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Financial pressures have led to a reduced length of stay (LOS) in inpatient psychiatric facilities for adolescents, yet research on the outcomes of short-term programs remains scant. The present study evaluated the outcomes of an adolescent inpatient program by: (1) probing depression, anxiety, and suicidal ideation at admission and discharge and (2) testing whether clinical or psychosocial factors moderate treatment response. Participants included adolescents (n = 777) aged 13–19 years admitted to an inpatient treatment program for acute psychiatric concerns. Clinical interviews were administered to probe mental disorders and past suicidal thoughts and behaviors (STBs), and self-report measures assessed symptom severity, child abuse, and peer victimization (i.e., bullying). Results showed a significant decrease in depression, anxiety, and suicidal ideation from admission to discharge. Comorbidity, past month NSSI, and lifetime suicide attempts emerged as moderators of treatment response, and peer victimization predicted symptom severity at discharge. Although findings suggest an overall improvement, participants with more severe clinical presentations (e.g., comorbidity, past month NSSI, lifetime suicide attempts, and more severe bullying) reported greater symptom severity at admission and discharge, suggesting that these patients may benefit from longer inpatient stays to achieve further symptom reduction. Although this may incur greater costs in the short-term, it also may prevent unintended economic and psychosocial consequences in the long-term. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the evolving role of Crisis Resolution and Home Treatment Team (CRHTT) within patient care pathway. Methods: 100 consecutive referrals to a CRHTT were analysed to establish whether the team was reviewing diagnoses and treatment in the manner of a second opinion service. Referrals from community teams were analysed independently to those relating to early hospital discharges. The effect of medication change prior to referral to another team was also examined to see whether it affected the likelihood or otherwise of a further change. Results: Whether a patient was seen by a psychiatrist appeared related to both source of referral and length of CRHTT stay. Most patients (76%) referred after early hospital discharge were not seen by a psychiatrist, but the majority (67%) of the community referrals were seen by a psychiatrist. Medications were changed for 69% of patients who received such a psychiatric assessment, and the diagnoses were changed in 28% of this group. Conclusions: This study indicates that CRHTT is moving into a role where it also offers second opinions on secondary care patients. It suggests that the value of such a role could be extended if there are sufficient resources to also offer psychiatric assessments to short-stay patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify factors which are associated with the length of stay in a Swiss mental hospital. Demographical and clinical data of all patients who were admitted to the adult inpatient psychiatric service of the Federal State of Aargau in 2016 were examined regarding their association with the length of stay. The study sample included N = 1479 patients. Mean length of stay was 33 days and the median equalled 26 days. Higher age and a primary diagnosis of psychotic or affective disorder were associated with increased length of stay. In contrast, foreign nationality and compulsory admission were associated with reduced length of stay. While some of our findings were in line with recent findings from Italy and the United Kingdom, others could not be replicated. [ABSTRACT FROM AUTHOR]

Objective: We examine the association between rates of homicide resulting in a mental health disposition (termed mentally abnormal homicide [MAH]) and homicides without such a disposition, as well as to province-wide psychiatric hospitalisation and incarceration rates.Method: In this population-based study, we investigate all adult homicide perpetrators ( n = 4402) and victims ( n = 3783) in Ontario from 1987 to 2012. We present annual rates of mentally abnormal and non-mentally abnormal homicide and position them against hospitalisation and incarceration rates.Results: Among the total sample of homicide accused, 3.7% were mentally abnormal. Most (82.5%) had a psychotic disorder at the time of the offense. Contrasted with declining hospitalisation, incarceration, and population homicide rates, the rate of MAH remained constant at an average of .07 perpetrators per 100,000 population. The rate of MAH was not associated with discharges from or average length of stay in psychiatric hospitals (ρ = 0.10; 0.34, P > 0.10), incarceration rates (ρ = 0.16, P = 0.42), or the total homicide rate (ρ = 0.25, P = 0.22). The proportion of MAH perpetrators with a substance use disorder increased modestly over time (β = 0.35, R2 = 0.12, P = 0.08).Conclusions: The rate of MAH has not changed appreciably over the past 25 years. Declining psychiatric service utilisation was not associated with the rate of homicide committed by people with mental illness and, secondarily, was not linked to increases in the population homicide or incarceration rates. Substance use has become a more prevalent problem for this population. [ABSTRACT FROM AUTHOR]

A significant number of patients with intellectual disability (ID) were admitted to forensic mental health asylums during the period 1915-1987. Many of these patients stayed for more than a decade, because of previous offending behaviour. We investigated the daily lives of 262 patients with an ID using casebooks. Two of the patients were studied more in detail. The available documents describe most of these patients as sociable, well-behaved and socially engaged although they missed having contacts outside the hospital. Long-stay patients were studied more in detail. [ABSTRACT FROM AUTHOR]

Critical Time Intervention (CTI) is a time-limited mental health intervention offered to people with mental disorders during critical/transition periods. This study assesses the impact of CTIBR on social performance and quality of life within a population in the process of deinstitutionalization, after long-term hospitalization in a psychiatric institution. The study population was split into two groups, one of which received CTI plus the regular care. Results showed no advantage of the intervention compared to the regular programs provided by the institution. When study participants are analyzed as a group, we found positive improvement regarding their social functioning and self-perception of their mental-health. Results show that it is possible for elderly patients discharged from longterm psychiatric care to live in residential facilities in the community, supervised by clinical teams. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the presentations of patients by ambulance, under Section 20 of the NSW Mental Health Act of 2007, to a hospital emergency department (ED) with a 24-hour Mental Health Team.Methods: Patient records between December 2013 and December 2014 were audited and analysed in Excel.Results: There were 47 such presentations: 51% required a mental health admission. Patients required management for up to six of the nine identified mental health and physical problems. As the number of clinical problems in these patients increased, the length of their stay and the likelihood of discharge to home increased. The need for psychiatric admission did not appear to prolong their length of stay, though chemical sedation did. The availability of an ED mental health team did assist in achieving a length of stay that was in keeping with Australian National Emergency Access Target guidelines.Conclusions: A 24-hour ED mental health team provided specialised assessment and management for patients, alongside the necessary emergency medical intervention. This team assisted in easing the increasing pressure on the ED and minimising the patients' length of stay. The team redirected patients requiring admission, facilitated timely discharge of others and revoked Section 20 when less restrictive care was appropriate. [ABSTRACT FROM AUTHOR]

