New Research Sheds Light on Schizophrenia Readmission Rates Following Treatment

While treatment options do not impact 30-day readmissions, they can influence hospital length of stay and costs.

With many options available to treat schizophrenia or schizoaffective disorders, it is unknown if there is a true hierarchy of treatment in decreasing hospital readmission rates.

A team, led by Austin Goebel, DO, Unity Health, examined whether patients who were discharged on a long-acting injectable antipsychotic would have a significantly lower readmission rate by eliminating some of the medication adherence issues commonly found in this patient population.

These findings were presented at the 2021 American Psychiatric Association Annual Meeting.

The Diseases

Both schizophrenia and schizoaffective disorders feature similar symptoms, including periods of delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms.

However, schizoaffective disorder also has mood symptoms for the majority of the duration of the active and residual periods of the illness.

Recent research has compared the efficacy of oral and long-acting injectable antipsychotic medications with inconclusive results.

The Treatments

In the retrospective cohort, the investigators compared readmission rates between injectable long-acting antipsychotics and oral antipsychotics in 307 adults between 18-65 who were admitted at an inpatient psychiatric facility, diagnosed with either schizophrenia or schizoaffective disorder, and received either oral aripiprazole (Abilify) (n = 81), Aripiprazole Lauroxil (Aristada) (n = 36), Risperidone (Risperdal) (n = 58), and Paliperidone Palmitate (Invega Sustenna) (n = 132).

The investigators sought outcomes of 30-day and 90-day readmissions, hospital length of stay (LOS), and hospitalization costs.

Each patient was separated into 4 different groups based on their treatments and the researchers compared aripiprazole with aripiprazole lauroxil and risperidone with paliperidone palmitate.

There was no evidence showing the likelihood of 30-day readmission was lower for any of the treatments after adjusting for age, sex, and smoking status (OR, 0.667; 95% CI, 0.064-6.95; P = 0.735; OR, 0.101; 95% CI, 0.353-4.38; P = 0.734).

However, there was evidence that giving aripiprazole lauroxil instead of oral aripiprazole increased both the length of stay (P = 0.0247) and hospitalization cost (P = 0.0184).

“Our study did not find conclusive evidence that giving either Aristada or Invega Sustenna could reduce 30 or 90-day readmission rates,” the authors wrote. “For Aristada, the average LOS and hospitalization costs increased significantly compared to Abilify. Some patients required 45-day court-ordered holds in order to obtain a long-acting injection, which lead to longer LOS.”

Schizophrenia Risk Factors

While schizophrenia treatment has evolved from symptom reduction and relapse prevention to functional recovery in recent years, the recovery rates remain low.

However, identifying variables linked to the real-life functioning domains could help yield more effective personalized and integrated treatment programs.

Researchers found 5 baseline variables directly associated with real-life functioning at follow-up—neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, −0.126; 95% CI, −0.190 to −0.062; P < .001); positive symptoms with work skills (β, −0.059; 95% CI, −0.112 to −0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001).

The study, “Comparing Outcomes of Oral Antipsychotics Versus Long-Acting Injectable Antipsychotics,” was published online by the American Psychiatric Association.