Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of General Psychiatry
Published in: Annals of General Psychiatry 1/2012

Open Access 01-12-2012 | Primary research

Number of prior episodes and the presence of depressive symptoms are associated with longer length of stay for patients with acute manic episodes

Authors: Manuel Martin-Carrasco, Ana Gonzalez-Pinto, Jaime L Galan, Javier Ballesteros, Jorge Maurino, Eduard Vieta

Published in: Annals of General Psychiatry | Issue 1/2012

Login to get access

Abstract

Background

Few studies have analyzed predictors of length of stay (LOS) in patients admitted due to acute bipolar manic episodes. The purpose of the present study was to estimate LOS and to determine the potential sociodemographic and clinical risk factors associated with a longer hospitalization. Such information could be useful to identify those patients at high risk for long LOS and to allocate them to special treatments, with the aim of optimizing their hospital management.

Methods

This was a cross-sectional study recruiting adult patients with a diagnosis of bipolar disorder (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) criteria) who had been hospitalized due to an acute manic episode with a Young Mania Rating Scale total score greater than 20. Bivariate correlational and multiple linear regression analyses were performed to identify independent predictors of LOS.

Results

A total of 235 patients from 44 centers were included in the study. The only factors that were significantly associated to LOS in the regression model were the number of previous episodes and the Montgomery-Åsberg Depression Rating Scale (MADRS) total score at admission (P < 0.05).

