Prediction of homelessness within three months of discharge among inpatients with schizophrenia.
ABSTRACT The authors' goal was to identify factors that place inpatients with schizophrenia at risk of becoming homeless after hospital discharge.
Patients with schizophrenia or schizoaffective disorder (N=263) were assessed at discharge from general hospitals in New York City and reassessed three months later to evaluate whether they had become homeless. Sociodemographic and clinical characteristics associated with homelessness were identified using likelihood ratio chi square analysis and logistic regression.
Twenty patients (7.6 percent) reported an episode of homelessness during the follow-up period. Patients who had a drug use disorder at hospital discharge were significantly more likely to report becoming homeless than those without a drug use disorder. Patients with a total score above 40 on the Brief Psychiatric Rating Scale (BPRS) at hospital discharge were more likely to report becoming homeless than patients with lower scores, as were those with Global Assessment Scores less than 43. Twelve of 30 patients with a drug use disorder, a BPRS score above 40, and a GAS score less than 43 at hospital discharge reported becoming homeless.
The combination of a drug use disorder, persistent psychiatric symptoms, and impaired global functioning at the time of hospital discharge poses a substantial short-term risk of homelessness among patients with schizophrenia. Patients who fit this profile may be candidates for community-based programs that are specifically aimed at preventing homelessness among patients with severe mental illness.
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ABSTRACT: Despite their widespread use, long acting injectable (LAI) antipsychotics (APs), are often regarded with some negativity because of the assumption of punishment, control and insufficient evolution towards psychosocial development of patients. However, LAI APs have proved effective in schizophrenia and other severe psychotic disorders because they assure stable blood levels, leading to a reduction of the risk of relapse. Therapeutic opportunities have also arisen after introduction of newer, second-generation LAI APs in recent years. Newer LAI APs are more readily dosed optimally, may be better tolerated and are better suited to integrated rehabilitation programmes. This review outlines the older and newer LAI APs available for the treatment of schizophrenia, with considerations of past and present pharmacological and therapeutic issues. Traditional, evidence-based approaches to systematic reviews and randomized clinical trials are of limited utility in this area so this paper’s blending of experimental trials with observational research is particularly appropriate and effective.Therapeutic Advances in Psychopharmacology 07/2014; DOI:10.1177/2045125314540297 · 1.53 Impact Factor
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ABSTRACT: This paper develops models for prediction of disease status from longitudinal data. The estimation of area under curve (AUC) is illustrated on the basis of estimates of sensitivity and specificity for repeated binary outcomes of disease status. There are several research papers in this field on cross-sectional data but only a few dealt with the repeated observations. This paper shows the procedures to deal with repeated observations employing Markov models. These procedures employ covariate dependent Markov models for estimating sensitivity and specificity, which in turn, produce the estimates for area under curve. The tests for equality of areas under curve for two models are also suggested. An application is illustrated for depression data from the Health and Retirement Survey, USA. The results indicate that the transition model approach can reveal the matching of disease status very efficiently; an estimate of more than 0.96 was obtained for the AUC for a transition model based prediction of disease from the depression data.Pakistan Journal of Statistics 03/2014; 30(2):181-196. · 0.34 Impact Factor
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ABSTRACT: Previous research on housing loss among severely mentally ill persons who have been placed in housing after being homeless has been largely atheoretical and has yielded inconsistent results. We develop a theory of housing loss based on identifying fundamental causes-problems in motives, means and social situation-and test these influences in a longitudinal, randomized comparison of housing alternatives. As hypothesized, individuals were more likely to lose housing if they had a history of alcohol or drug abuse, desired strongly to live independently contrary to clinician recommendations, or were African Americans placed in independent housing. Deficits in daily functioning did not explain these influences, but contributed to risk of housing loss. Our results demonstrate the importance of substance abuse, the value of distinguishing support preferences from support needs, and the necessity of explaining effects of race within a social context and thus should help to improve comparative research.12/2009; 2(4):132. DOI:10.1016/j.ajp.2009.10.006