Background: An interest in hospital accreditation is growing rapidly among many countries to enhance the quality of health care services. The literature showed a positive association between accreditation and some processes of health care. One of the main factors that influence bed availability is the length of hospital stay (LOS), which is considered as an important indicator of the quality of inpatient psychiatric hospitalization. We aimed to investigate whether hospital accreditation drives improvements for the length of stay in psychiatric inpatients. Methods: The study reviewed medical records of consecutive hospital admissions for pre- and post-accreditation comparisons of LOS in two acute mental health wards at a teaching general hospital in Riyadh, Saudi Arabia. Data obtained from the 12-month-post-accreditation period (July 2011 to June 2012) were compared with those from the 12-month-pre-accreditation period (July 2009 to June 2010). The adoption of accreditation program occurred over a 12-month period in the middle of the study (July 2010 to June 2011). Compiled information included demographics, diagnosis, assessment, and LOS. All identified charts were reviewed; there were no exclusion criteria. Patients were not contacted. Results: Post-accreditation, the mean (SD) length of stay was 35.3 ± 18.5 days and the range was 3-113 days. Whereas in the pre-accreditation period the mean (SD) length of stay was 41.1 ± 29.5 days and the range was 1-167 days. The difference was statistically significant (P = 0.026). Conclusion: Accreditation reduces excess LOS and contributes to improving the quality of psychiatric inpatient care and access to psychiatric beds. [ABSTRACT FROM AUTHOR]

We compared admission rates and outcomes for bipolar disorder patients using the medical records of patients with a first hospital admission in 1875–1924 retrospectively diagnosed based on International Classification of Diseases (ICD)-10 criteria, and patients with a first admission in 1994–2007. The incidences of first admissions in the historical and contemporary periods are comparable: 1.2 and 1.3 per hundred thousand per year, respectively. Manic episodes constituted a greater proportion of admissions historically, while depressive episodes made up more in the contemporary sample. There is no evidence for a reduction in the mean inter-admission intervals with duration of illness. This study suggests that modern treatments may have decreased lengths of stay in hospital, but at a cost of contributing to more admissions. It also points to a shift in the threshold for admissions. [ABSTRACT FROM AUTHOR]

Objective: Our aim is to compare demographic and clinical characteristics of patients with early and late-onset diagnosed as bipolar disorder type I (BPD-I) manic episode retrospectively. Method: A total of 24 elderly (=65 years old) hospitalized patients with bipolar disorder were divided into 2 groups as those with early-onset and late-onset disorder, according to a threshold of 50 years of age, and were retrospectively compared with 29 young patients (19-55 years old) in terms of sociodemographic characteristics, clinical symptoms, family history, prophylactic treatment, co-existing medical conditions, duration of hospitalization, psychiatric treatment, and clinical improvement. Results: A positive family history was also more prevalent in young patients and patients with early-onset disease. Co-existing medical conditions were more common in patients with late-onset disease. A positive correlation was found between the duration of education and duration of illness. Flight of ideas and pressured speech were more commonly observed in young patients and patients with early-onset disease. While delusions of erotomanic type were more frequent in young patients, persecution delusions were more common in elderly patients. In terms of treatment, valproate was preferred in the elderly patients and antipsychotic medications were more frequently used in late-onset elderly patients when compared to earlyonset elderly patients. The duration of hospitalization was longer in elderly patients than younger ones. Conclusion: Our findings show that late-onset mania has different characteristics compared to early-onset mania in terms of clinical characteristics, symptom profile, family history, co-existing medical diseases, duration of hospitalization, and response to treatment. However, it is hard to conclude that it as a different clinical subgroup when previous studies about late-onset mania are taken into consideration. Further studies with adequate sample sizes are needed. [ABSTRACT FROM AUTHOR]

Background: Length of stay in psychiatric hospitals interests health service planners, economists and clinicians. At a systems level it is preferable to study general adult and forensic psychiatric beds together since these are likely to be inter-dependent. We examined whether patients were placed according to specialist need or according to their crosssectional length of stay. Methods: A one night census of all registered mental nursing home (RMNH) beds was carried out for a defined catchment area of 1.2 m population in north London in November 1999. This included all public sector psychiatric hospital beds, independent sector and forensic beds in and outside the catchment area. Cross-sectional length of stay was defined as time since the date of admission from the community. Log rank (Mantel-Cox) Chi squared was used to test for differences between groups and hierarchical logistic regression for statistical modelling. Results: There were 1,085 occupied psychiatric beds. Cross-sectional LOS was greater than 365 days in 43.5%. Forensic beds had longer cross-sectional LOS than general beds. LOS increased with the level of therapeutic security from open through low, medium and high secure. Cross-sectional LOS was shorter for open hospital beds than community RMNH beds, shorter for informal patients than those detained under civil mental health law, and longest for forensic detentions. Longest cross-sectional LOS were for patients placed in RMNHs in the community, 10.7% of whom were 'forensic' as were 25.4% of low secure patients. Designated length of stay (acute, rehab/medium term and long term) was also associated with increasing cross-sectional LOS. In regression analysis only three variables contributed to a model of cross-sectional LOS, commissioning status (general or forensic), designated length of stay and designated level of therapeutic security. Conclusions: Studying cross-sectional LOS for whole systems (all psychiatric beds) is essential for operational health service management. At the time of this survey 'forensic' status was the main way of accessing long term high dependency places. This has been an organic development over time, a response to patient needs rather than the outcome of any specific policy or plan. [ABSTRACT FROM AUTHOR]

