Naturalistic outcomes of patients discharged from a community treatment order: QA project

Abstract

Objective

To study outcomes for patients after they are discharged from Community treatment orders (CTO) including rate of relapse, median time to relapse and to identify the risk factors associated with relapse.

Method

The study population included patients discharged from CTO from July 2017 to December 2021, managed by a major metropolitan* case management team (CMT). The data were collected from electronic medical records (EMR). Descriptive analysis was conducted to study the sample characteristics. Logistic regression using univariate and multivariate analysis was performed to examine the associations between factors related to relapse.

Results

A total of 128 patients were studied. The relapse rate was 27.4% with median time to relapse of 72 days. Poor insight, poor treatment compliance, duration of CTO and number of CMT contacts were significantly associated with relapse while substance use, psychiatric comorbidities and psychosocial factors were not.

Conclusions

The findings suggest that people who relapsed had poor insight and poor medication adherence, had CTO for a longer period and had frequent contact from CMT even after discharge from CTO.

Keywords

Community treatment order predictors of relapse discharge from cto relapse after CTO discharge

Get full access to this article

View all access options for this article.

References

Rugkåsa

. Effectiveness of community treatment orders: the international evidence. Can J Psychiatr 2016; 61(1): 15–24. DOI: 10.1177/0706743715620415.

Rugkåsa

Yeeles

Koshiaris

, et al. Recall of patients on community treatment orders over three years in the OCTET CTO cohort. BMC Psychiatr 2016; 16(1): 392. DOI: 10.1186/s12888-016-1102-4.

O'Reilly

. Why are community treatment orders controversial? Can J Psychiatr 2004; 49(9): 579–584. DOI: 10.1177/070674370404900902.

Munetz

Galon

Frese

III . The ethics of mandatory community treatment. J Am Acad Psychiatry Law 2003; 31(2): 173–183.

McIvor

. The community treatment order: clinical and ethical issues. Aust N Z J Psychiatr 1998; 32(2): 223–228. DOI: 10.3109/00048679809062732.

Burns

Yeeles

Koshiaris

, et al. Effect of increased compulsion on readmission to hospital or disengagement from community services for patients with psychosis: follow-up of a cohort from the OCTET trial. Lancet Psychiatr 2015; 2(10): 881–890. DOI: 10.1016/S2215-0366(15)00231-X.

Kisely

Hall

. An updated meta-analysis of randomized controlled evidence for the effectiveness of community treatment orders. Can J Psychiatr. 2014; 59(10): 561–564. DOI: 10.1177/070674371405901010. Erratum in: Can J Psychiatry. 2017 May;62(5):357.

Maughan

Molodynski

Rugkåsa

, et al. A systematic review of the effect of community treatment orders on service use. Soc Psychiatr Psychiatr Epidemiol 2014; 49(4): 651–663. DOI: 10.1007/s00127-013-0781-0.

Harris

Chen

Jones

, et al. Community treatment orders increase community care and delay readmission while in force: results from a large population-based study. Aust N Z J Psychiatr 2019; 53(3): 228–235. DOI: 10.1177/0004867418758920.

10.

Awara

Jaffar

Roberts

. Effectiveness of the community treatment order in streamlining psychiatric services. J Ment Health 2013; 22(2): 191–197. DOI: 10.3109/09638237.2013.775408.

11.

Ingram

Muirhead

Harvey

. Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: changes in problem behaviours and social functioning. Aust N Z J Psychiatr 2009; 43(11): 1077–1083. DOI: 10.3109/00048670903179103.

12.

Vaughan

McConaghy

Wolf

, et al. Community treatment orders: relationship to clinical care, medication compliance, behavioural disturbance and readmission. Aust N Z J Psychiatr 2000; 34(5): 801–808. DOI: 10.1080/j.1440-1614.2000.00813.x.

13.

Kazadi

NJB

Moosa

MYH

Jeenah

. Factors associated with relapse in schizophrenia. Soc Anxiety J Psychiatry 2008; 14(2): 52–53.

14.

Lam

Watkins

Hayward

, et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003; 60(2): 145–152. DOI: 10.1001/archpsyc.60.2.145.

15.

Weiden

Olfson

. Cost of relapse in schizophrenia. Schizophr Bull 1995; 21(3): 419–429. DOI: 10.1093/schbul/21.3.419.

16.

Agenagnew

Kassaw

. The lifetime prevalence and factors associated with relapse among mentally ill patients at Jimma University Medical Center, Ethiopia: cross sectional study. J Psychosoc Rehabil Ment Health 2020; 7(2): 211–220. DOI: 10.1007/s40737-020-00176-7.

17.

Lincoln

Lüllmann

Rief

. Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull 2007; 33(6): 1324–1342. DOI: 10.1093/schbul/sbm002.

18.

Bergé

Mané

Salgado

, et al. Predictors of relapse and functioning in first-episode psychosis: a two-year follow-up study. Psychiatr Serv 2016; 67(2): 227–233. DOI: 10.1176/appi.ps.201400316.

19.

Xiao

, et al. High relapse rate and poor medication adherence in the Chinese population with schizophrenia: results from an observational survey in the People's Republic of China. Neuropsychiatr Dis Treat 2015; 11: 1161–1167. DOI: 10.2147/NDT.S72367.

20.

Winklbaur

Ebner

Sachs

, et al. Substance abuse in patients with schizophrenia. Dialogues Clin Neurosci 2006; 8(1): 37–43. DOI: 10.31887/DCNS.2006.8.1/bwinklbaur.

21.

Linszen

Dingemans

Lenior

. Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry 1994; 51(4): 273–279. DOI: 10.1001/archpsyc.1994.03950040017002.

22.

Moges

Belete

Mekonen

, et al. Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study. Int J Ment Health Syst 2021; 15(1): 42. DOI: 10.1186/s13033-021-00464-0.

23.

Lin

Joshi

Keenan

, et al. Associations between relapses and psychosocial outcomes in patients with schizophrenia in real-world settings in the United States. Front Psychiatry 2021; 12: 695672. DOI: 10.3389/fpsyt.2021.695672.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.11 MB