 37(1):16-24

    Google Scholar 

  13. Kane JM, Aguglia E, Altamura AC, Ayuso Gutierrez JL, Brunello N, Fleischhacker WW, Gaebel W, Gerlach J, Guelfi JD, Kissling W, Lapierre YD, Lindstrom E, Mendlewicz J, Racagni G, Carulla LS, Schooler NR: Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy. Eur Neuropsychopharmacol 1998; 8(1):55-66

    Google Scholar 

  14. Lehman AF, Steinwachs DM: At issue: Translating research into practice: The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 1998; 24:1-10

    Google Scholar 

  15. Miller AL, Chiles JA, Chiles JK, Crismon ML, Rush AJ, Shon SP: The Texas Medication Algorithm Project (TMAP) schizophrenia algorithms. J Clin Psychiatry 1999; 60:649-657

    Google Scholar 

  16. Citrome L, Levine J, Allingham B: Utilization of depot neuroleptic medication in psychiatric inpatients. Psychopharmacol Bull 1996; 32(3):321-326

    Google Scholar 

  17. Kuno E, Rothbard AB: Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. Am J Psychiatry 2002; 159:567-572

    Google Scholar 

  18. Tavcar R, Dernovsek MZ, Zvan V: Choosing antipsychotic maintenance therapy—A naturalistic study. Pharmacopsychiatry 2000; 33(2):66-71

    Google Scholar 

  19. Jibson MD, Tandon R: New atypical antipsychotic medications. J Psychiatr Res 1998; 32:215-228

    Google Scholar 

  20. Gaebel W: Towards the improvement of compliance: The significance of psycho-education and new antipsychotic drugs. Int Clin Psychopharmacol 1997; 12(Suppl 1):S37-S42

    Google Scholar 

  21. Tran PV, Dellva MA, Tollefson GD, Wently AL, Beasley CM, Jr: Oral olanzapine versus oral haloperidol in the maintenance treatment of schizophrenia and related psychoses. Br J Psychiatry 1998; 172:499-505

    Google Scholar 

  22. Conley RR, Love RC, Kelly DL, Bartko JJ: Rehospitalization rates of patients recently discharged on a regimen of risperidone or clozapine. Am J Psychiatry 1999; 156:863-868

    Google Scholar 

  23. Essock SM, Hargreaves WA, Covell NH, Goethe J: Clozapine's effectiveness for patients in state hospitals: Results from a randomized trial. Psychopharmacol Bull 1996; 32(4):683-697

    Google Scholar 

  24. Hogarty GE: Prevention of relapse in chronic schizophrenic patients. J Clin Psychiatry 1993; 54(Suppl 3):18-23

    Google Scholar 

  25. Rabinowitz J, Licthenberg P, Kaplan Z, Mark M, Nahon D, Davidson M: Rehospitalization rates of chronically ill schizophrenic patients discharged on a regimen of risperidone, olanzapine, or conventional antipsychotics. Am J Psychiatry 2001; 158:266-269

    Google Scholar 

  26. Hogarty GE, Ulrich RF: The limitations of antipsychotic medication on schizophrenia relapse and adjustment and the contributions of psychosocial treatment. J Psychiatr Res 1998; 32:243-250

    Google Scholar 

  27. Schooler NR, Keith SJ, Severe JB, Matthews SM, Bellack AS, Glick ID, Hargreaves WA, Kane JM, Ninan PT, Frances A, Jacobs M, Lieberman JA, Mance R, Simpson GM, Woerner MG: Relapse and rehospitalization during maintenance treatment of schizophrenia. The effects of dose reduction and family treatment. Arch Gen Psychiatry 1997; 54(5):453-463

    Google Scholar 

  28. Moore DB, Kelly DL, Sherr JD, Love RC, Conley RR: Rehospitalization rates for depot antipsychotics and pharmacoeconomic implications: Comparison with risperidone. Am J Health Syst Pharm 1998; 55(Suppl 4):17-19