Conclusions

Patients with a high number of previous episodes and those with depressive symptoms during mania are more likely to stay longer in hospital. Patients with severe depressive symptoms may have a more severe or treatment-resistant course of the acute bipolar manic episode.
Literature
1.
Pini S, de Queiroz V, Pagnin D, Pezawas L, Angst J, Cassano GB, Wittchen HU: Prevalence and burden of bipolar disorders in European countries. Eur Neuropsychopharmacol. 2005, 15: 425-434. 10.1016/j.euroneuro.2005.04.011.CrossRefPubMed
2.
Fajutrao L, Locklear J, Priaulx J, Heyes A: A systematic review of the evidence of the burden of bipolar disorder in Europe. Clin Pract Epidemiol Ment Health. 2009, 5: 3-10.1186/1745-0179-5-3.PubMedCentralCrossRefPubMed
3.
Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, Lopez-Castroman J, Fernandez del Moral AL, Jimenez-Arriero MA, Gronzalez de Rivera JL, Saiz-Ruiz J, Leiva-Murillo JM, de Prado-Cumplido M, Santiago-Mozos R, Artés-Rodríguez A, Oquendo MA, de Leon J: Diagnostic stability and evolution of bipolar disorder in clinical practice: a prospective cohort study. Acta Psychiatr Scand. 2007, 115: 473-480. 10.1111/j.1600-0447.2006.00984.x.CrossRefPubMed
4.
Gonzalez-Pinto A, Gutierrez M, Mosquera F, Ballesteros J, Lopez P, Ezcurra J, Figuerido JL, de Leon J: First episode in bipolar disorder: misdiagnosis and psychotic symptoms. J Affect Disord. 1998, 50: 41-44. 10.1016/S0165-0327(98)00032-9.CrossRefPubMed
5.
Frye MA, Altshuler LL, McElroy SL, Suppes T, Keck PE, Denicoff K, Nolen WA, Kupka R, Leverich GS, Pollio C, Grunze H, Walden J, Post RM: Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. Am J Psychiatry. 2003, 160: 883-889. 10.1176/appi.ajp.160.5.883.CrossRefPubMed
6.
Simon NM, Otto MW, Wisniewski SR, Fossey M, Sagduyu K, Frank E, Sachs GS, Nierenberg AA, Thase ME, Pollack MH: Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2004, 161: 2222-2229. 10.1176/appi.ajp.161.12.2222.CrossRefPubMed
7.
González-Pinto A, Alberich S, Barbeito S, Alonso M, Vieta E, Martínez-Arán A, Saenz M, López P: Different profile of substance abuse in relation to predominant polarity in bipolar disorder: the Vitoria long-term follow-up study. J Affect Disord. 2010, 124: 250-255. 10.1016/j.jad.2009.11.005.CrossRefPubMed
8.
López P, Mosquera F, de León J, Gutiérrez M, Ezcurra J, Ramírez F, González-Pinto A: Suicide attempts in bipolar patients. J Clin Psychiatry. 2001, 62: 963-966. 10.4088/JCP.v62n1208.CrossRefPubMed
9.
Simon NM, Zalta AK, Otto MW, Ostacher MJ, Fischmann D, Chow CW, Thompson EH, Stevens JC, Demoupulos CM, Nierenberg AA, Pollack MH: The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. J Psychiatr Res. 2007, 41: 255-264. 10.1016/j.jpsychires.2006.08.004.CrossRefPubMed
10.
Ostacher MJ, Perlis RH, Nierenberg AA, Calabrese J, Stange JP, Salloum I, Weiss RD, Sachs GS, STEP-BD Investigators: Impact of substance use disorders on recovery from episodes of depression in bipolar disorder patients: prospective data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2010, 167: 289-297. 10.1176/appi.ajp.2009.09020299.PubMedCentralCrossRefPubMed
11.
Murray CJ, Lopez AD: Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997, 349: 1498-1504. 10.1016/S0140-6736(96)07492-2.CrossRefPubMed
12.
Dean BB, Gerner D, Gerner RH: A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Curr Med Res Opin. 2004, 20: 139-154. 10.1185/030079903125002801.CrossRefPubMed
13.
Osby U, Tiainen A, Backlund L, Edman G, Adler M, Hallgren J, Sennfäit K, van Baardewijk M, Sparen P: Psychiatric admissions and hospitalization costs in bipolar disorder in Sweden. J Affect Disord. 2009, 115: 315-322. 10.1016/j.jad.2008.09.011.CrossRefPubMed
14.
Das GR, Guest JF: Annual cost of bipolar disorder to UK society. Br J Psychiatry. 2002, 180: 227-233. 10.1192/bjp.180.3.227.CrossRef
15.
Tafalla M, Salvador-Carulla L, Saiz-Ruiz J, Diez T, Cordero L: Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain. BMC Psychiatry. 2010, 10: 31-10.1186/1471-244X-10-31.PubMedCentralCrossRefPubMed
16.
Keck PE, Nabulsi AA, Taylor JL, Henke CJ, Chmiel JJ, Stanton SP, Bennett JA: A pharmacoeconomic model of divalproex vs. lithium in the acute and prophylactic treatment of bipolar I disorder. J Clin Psychiatry. 1996, 57: 213-222.PubMed
17.
Munley PH, Devone N, Einhorn CM, Gash IA, Hyer L, Kuhn KC: Demographic and clinical characteristics as predictors of length of hospitalization and readmission. J Clin Psychol. 1977, 33: 1093-1099. 10.1002/1097-4679(197710)33:4<1093::AID-JCLP2270330438>3.0.CO;2-9.CrossRefPubMed
18.
Creed F, Tomenson B, Anthony P, Tramner M: Predicting length of stay in psychiatry. Psychol Med. 1997, 27: 961-966. 10.1017/S0033291796004588.CrossRefPubMed
19.
Rocca P, Mingrone C, Mongini T, Montemagni C, Pulvirenti L, Rocca G, Bogetto F: Outcome and length of stay in psychiatric hospitalization, the experience of the University Clinic of Turin. Soc Psychiatry Psychiatr Epidemiol. 2010, 45: 603-610. 10.1007/s00127-009-0091-8.CrossRefPubMed
20.
Ballesteros RJ, Martinez PL, Martin CM, Ibarra GN, Bulbena VA: Assessment of the Life Skills Profile and the Brief Psychiatric Rating Scale as predictors of the length of psychiatric hospitalization. Actas Esp Psiquiatr. 2002, 30: 225-232.
21.
Lerner Y, Zilber N: Predictors of cumulative length of psychiatric inpatient stay over one year: a national case register study. Isr J Psychiatry Relat Sci. 2010, 47: 304-307.PubMed
22.