Background: Japan has introduced an acute psychiatric care unit to the public healthcare insurance program, but its requirement of a shorter length of stay could lead to discharges without proper discharge planning. The aim of this study was to examine the association between the implementation of discharge planning and the length of stay of acute psychiatric inpatients in Japan. Methods: This retrospective cross-sectional study included 449 patients discharged from the 'psychiatric emergency ward' of 66 hospitals during a two-week period from March 7 to 20, 2011. The assigned nurse or nursing assistant for each patient provided information on the implementation of discharge planning in the hospital stay. Results: Approximately one quarter of the 449 patients (n = 122) received no support for coordination with post-discharge community care resources. The 122 patients who had received no support for community care coordination had a significantly lower mean age at admission, a shorter length of stay, and a higher rate of either no follow-up or unidentified post-discharge outpatient service than the other 327 patients. Multilevel linear regression analysis demonstrated a significantly greater length of stay among patients who were older, those who had a primary diagnosis of schizophrenia, those who were admitted compulsorily, those who received hospital outpatient services, and those who received community care coordination support from the assigned nurse or nursing assistant. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. Conclusion: Patients to whom the assigned nurse or nursing assistant provided support on community care coordination experienced a significantly greater length of hospital stay. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. The mental health policy should increase focus on discharge planning in the acute psychiatric setting to enhance a link between psychiatric inpatient care and post-discharge community care resources. [ABSTRACT FROM AUTHOR]

This study examined the effects of a waitlist policy for state psychiatric hospitals on length of stay and time to readmission using data from North Carolina for 2004-2010. Cox proportional hazards models tested the hypothesis that patients were discharged 'quicker-but-sicker' post-waitlist, as hospitals struggled to manage admission delays and quickly admit waitlisted patients. Results refute this hypothesis, indicating that waitlists were associated with increased length of stay and time to readmission. Further research is needed to evaluate patients' clinical outcomes directly and to examine the impact of state hospital waitlists in other areas, such as state hospital case mix, local emergency departments, and outpatient mental health agencies. [ABSTRACT FROM AUTHOR]

Background: Parkinson’s disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay. Methods: A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays. Results: A significant effect for dopaminergic administration (p<0.01) on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4). Contraindicated dopamine blocking agents were administered in 23% (71/339) of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4), p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1) compared to those who did not (M=5.9 days, SD=6.8). Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors. Conclusions: Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson’s disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization. [ABSTRACT FROM AUTHOR]

This study examined trends in general hospital discharges and dispositions involving episodes of severe mental illness (SMI) with and without co-occurring substance use disorders. We analyzed data from the National Hospital Discharge Survey from 1979 through 2008. Discharges involving SMI and co-occurring substance use disorders (COD) were associated with shorter lengths of stay and had a greater likelihood of being discharged routinely or home and reduced likelihood of being transferred to a short- or long-term facility. Although COD discharges had a greater odds of leaving against medical advice than SMI discharges, this effect was not significant over time. A greater understanding of hospital discharge planning practices is needed to ensure that patients are linked to appropriate aftercare services. [ABSTRACT FROM AUTHOR]

Introduction For many patients with psychiatric disorders, the course of illness is characterized by frequent relapses, resulting to re-hospitalization and high costs. While the correlates of readmission have been extensively studied in developed countries, few studies have examined readmission in low- and middle-income countries where bed supply is limited. Methods Using administrative data from the Guangzhou Psychiatric Hospital ( GPH), we used Cox regression models to evaluate the relationship among age, gender, index length of stay ( LOS), and the number of previous admissions to post-discharge readmission risk. Linear regression is used to evaluate predictors of total hospital days during the year after the index discharge. Results Between April 1, 2010 and March 31, 2011, 2,525 patients were discharged with International Classification of Diseases, 10th Revision psychiatric diagnoses from GPH, with an average LOS of 64.2 (SD = 69.0), and 317 (12.4%) were readmitted in the following year. Survival analysis showed older age ( P < 0.05), and the number of previous hospitalizations ( P < 0.01) were significant predictors of the risk of readmission but not diagnosis or LOS. The number of previous admissions was the only predictor of total bed days of psychiatric care at GPH in the year following the initial discharge. Discussion Shortened LOS was not associated with increased readmission risk or post-discharge hospital days. Rather, the number of past hospitalizations was the major predictor of both readmission risk and post-discharge hospital days of psychiatric care, and such patients deserve special attention. Lowering LOS may be justified, allowing funds to be redeployed to outpatient or community-based care. [ABSTRACT FROM AUTHOR]

Background Colonization with MRSA is believed to have deteriorating effects on neurological rehabilitation patients because MRSA carriers need to be isolated. Methods Medical records of neurological early rehabilitation patients (most of them after stroke) admitted to a large rehabilitation facility in Northern Germany in 2010 have been carefully reviewed with respect to MRSA status, outcome variables (functional independence), morbidity, and length of stay (LOS). Results 74/569 (13.0%) patients were MRSA positive on admission. MRSA carriers had a significantly longer LOS in early neurological rehabilitation (63.7 (37.1) vs. 25.8 (24.5) days, p < 0.001), worse functional status on admission (Barthel index (BI) 13.6 (9.9) vs. 25.6 (24.1), p < 0.001), worse Glasgow Coma Scale (9.5 (3.2) vs. 12.0 (3.3), p < 0.001), more codiagnoses (20.5 (5.1) vs. 13.3 (5.5), p < 0.001), and higher Patient Clinical Complexity Levels (PCCL). The outcome was significantly worse among MRSA positive patients (BI 25.5 (21.2) vs. 47.4 (31.0), p < 0.001; Early Rehabilitation Index -47.3 (51.4) vs. -26.0 (35.4), p < 0.001). Isolated patients had slightly less therapy per day (131.6 (16.6) vs. 140.2 (18.7) min/day, p < 0.001), but the overall sum of therapy was significantly larger in the MRSA positive group due to longer LOS. Conclusions Functional recovery of MRSA carriers in early neurological rehabilitation is worse than in MRSA negative patients. Poorer outcome is not resulting from isolation (less therapy) but from functional status and higher morbidity on admission. [ABSTRACT FROM AUTHOR]

The article focuses on a research which explores the predictors of the length of stay in a psychiatric emergency care centre (PECC) in Australia. It examines demographic and clinical characteristics through file audit in 477 patients who were presented to a PECC within a six-month period. An overview of the results of the study is provided.

