Symptoms predicting inpatient service use among patients with bipolar affective disorder

Objective: Symptoms that were risk factors for hospital readmission among p sychiatric inpatients diagnosed as having bipolar affective disorder were e valuated. Methods: Subjects were 100 persons consecutively admitted to a ps ychiatric inpatient unit at a university-affiliated hospital who met Resear ch Diagnostic Criteria for bipolar I or II disorder or schizoaffective diso rder, manic type. Patients were assessed using the Schedule for Affective D isorders and Schizophrenia-Lifetime Version (SADS-L) and the Brief Psychiat ric Rating Scale (BPRS) within one week of discharge, and their hospitaliza tion status was documented by monthly phone contacts over a period of 15 mo nths. Results: Twenty-four patients (24 percent) were rehospitalized within six months of discharge, and 44 (44 percent) were readmitted within 15 mon ths. Survival analysis using the Cox proportional hazard regression model d emonstrated that patients with high scores on a BPRS-derived mania factor w ere at significantly decreased risk of rehospitalization, whereas those sco ring high on a factor consistent with neurovegetative depression were at si gnificantly increased risk. A greater number of previous psychiatric admiss ions and younger age were also associated with significantly increased risk of rehospitalization. Conclusions: The findings suggest that patients with bipolar disorder presenting with a depressive episode characterized by pro minent neurovegetative features should be treated more aggressively with bo th pharmacotherapy and intensive outpatient services to reduce the relative ly high risk of rehospitalization that appears to be associated with this t ype of depression.