Zhang J, Harvey C, Andrew C: Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study. Aust N Z J Psychiatry. 2011, 45: 578-585. 10.3109/00048674.2011.585452.PubMedCentralCrossRefPubMed
23.
Tulloch AD, Fearon P, David AS: Length of stay of general psychiatric inpatients in the United States: systematic review. Adm Policy Men Health. 2011, 38: 155-168. 10.1007/s10488-010-0310-3.CrossRef
24.
Brunelle J, Consoli A, Tanguy ML, Huynh C, Perisse D, Deniau E, Guillé JM, Gérardin P, Cohen D: Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents: a chart review. Eur Child Adolesc Psychiatry. 2009, 18: 185-193. 10.1007/s00787-008-0715-7.CrossRefPubMed
25.
Salvador-Carulla L, Tibaldi G, Johnson S, Scala E, Romero C, Munizza C: Patterns of mental health service utilization in Italy and Spain: an investigation using the European Service Mapping Schedule. Soc Psychiatry Psychiatr Epidemiol. 2005, 40: 149-159. 10.1007/s00127-005-0860-y.CrossRefPubMed
26.
Colom F, Vieta E, Martinez-Aran A, Garcia-Garcia M, Reinares M, Torrent C, Goikolea JM, Banus S, Salamero M: Spanish version of a scale for the assessment of mania: validity and reliability of the Young Mania Rating Scale. Med Clin (Barc). 2002, 119: 366-371.CrossRef
27.
Lobo A, Chamorro L, Luque A, Dal Re R, Badia X, Baro E: Validation of the Spanish versions of the Montgomery-Åsberg depression and Hamilton anxiety rating scales. Med Clin (Barc). 2002, 118: 493-499.CrossRef
28.
González-Pinto A, Mosquera F, Reed C, Novick D, Barbeito S, Veja P, Bertsch J, Alberich S, Haro JM: Validity and reliability of the Hamilton depression rating scale (5 items) for manic and mixed bipolar disorders. J Nerv Ment Dis. 2009, 197: 682-686. 10.1097/NMD.0b013e3181b3b3a0.CrossRefPubMed
29.
Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W: Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997, 73: 159-171. 10.1016/S0165-1781(97)00123-6.CrossRefPubMed
30.
Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM: Assessment of insight in psychosis. Am J Psychiatry. 1993, 150: 873-879.CrossRefPubMed
31.
Gonzalez-Pinto A, Lalaguna B, Mosquera F, Pérez de Heredia JL, Gutierrez M, Ezcurra J, Gilaberte I, Tohen M: Use of olanzapine in dysphoric mania. J Affect Disord. 2001, 66: 247-253. 10.1016/S0165-0327(00)00313-X.CrossRefPubMed
32.
Gonzalez-Pinto A, Dardennes R, de Zelicourt M, Lopez P, Oliveros RG, Vieta E, Barbeito S, Echeverría E, Fagnani F: In-patient care costs of patients with bipolar I disorder: a comparison between two European centers. J Affect Disord. 2010, 121: 152-155. 10.1016/j.jad.2009.05.010.CrossRefPubMed
33.
Bowden CL: Efficacy of lithium in mania and maintenance therapy of bipolar disorder. J Clin Psychiatry. 2000, 61 (Suppl 9): 35-40.PubMed
34.
Welge JA, Keck PEJ, Meinhold JM: Predictors of response to treatment of acute bipolar manic episodes with divalproex sodium or placebo in 2 randomized, controlled, parallel-group trials. J Clin Psychopharmacol. 2004, 24: 607-612. 10.1097/01.jcp.0000145342.38170.7f.CrossRefPubMed
35.
Hantouche EG, Akiskal HS, Azorin JM, Chatenet-Duchene L, Lancrenon S: Clinical and psychometric characterization of depression in mixed mania: a report from the French National Cohort of 1090 manic patients. J Affect Disord. 2006, 96: 225-232. 10.1016/j.jad.2005.01.005.CrossRefPubMed
36.
Vieta E, Morralla C: Prevalence of mixed mania using 3 definitions. J Affect Disord. 2010, 125: 61-73. 10.1016/j.jad.2009.12.019.CrossRefPubMed
37.
Pacchiarotti I, Mazzarini L, Kotzalidis GD, Valentí M, Nivoli AM, Sani G, Torrent C, Murru A, Sanchez-Moreno J, Patrizi B, Girardi P, Vieta E, Colom F: Mania and depression. Mixed, not stirred. J Affect Disord. 2011, 133: 105-113. 10.1016/j.jad.2011.03.037.CrossRefPubMed
38.
Gonzalez-Pinto A, Reed C, Novick D, Bertsch J, Haro JM: Assessment of medication adherence in a cohort of patients with bipolar disorder. Pharmacopsychiatry. 2010, 43: 263-270. 10.1055/s-0030-1263169.CrossRefPubMed
39.
Harman JS, Cuffel BJ, Lelleher KJ: Profiling hospitals for length of stay for treatment of psychiatric disorders. J Behav Health Serv Res. 2004, 31: 66-74. 10.1007/BF02287339.CrossRefPubMed
40.
Vieta E, Colom F, Corbella B, Martinez-Aran A, Reinares M, Benabarre A, Gastó C: Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord. 2001, 3: 253-258. 10.1034/j.1399-5618.2001.30504.x.CrossRefPubMed
Metadata
Title
Number of prior episodes and the presence of depressive symptoms are associated with longer length of stay for patients with acute manic episodes
Authors
Manuel Martin-Carrasco
Ana Gonzalez-Pinto
Jaime L Galan
Javier Ballesteros
Jorge Maurino
Eduard Vieta
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Annals of General Psychiatry / Issue 1/2012
Electronic ISSN: 1744-859X
DOI
https://doi.org/10.1186/1744-859X-11-7

Other articles of this Issue 1/2012

Annals of General Psychiatry 1/2012 Go to the issue

Case report

Steroid psychosis in a polyarteritis nodosa patient successfully treated with risperidone: tracking serum brain-derived neurotrophic factor levels longitudinally

Primary research

Sexual obsessions and suicidal behaviors in patients with mood disorders, panic disorder and schizophrenia

Primary research

Pharmacoeconomic analysis of paliperidone palmitate for treating schizophrenia in Greece

Primary research

Gender, trauma type, and PTSD prevalence: a re-analysis of 18 nordic convenience samples

Case report

Treatment of refractory catatonic schizophrenia with low dose aripiprazole

Primary research

No association between dietary patterns and depressive symptoms among a community-dwelling population in Japan