The aim of the present study is to clarify the influence of deinstitutionalization on discharged long-stay patients based on a review of recently published literature. English-language studies were searched from PubMed and Embase for the years 2000-2012, with the terms 'long-stay' or 'chronic mentally ill' and 'deinstitutionalis(z)ation' or 'community' or 'discharged' in the title and/or abstract. The present study defined long-stay as hospitalization >6 months. A total of 14 articles were identified. The majority of the participants suffered from schizophrenia. The most frequently assessed outcomes were social functioning, psychiatric symptoms and quality of life ( QOL)/participant attitudes towards the environment. For social functioning, most of the studies found favorable changes. As regards psychiatric symptoms, stability or at least some improvements were detected. For QOL/participant attitudes towards the environment, positive changes, at least at some time-points, were noted. Significant deterioration was rare in all of the three outcomes. The majority of the participants showed enhancements in social functioning despite the fact that functional impairment is common in persons with schizophrenia, which indicates that even long-stay patients could achieve better functioning by deinstitutionalization. Although the stability in symptoms might be due to continuous schizophrenia course, moving to the community may also lead to improvement. The favorable changes in QOL/participants' attitudes towards the environment are in line with other studies. [ABSTRACT FROM AUTHOR]

Objective: To determine predictors of hospital length of stay (LOS) for adult and geriatric patients with mood disorders admitted to inpatient psychiatric beds. Method: Admission and discharge data from a large urban mental health centre, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the Resident Assessment Instrument--Mental Health, an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 199 geriatric mood disorder admissions were compared with 570 adult mood disorder admissions. Predictors of hospital LOS were determined using a series of general linear models. Results: Living alone, number of recent psychiatric admissions, involuntary admission, and close or constant observation level predict longer hospital LOS in geriatric, but not in adult mood disorder, patients. Conversely, pain on admission predicts shorter hospital LOS in geriatric, but not among adult, mood disorder patients. Predictors of longer hospital LOS, irrespective of admission group (adult, compared with geriatric), include incapacity, negative symptoms, and increased dependence for instrumental activities of daily living. Conclusions: Addressing these predictive factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources. INSETS: Clinical Implications;Limitations. [ABSTRACT FROM AUTHOR]

Objective: Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization. Method: We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge. Results: Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, ? ≼ 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P≼ 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, ? ≼ 0.001 ), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, ? ≼ 0.001 ), and with selfharm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, ? ≼ 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, ? ≼ 0.001) were less likely to receive aftercare. Conclusions: Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth. INSETS: Clinical Implications;Limitations. [ABSTRACT FROM AUTHOR]

Objective: This study examined the extent to which hospital and regional characteristics are associated with length of hospitalization among patients with serious mental illness. Methods: Data from the Pennsylvania Health Care Cost Containment Council and 2006 American Hospital Association data were obtained. The sample consisted of 106 hospitals from which 45,497 adults with serious mental illness were discharged in 2006. Guided by the extended version of Andersen's health care utilization model, hierarchical linear modeling, including patient case mix, hospital, and regional characteristics, was used to explain variations in hospitalization length. Results: The average length of stay was 10.0±3.0 days. Stays were longer at psychiatric hospitals than at general acute care facilities and at hospitals with a greater percentage of Medicare patients and patients with serious mental illness and a higher rate of readmission. In terms of regional characteristics, stays were also longer at hospitals in counties where the county mental health program received a larger percentage of the state's mental health budget and a smaller share of the budget was used for residential care. Conclusions: Hospital type and case mix, along with the presence of housing resources funded by county mental health programs, were found to be associated with variations in length of hospitalization. Further research of a longitudinal or prospective nature is required to determine whether the availability of housing programs for persons with mental disorders leads to shorter hospital stays for those in crisis and to determine whether longer stays are the result of differences in hospital practices. [ABSTRACT FROM AUTHOR]

Deinstitutionalization, the replacement of long-stay hospitals with community-based alternatives, can have favourable outcomes for people experiencing mental health problems. However, in many cases the community services needed for comprehensive care are not available. This raises the question as to whether the move from the long- stay hospital has been positive or not for health of clients. Therefore, it is important to examine clients' lived experiences of such a move. This is the aim of the present study which was based on a phenomenological approach. The results indicate that participants experienced a significant change in their lives in relation to their psychological, physical and social health and well-being. Freedom for self- determination and living in an environment that gives them autonomy is at the core of their personal experience. It could be argued that deinstitutionalization generated a shift in client experience in relation to their health and well-being. [ABSTRACT FROM AUTHOR]

Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above. [ABSTRACT FROM AUTHOR]

Abstract: Background: Early onset of bipolar disorder (BD) is an important clinical predictor of a more severe course and poorer outcome. A higher proportion of childhood onset BD has been reported in studies from USA compared to Europe. We investigated age at onset of first affective episode in a Norwegian sample and compared it to previous European and US findings. In addition, we examined whether age at onset influenced on time to first treatment, and if patient characteristics related to illness severity influenced age at onset. Methods: Two hundred and twenty five BD patients were recruited consecutively mainly from psychiatric out-patient units at three major hospitals in Oslo, Norway, diagnosed using SCID-I and divided into four groups based on age at onset. Results: Six percent of the patients had onset in childhood, 32% in adolescence, 43% in young adulthood, and 19% as adults. Average age at onset was 22.8years (SD 9.4). There was a significantly higher age at onset and a significantly shorter time from onset to first treatment in patients with lifetime hospitalization. Limitation: Retrospective information which could be confounded by collection bias. Conclusion: Age at onset in our sample resembled previous European studies, but not US- or Norwegian studies. The difference in age at onset seems more related to different definitions of onset, than to hospitalization history. This highlights the importance of improving the research criteria and of using similar criteria to ascertain age at onset. [Copyright &y& Elsevier]

