2017 Resarch Forum

PSY: M-1

Principal Investigator & Applicant: Samantha Madziarski MD MBA

Examining an inpatient psychiatric unit: The prognostic value of age, gender, race, substance abuse, diagnosis, and antipsychotic treatment on the length of stay and its legal ramifications, a pilot study Samantha Madziarski MD MBA, Sabina Bera MD MS, Kelsey Stevens MD, Matt Cupp MS III, Aida Fran MS III, Kristine Galang RN MS IV, Christopher Spates MS III, Fi Lo MPH MS IV, Kong Davis MS III, Sara Abdijadid DO MS INTRODUCTION: There has been a rise in recognition and treatment of mental health illness (state and country). A history of mandatory admission has evolved from institutionalization of the mentally ill to shorter hospitalizations (voluntary or involuntary basis). The legal hold in California applies to individuals deemed dangerous to self, others, and/or gravely disabled (unable to utilize food, clothing, or shelter). PURPOSE: There is sparse literature available regarding the prognostic factors surrounding inpatient variables (legal processes during admission, gender, diagnosis, substance abuse and antipsychotic treatment) and the effect of these variables on LOS. These variables will be evaluated in the report below. METHODS: Data from admissions to the Inpatient Psychiatric Unit (07/2016 to 09/2016) using DMS 5 criteria for diagnosis was collected (age, gender, legal hold status, substance abuse, LOS, antipsychotic medications). The data was analyzed using R statistical software; results are described below. RESULTS: Females (n=44) are more likely than males (n=57) to have a legal hold (OR = 2.43, p = 0.0319). Discharge diagnosis of Bipolar, Depressive, or Psychotic disorder did not predict LOS (Anova p = 0.14). The type of antipsychotic treatment (atypicals, typicals, long acting injectable, no antipsychotic) showed a weak suggestion of a lower LOS (<5 days) in the group who did not receive an antipsychotic as treatment (Kruskal-Wallis p=0.08). A positive (vs negative) urine toxicology showed a longer LOS - 4.77 days (11.77 days vs 7). The group who did not have a urine toxicology screen had a shorter LOS (< 5 days) than the negative result group using Turkeys HSD post hoc comparison test. The p-value for all three groups is 0.0353. DISCUSSION: This data sample covered 101 patients at a specific time range with equal representation of major mental illnesses seen in an acute psychiatric unit. Urine specimen requests were not consistent. Gender and legal hold had the strongest association with LOS; diagnosis, age, race, or substance abuse treatment did not. Male gender is considered a risk factor, which leads to concern for males not being placed on appropriate legal holds, to ensure safety. CONCLUSIONS: Overall length of stay was higher in males and patients on legal holds. Positive urine toxicology also increased LOS. Not receiving an antipsychotic medication showed a weak suggestion for shorter LOS. It is not clear why females were more likely to be on legal holds while males had increased LOS which can be investigated in future studies. Other disorders (Anxiety, Intellectual Disability, Personality disorders) were not part of the diagnoses analyzed and can be considered in future studies.