Protocols for Schizophrenia-Related Hospitalizations

Considerations for preventing frequent hospital readmissions for patients with schizophrenia due to relapses and other medical conditions.

Henry Nasrallah, MD: For patients who are being readmitted often, our No. 1 protocol is to try to stop readmission. It’s very bad for the patient biologically, psychologically, and socially to be readmitted again and again, as well as to experience a psychotic episode. For such patients, we try our best to prevent readmission by making sure that the patients adhere to the prescribed medications in the inpatient unit and see which they respond well to. Because they are administered by nurses, we make sure that the patient is swallowing them. That’s why they work.

At the time of discharge, our protocol for such patients is to switch them to long-acting injectables of the antipsychotic drug that worked for them in the inpatient unit. The medication is delivered in the outpatient setting without interruption and will relieve patients of the burden of having to remember to take the pills every single day, which is a big problem in patients with severe mental illness. That is why many of them keep relapsing and coming back to the inpatient unit. Our main protocol is to guarantee adherence and delivery of medication to the patient’s brain.

Our patients are afflicted with many medical conditions. It’s well known that patients with schizophrenia have a lot of cardiovascular and pulmonary disease, GI [gastrointestinal] disease], and immunological issues. We call them comorbidities, but many times, they may lead to the patient utilizing the health care system by coming to the emergency department for various medical complaints, not just psychiatric, or they will come because of drug-drug interactions and adverse effects.

Sometimes these are psychiatric issues, and sometimes they’re a general medical issue. Ideally, for patients like that who have a multitude of medical problems, it’s very important to have collaborative care so that psychiatrists and primary care physicians or specialists work together. If the patient has significant heart disease, we will work directly with the cardiologist. If they have a significant endocrinological condition, we will work with the endocrinologist, etc. Usually, the primary care physician would be the best person to work with and would refer the patient to where they need care, other than the psychiatric care that we provide them.

Transcript Edited for Clarity