Abstract: Background: This study aimed to characterize the inpatient utilization of depot antipsychotics. Method: The characteristics of adults with schizophrenia or schizoaffective disorder, hospitalized for at least 28days, and who were prescribed depot antipsychotics were examined from 2004 to 2006 using a database from a large state-operated psychiatric hospital system. Demographic and clinical characteristics of patients receiving depot fluphenazine or haloperidol were compared to those prescribed depot risperidone. Results: We identified 2210 unique patients who initiated treatment with a depot antipsychotic (after receiving oral antipsychotics). Of these, 1484 (67.1%) received depot fluphenazine or haloperidol, and 726 (32.9%) received risperidone as their initial depot antipsychotic. Patients who received depot risperidone did not differ from those receiving depot fluphenazine or haloperidol with regard to demographics, diagnosis of schizoaffective disorder, number of comorbid psychiatric or medical diagnoses, or diagnosis of substance abuse. Patients started on depot risperidone during the observation period had a longer length of stay prior to initiation of depot than those started on depot fluphenazine or haloperidol (583days vs. 237days, t =5.489, p <.001). Patients who started on depot risperidone were less likely to be discharged on that medication than were patients who started on depot fluphenazine or haloperidol (odds ratio from Cox regression model=0.846 [95% CI 0.745–0.960]). Conclusions: Patients initiated on depot risperidone had a longer length of stay prior to their first injection and were less likely to be discharged on that medication compared to patients initiated on depot fluphenazine or haloperidol, possibly indicating that patients initiating depot risperidone had a more severe or treatment-resistant course of illness and/or that there were reimbursement barriers for the outpatient utilization of depot risperidone, or that efficacy differences exist between the depot antipsychotics at the doses used in this population. [Copyright &y& Elsevier]

Abstract: This study analyzes the experiences of youth placed out-of-home for behavioral reasons by human services and juvenile corrections departments in a large Midwestern metropolitan county. The study goals are to determine whether youth placed by each department have similar characteristics and analyze the factors associated with length of stay in placement. Many local human services and corrections departments are attempting to coordinate their services in an effort to improve the outcomes for youth and their families. The study findings suggest that the youth placed by the two departments are similar in many ways, yet there are some important differences. Factors associated with length of stay differ between the two departments, suggesting that youth experiences differ once placed. Out-of-home placements of youth for behavioral reasons are costly, and policymakers continually question the effectiveness of placements in providing treatment to youth with behavioral problems. Our study identifies key factors associated with long placement stays for youth placed by both human services and corrections departments. By targeting intensive intervention and treatment towards these youth and their families, local governments may be able to reduce the length of stay in out-of-home placement and effectively address the youths'' behavioral problems. [Copyright &y& Elsevier]

Abstract: Background: Bipolar disorder (BPD) is a disabling disease with high morbidity rates. An international (Spain, France) comparative study about hospitalizations and in-patient care costs associated with BPD I was performed. Centers were included if they had access to a database of computerized patient charts exhaustively covering a defined catchment area. Methods: Economic evaluation was performed by multiplying the average cumulated annual length of stay (LOS) of hospitalized bipolar patients by a full cost per day of hospitalization in each center to obtain the corresponding annual costs. Results: Hospitalization rates per annum and per 100,000 individuals (general population aged 15+) were similar between France (43.6) and Spain (43.1). There were only slight differences in relation to length of stay (LOS) per patient hospitalized with 18.1 days in Spain and 20.4 days in France. The overall estimated annual hospitalization costs were in the same order of magnitude after adjustment to an adult population of 100,000: €232,000 (Spain) and €226,500 (France). Mixed episodes had the longest LOS followed by depressive episodes, while manic episodes had the shortest ones. Mania was the most costly disorder representing 53.7% of annual BPD in-patient care costs. Conclusions: BPD I care requires large resources and frequent hospitalizations, especially during manic episodes. Depressive and mixed episodes require longer hospital stays than manic episodes. Out-patient costs should now be evaluated. [Copyright &y& Elsevier]

During the past decades, extensive reformatory changes in institutional psychiatric care have been implemented in Norway. The objective of the present study was to investigate whether these changes have resulted in shortened length of psychiatric hospital stays for suicide attempters. Further, to examine if length of hospital stay and time period in which the patients received treatment were related to the risk of a repeated suicide attempt and/or committing suicide. All cases of suicide attempters hospitalised between 1984 and 2006 in the municipality of Bærum, a suburb outside Oslo, were examined. The period of observation was further subdivided in two time intervals on the basis of the de-institutionalisation of psychiatric care, which started to plateau in 1996. Among 1,574 patients consecutively admitted to the local general hospital after a suicide attempt, 330 were admitted to inpatient psychiatric care. Patients admitted in the period 1996–2006 had significantly shorter hospital stays than patients in the preceding period 1984–1995 (Log Rank P < 0.001). Neither the time period of treatment variable nor the length of hospital stay variable was significantly associated with the risk of a repeated suicide attempt or suicide. Psychiatric de-institutionalisation appears as not having affected suicide attempt repetition. It is possible that reduced length of hospital stay has been compensated by improved mental health care in general and extended outpatient services in particular. [ABSTRACT FROM AUTHOR]

