A review of the causes and impact of hospitalization in schizophrenia has shown that hospitalization is more likely the result of cognitive and functional decline rather than a contributor.
"While it is difficult to disentangle the consequence of the reasons for hospitalization from the effects of hospitalization, most contemporary hospitalizations are extremely brief, and the cause is typically psychotic exacerbation or aggressive and hostile behavior," wrote Philip D. Harvey, Ph.D., and his colleagues at the University of Miami.
"It is important to know whether being treated in a hospital, for either the short or long term, is an antecedent or consequence of clinical symptoms, cognitive deficits, and disability."
Historically, patients with schizophrenia were institutionalized in hospitals for long periods of time, but that changed with the introduction of chlorpromazine as treatment in the mid-1950s. This led to the discharge of a significant proportion of patients from long-stay care and changed the model of care for schizophrenia.
"Further, the entire inpatient treatment model for schizophrenia has changed drastically, from stays that averaged 6-12 weeks for "acute admissions" 25 years ago, to 5- to 7-day stays or even admissions that are not designated as admissions because the patient stays in the emergency room for up to 72 h," the authors reported (Neurobiol. Dis. 2013;53:18-25).
They concluded that while long hospital stays had the potential for adverse effects on functioning, there was an increased risk for medication nonadherence and psychotic relapses under the current model of care.
The review examined the ways in which hospitalization is used in schizophrenia, and how hospitalization relates to the course of the illness, assessment of patients, and general understanding of the disease.
Aggressive and disruptive behavior commonly precedes acute admission and can mean that patients are difficult to discharge even during times of high demand. Aggression is often predicted by deficits in frontal lobe function and is also associated with negative symptoms.
"Reducing aggression associated with cognitive deficits is challenging, because of the lack of interventions that target cognition and the possibility that cognitive functioning declines over time," the authors wrote.
The authors also identified recurrent or persistent psychosis as a risk factor for cortical deterioration and functional impairments, such as those seen in older institutionalized patients.
"Thus, these data suggest that continued efforts to engage people with schizophrenia in treatment can serve to prevent cognitive and functional declines associated with psychosis," the researchers wrote.
Clozapine treatment had been associated with a reduced risk of cortical degeneration and a reduction in psychosis among a subgroup of treatment-resistant patients, the authors said.
"Data to date [suggest] that these cognitive enhancement treatments are not effective on psychosis, so further developments in the treatment of nonadherent and treatment resistant patients seem required."
The review was partly supported by grants from the National Institute on Aging and National Institute of Mental Health. The authors did not declare any conflicts of interest.