    Google Scholar 

  29. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53:457-481

    Google Scholar 

  30. Prentice RL: Linear rank tests with right censored data. Biometrika 1978; 65:167-179

    Google Scholar 

  31. Cox DR: Regression models with life tables. J R Stat Soc 1972; 34:187-220

    Google Scholar 

  32. Aickin M, Gensler H: Adjusting for multiple testing when reporting research results: The Bonferroni vs. Holm methods. Am J Public Health 1996; 86:726-728

    Google Scholar 

  33. Kane J, Honigfeld G, Singer J, Meltzer H: Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45(9):789-796

    Google Scholar 

  34. Conley RR, Buchanan RW: Evaluation of treatment-resistant schizophrenia. Schizophr Bull 1997; 23(4):663-674

    Google Scholar 

  35. Marder SR, Davis JM, Chouinard G: The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: Combined results of the North American trials. J Clin Psychiatry 1997; 58(12):538-546

    Google Scholar 

  36. Tollefson GD, Sanger TM: Negative symptoms: A path analytic approach to a double-blind, placebo-and haloperidol-controlled clinical trial with olanzapine. Am J Psychiatry 1997; 154(4):466-474

    Google Scholar 

  37. Patel NC, Dorson PG, Edwards N, Mendelson S, Crismon ML: One-year rehospitalization rates of patients discharged on atypical versus conventional antipsychotics. Psychiatr Serv 2002; 53:891-893

    Google Scholar 

  38. Mahmoud R, Engelhart L, Ollendorf D, Oster G: The Risperidone Outcomes Study of Effectiveness (ROSE): A model for evaluating treatment strategies in typical psychiatric practice. J Clin Psychiatry 1999; 60(Suppl 3):42-47

    Google Scholar 

  39. Desai NM, Huq Z, Martin SD, McDonald G: Switching from depot antipsychotics to risperidone: Results of a study of chronic schizophrenia. The schizophrenia treatment and assessment group. Adv Ther 1999; 16(2):78-88

    Google Scholar 

  40. McKane JP, Robinson AD, Wiles DH, McCreadie RG, Stirling GS: Haloperidol decanoate v. fluphenazine decanoate as maintenance therapy in chronic schizophrenic in-patients. Br J Psychiatry 1987; 151:333-336

    Google Scholar 

  41. Bransgrove LL, Kelly NW: Movement disorders in patients treated with long-acting injectable antipsychotic drugs. Am J Hosp Pharm 1994; 51(7):895-899

    Google Scholar 

  42. Masimiremba CM, Hasler JA: Genetic polymorphism of drug metabolism enzymes in African populations: Implications for the use of neuroleptics and antidepressants. Brain Res Bull 1997; 44(5):561-571

    Google Scholar 

  43. Bertilsson L: Geographical/interracial differences in polymorphic drug oxidation, current state of knowledge of cytochromes P450 (CYP) 2D6 and 2C19. Clin Pharmacokinet 1995; 29:192-209

    Google Scholar 

  44. Tunnicliffe S, Harrison G, Standen PJ: Factors affecting compliance with depot injection treatment in the community. Soc Psychiatry Psychiatr Epidemiol 1992; 27(5):230-233

    Google Scholar 

  45. Segal SP, Bola JR, Watson MA: Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services. Psychiatr Serv 1996; 47(3):282-286

    Google Scholar 

  46. Glazer WM, Morganstern H, Doucette J: Race and tardive dyskinesia among outpatients at a CMHC. Hosp Community Psychiatry 1994; 45(1):38-42

    Google Scholar 

  47. Treatment of schizophrenia 1999. The expert consensus guideline series. J Clin Psychiatry 1999; 60(Suppl 11):3-80

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Maryland Psychiatric Research Center, University of Maryland, Baltimore, Maryland

    Robert R. Conley & Deanna L. Kelly

  2. Baltimore School of Pharmacy, University of Maryland, Baltimore, Maryland

    Raymond C. Love & Robert P. McMahon

Authors
  1. Robert R. Conley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deanna L. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raymond C. Love
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert P. McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert R. Conley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Conley, R.R., Kelly, D.L., Love, R.C. et al. Rehospitalization Risk with Second-Generation and Depot Antipsychotics. Ann Clin Psychiatry 15, 23–31 (2003). https://doi.org/10.1023/A:1023276509470

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023276509470

Search

Navigation