Abstract: To examine the effect of co-location of psychogeriatric and geriatric services on length of stay and changes in patients’ psychosocial characteristics. A retrospective analysis of the performance indices of psychogeriatric patients aged ≥50 years admitted to a co-located psychogeriatric and geriatric unit at Bankstown-Lidcombe Hospital, New South Wales (NSW), Australia from April 2004 to June 2006. Comparisons were made between the performance of the Bankstown-Lidcombe’s unit and the NSW state average (consisting of traditional solitary models of care) with respect to patients’ length of stay (LOS) and changes in psychosocial indices. Bankstown’s patients had a higher burden of psychosocial impairments. The mean LOS for psychogeriatric episodes was significantly shorter at Bankstown-Lidcombe Hospital than the NSW state average (28.3±19.6 days vs. 33.4±22.7 days, p <0.001). The overall improvement in aspects of mental state and social behaviors for psychogeriatric admissions at Bankstown-Lidcombe Hospital was significantly better than the NSW state average. Co-location of psychogeriatric and geriatric services reduced patients’ LOS and improved psychosocial performance compared to traditional models of care. However, more robust studies are required to fully examine the benefits of this type of service. [Copyright &y& Elsevier]

Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions. [ABSTRACT FROM AUTHOR]

This study assessed factors associated with extended length of stay (ELOS) for patients presenting to a psychiatric emergency service (PES). Two hundred six subjects with a length of stay of 24 h or longer were compared with time-matched controls (patients that presented directly after the ELOS patient). Binary logistic regression was used to identify risk factors for ELOS. ELOS was associated with suicidal ideation, disposition to an inpatient unit, homicidal ideation, lack of insurance, homelessness, male gender, past history of psychiatric hospitalization, diagnosis of substance abuse, significant psychiatric co-morbidity (represented by three or more Axis I diagnoses), and diagnosis of a psychotic disorder. Lack of insurance, suicidal ideation, disposition to inpatient unit, and homicidal ideation all made nonredundant contributions to predicting stays of 24 h or longer. [ABSTRACT FROM AUTHOR]

We studied the predictors of length of hospital stay in medium secure hospital beds among 157 male patients discharged from medium secure beds in two London boroughs between 2002 and 2006. Patients who were subject to Section 37/41 restriction stayed in medium secure care on average 483 days longer than those under civil sections or transferred from prison (p = .001). Those under Section 37/41 had a significantly longer length of stay than those under Section 37 or Section 3 (p ≤ .05). Those on restriction orders were significantly more likely to be discharged to a supported hostel than those in the civil/prison group (p = .008). Overall demand for hostel placements was high. The findings of this study suggest that those patients in medium secure units on Section 37/41 restriction orders will have longer admission times and are more likely to be discharged into supported mental health hostels. More research is needed to establish a link between delayed discharges for those under Section 37/41 in medium secure units and lack of supported mental health hostel beds in the community. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to compare psychiatrists'' in-patient caseload volume with length of stay (LOS) and 30-day readmission rates in Taiwan. We hypothesized that high-volume psychiatrists would be associated with shorter LOS and lower 30-day readmission rates. The sample of 66,959 patients hospitalized for the first time for mental disorders was taken from Taiwan''s 2001–2003 National Health Insurance Research Database and categorized into four patient groups according to attending psychiatrists'' caseload volume. A total of 21,669 (32.4%) of the patients sampled were readmitted within a 30-day period, with the mean LOS being 24.0 (±19.5) days. As caseload volume increased, there was a corresponding increase in the adjusted odds ratio for 30-day readmission rates. The regression analysis reveals adjusted LOS for patients treated by psychiatrists with medium caseload volumes was 1.22 days shorter than that for patients treated by low caseload volume psychiatrists. The adjusted LOS for patients seeing high caseload volume psychiatrists was 2.03 days shorter than for those seeing psychiatrists with low caseload volumes; and for the very-high-volume group, it was 7.59 days shorter. Although the findings confirm our hypothesis regarding LOS, they do not support our hypothesis regarding the relationship between psychiatrists'' caseload volume and readmission rates. [Copyright &y& Elsevier]

Abstract: The institutionalization of psychiatric patients has put a tremendous burden on many societies, but few studies have examined the effects of institutional characteristics on patient length of stay (LOS). This paper investigated the association between institutional characteristics and LOS for 160,517 psychiatric patients in South Korea by applying a two-level modeling technique to administrative claims databases covering the entire patient population. Patient LOS, expressed in terms of days, was analyzed by taking account of institutional type, ownership, location, inpatient capacity, staffing, and patient demographics. The characteristics of inpatients were used as control variables and consisted of gender, age, sub-diagnosis, and the type of national health security program. The main findings of this study are: (1) patient LOS was 69% longer at psychiatric hospitals than at tertiary-care hospitals; (2) neither location nor inpatient capacity was associated with LOS; (3) larger staffs reduced LOS; and (4), LOS increased with a higher proportion of male inpatients, inpatients ≥65 years old, or inpatients diagnosed with organic or schizophrenic disorders, possibly through contextual effects. The results of this study suggest that researchers and policy makers could improve their assessment of psychiatric patient LOS and its association with health outcome by taking into account institutional characteristics and using multi-level analyses. [Copyright &y& Elsevier]

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Abstract: Objective: Mental health advance directives (ADs) are potentially useful for bipolar patients due to the episodic characteristic of their disease. The aim of the present study is to evaluate the impact of advance directives based on cognitive therapy (ADBCT) on the number and duration of hospitalizations as well as compulsory admissions and seclusion procedures. Method: Charts of all treatment non-adherent patients and committed patients who wrote their ADs following an ADBCT intervention within a 24 months period prior to the beginning of the study were included. Number and duration of psychiatric hospitalizations for a mood or a psychotic episode as well as compulsory admissions and seclusion procedures were recorded for each patient 2 years before ADBCT and during a follow-up period of at least 24 months. Results: The number of hospitalizations, the number of compulsory admission procedures and the number of days spent in psychiatric hospital reduced significantly after ADCBT in comparison to the 2 years who preceded this intervention. Conclusion: This retrospective data suggest that ADBCT is effective for patients with compliance and coercion problems. However, these results need to be confirmed in randomized controlled trials. Practice implications: ADBCT seems to be a useful approach for treatment-non-adherent and previously coerced patients. [Copyright &y& Elsevier]

Comorbidity of psychiatric disorder and substance use disorder (SUD) is very common. Clinical experience says that comorbidity increases inpatient length of stay. We aimed to discover which factors affect length of stay for inpatients at a psychiatric department in a specialized mental hospital in a Greek urban area, and specifically whether SUD is one of them. All patients admitted over a 12-month period were given the CAGE questionnaire and that part of the EUROPASI questionnaire dealing with substance use. This was followed by a diagnostic interview to establish the final diagnosis in accordance with the DSM-IV criteria. Following this, the patients' characteristics in conjunction with their average length of stay were all evaluated statistically. A total of 313 patients were assessed. Present substance use disorder was identified in 102 individuals (32.6%). The principal substances involved in addiction or abuse were alcohol, cannabis, benzodiazepines, and opiates. Patients differed as to their cooperation with the medication regime. On the other hand, there was no statistical difference regarding the number of hospitalisations. Psychopathology was not found to play a direct role, as no one diagnosis correlated with length of stay. The factors found to affect length of stay in this psychiatric department were the length of time they had been mentally ill and cooperation in taking medication. It appears that SUD is not one of the factors affecting length of stay. [ABSTRACT FROM AUTHOR]

Background: This study examines remuneration spending by drug-using participants in residential drug abuse research. Methods: Ninety-four adult males who participated in residential, non-treatment drug abuse research studies earned remuneration based on length of stay and specific research procedures. Remuneration could be in cash after discharge or for in-kind purchases and bill payments. Spending of remuneration was extracted from charts and evaluated with multivariate analyses. Results: Participants received average remuneration of $1,454, taking 59% in cash. Other categories included cigarettes (60.6% of subjects), toiletries (60.6%), clothing (54.3%), and housing (52.1%). Primary drug of abuse, total remuneration, monthly income, length of stay on the residential research unit, age, and education were significantly associated with in-kind remuneration choices. Less total remuneration, intoxication in the month prior to study, higher IQ, and non-white race were associated with taking more in cash. Conclusion: Residential drug abuse research participants prefer cash to in-kind research remuneration, and their choices reflected drug use and economic status. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate psychopharmacological treatment and the length of stay (LOS) of patients with schizophrenia in a maximum-security psychiatric unit. Data were collected from the hospital files of 82 consecutively admitted patients with schizophrenia who were both admitted and discharged between the years 1987 and 2000. Psychotropic medication and LOS at the time of discharge were registered. Ninety-five per cent of the patients received antipsychotic medication. Zuclopenthixol was the most frequent medication, given to 43% of the patients. Antipsychotic polypharmacy was found in 20% of the cases. Twenty-seven per cent of the patients were medicated with doses above the recommended therapeutic dose range. During the study period, there was no change in the administration and number of psychotropics, but there was an increase in the dosage of antipsychotics. However, LOS was unchanged during the same time. This supports other findings, which suggest that there is no clinical benefit of higher antipsychotic dosage. It is suggested that an optimized medication practice could yield beneficiary effects, not only for schizophrenic symptoms, but also for violence in schizophrenic patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The objective is to analyze if the mean hospital stay is less than the episodes or not in which electroconvulsive therapy (ECT) is applied. METHODS: With a retrospective design, we studied a sample of 30 patients in whom ECT was applied between 1996 and 2001. These patients were suffering a disorder for which ECT has been shown to be effective (schizophrenia, bipolar disorder and major depression). Each one of the episodes (n = 185) of these patients was studied, comparing the length of stay in the hospital in these patients in which ECT was applied (n = 135) with those where it was not (n = 50). Statistical analysis was carried out by non-parametric Mann-Whitney-U tests. The descriptive level of statistical significance was established at p < 0.05. RESULTS: This work shows statistically significant differences between the treatment groups (p = 0.000), the length of stay being longer when ECT is applied. [ABSTRACT FROM AUTHOR]

Admission data from 6.366 patients on the psychiatry service at Naval Medical Center San Diego were used to form a linear regression model to examine variables that might influence length of stay. Information was available on active duty status, primary diagnosis, age, gender, and marital status. Active duty service, older age, single marital status, and a primary diagnosis of a psychotic or mood disorder were all significantly associated with longer hospital stays. Primary diagnosis of an adjustment or personality disorder was associated with a shorter stay. Taking into account these variables, lengths of stay for active duty personnel averaged 4.00 ± 0.39 days longer than for equivalent civilian admissions. Although military personnel are generally thought of as a healthy population, psychiatric hospital stays were found to be longer in service members than in their civilian counterparts. Financial re-percussions and possible reasons for this are discussed. [ABSTRACT FROM AUTHOR]

Deinstitutionalization and mainstreaming may have contributed to increased attendance in public emergency departments by people with mental health problems. This study describes changing patterns of attendances by patients with mental health problems to the emergency department (ED) of a public teaching hospital in Adelaide, South Australia.Records from a 10-year period from the ED were examined to identify changes in the number of, and diagnoses for, patients attending for primarily mental health concerns. Admission rates, detention and length of stay (LOS) were also examined in an attempt to identify trends.A tenfold increase in the number of patients attending the ED with primarily mental health problems has occurred over the 10-year period. This is within the context of relatively stable total ED presentations. The increase has been observed in all diagnostic categories although the greatest increase, by percentage, has been for psychotic disorders. A lesser increase was observed for patients presenting with overdose. People presenting with psychotic disorders are also more likely to be detained and admitted. LOS in the ED has also increased along with increasing demand.Reasons for the increased demand are likely multifactorial. While deinstitutionalization and mainstreaming have contributed, the closure of the ED at the local psychiatric hospital does not account entirely for the change. Insufficient community-based mental health services may also contribute to the reasons why people present to the ED and lack of inpatient beds contributes to the increasing LOS experienced in the ED. [ABSTRACT FROM AUTHOR]

INTRODUCTION Admission statistics can provide valuable data for planning and policy in the NHS. However, there has been little agreement about meaningful ways of summarising and expressing such data. We set out to (i) explore the distribution of length of inpatient stay and to examine the most appropriate measure of central tendency; and (ii) examine the relationship between severity of mental illness and length of stay. METHOD Length of stay was recorded for a 12-month cohort of psychiatric admissions to a district general hospital psychiatric unit. These data were compared with a previous cohort study and also with DoH statistics. RESULTS Length of inpatient stay followed an exponential decay curve. The median length of stay for all three cohorts examined was approximately 15 days. Absence of serious mental illness was significantly associated with shorter length of stay. CONCLUSION Length of stay is not normally distributed and so the median value is the preferred measure of central tendency. All cohorts examined showed a median value of around 15 days. Large numbers of patients are admitted for a week or less which has implications for inpatient and community services. [ABSTRACT FROM AUTHOR]

The aim of this study was to screen long-stay psychiatric patients for risk factors for coronary heart disease. Participants were interviewed individually and had anthropometric and physiological measurements and blood samples taken. Of the 64 participants, 2 7 (33%) were overweight and a further 25 (39%) obese. Of those interviewed (n =47), 34 (72%) were current smokers. In total, 44% of those sampled (n=57) had a raised screening blood pressure, 9% of those sampled (n=34) had an elevated serum cholesterol and in 17% of those sampled (n=53), electrocardiogram abnormalities consistent with coronary heart disease or hypertension were present. Risk factors for coronary heart disease were more common in this population of chronically and severely mentally ill inpatients than in the general population. These patients need careful ongoing monitoring and measures aimed at coronary heart disease risk reduction. [ABSTRACT FROM AUTHOR]

This study investigated associations between the presence of developmental disabilities and length of inpatient stay for mental health care. All psychiatric admissions of people with developmental disabilities over a 5-year period were selected (n = 294), and were compared using survival analysis to a random sample of admissions from the general psychiatric population (n = 287). Overall, people with developmental disabilities stayed in hospital longer than those without developmental disabilities, and this extra stay was partially attributed to casemix differences between the cohorts. Subanalyses in both cohorts showed that those going back to their usual living arrangement stayed a shorter period than those who were discharged elsewhere, and that people with developmental disabilities were less likely to be discharged to their usual living arrangement than were people without the disability. This study highlighted the importance of specialized residential and personal supports for people with developmental disabilities and a coexisting mental disorder. [ABSTRACT FROM AUTHOR]

Objective: To test if predictors of length of stay are based on empirical evidence. Method: 1001 regularly terminated treatment episodes from 13 child and adolescent psychiatric hospitals were analysed. In order to cross- validate the results, the sample was randomly divided into a definition sample (n = 500) and a validation sample (n = 501). The variables in the definition sample were screened statistically for their suitability as predictors of logarithmic length of stay (logLOS). Variables shown to be significant and uncorrelated were entered into multifactor analyses of variance in order to generate the model with the largest amount of explained variance of logLOS. Subsequently the results were tested against the validation sample. Results: In the definition sample we found the three predictor variables admission as crisis intervention, out of home dispositions and psychoanalytic therapy which could explain 23.7 % of the variance of logLOS. Unfortunately, this could not be replicated in the validation sample as a model. Conclusion: Simple models of prediction of LOS in the field of child and adolescent psychiatry cannot be reliably based on empirical evidence. The main consequence is that fixed disorder-related reimbursement systems do not seem justified. [ABSTRACT FROM AUTHOR]

Established following the Reed Report (1991) recommendations, Redford Lodge is an independent psychiatric hospital offering medium secure provision for mentally ill patients and offenders. For this study social and behavioural data were collected on admission and discharge for the 166 patients admitted over the three years 1995-1998 and 49 discharged patients were reassessed at six-month follow-up. Predictors of length of stay, discharge and success at follow-up were examined in relation to social and demographic factors and engagement in therapy programmes.Patients' socio-demographic variables were not significantly related to their length of stay, place of discharge or success at follow-up. One predictor of progress after discharge was employment. Contact with family was identified as a significant factor associated with shorter stay and positive place of discharge but not associated with success at follow-up. Engagement in psychological therapies and/or group activities was directly related to length of stay, general progress and improvement in mental state but not to subsequent involvement in community services or general success in independent living at follow-up.Although the findings suggest treatment is successful, further research is needed to identify specific treatment variables that have a positive long-term effect. [ABSTRACT FROM AUTHOR]

Introducción. El tiempo de ingreso hospitalario se utiliza en entornos administrativos como indicador indirecto de la efectividad y eficiencia de programas de tratamiento, y es infrecuente que otros factores relacionados se tomen en cuenta. Los objetivos de este estudio son analizar la relación entre gravedad psicopatológica y funcionamiento adaptativo, y valorar el poder predictivo de ambos constructos sobre el tiempo de ingreso. Metodología. Estudio multicéntrico prospectivo (n = 132). La variable de resultado es el tiempo de ingreso truncado a 90 días. Las variables explicativas son la gravedad psicopatológica (Escala breve de valoración psiquiátrica [BPRS]) y el funcionamiento adaptativo (Perfil de habilidades de la vida cotidiana [LSP]) de los pacientes a su ingreso. Resultados. Después de ajustar por edad, género y diagnóstico psiquiátrico al alta, la presencia de síntomas negativos (OR = 2,3; IC: 95% = 1,3 ­ 4,1), la capacidad de vida autónoma (OR = 0,85; IC 95% = 0,78 ­ 0,93), y la puntuación total en la escala LSP (OR = 0,96; IC 95% = 0,93 ­ 0,98) se asociaron significativamente al tiempo de ingreso. Estas tres variables no se diferenciaron en su poder predictivo (χ2 = 1,9 con 2 g.l.; p = 0,4). Conclusiones. Los déficits de funcionamiento adaptativo son tan importantes como la sintomatología negativa en la predicción del tiempo de ingreso. Ambos dominios de evaluación debieran incluirse en la información administrativa de alta. [ABSTRACT FROM AUTHOR]