A total of 1,460 participants in the Clinical
Antipsychotic Trials of Intervention Effectiveness (CATIE) clinical trial were followed from the time they began a randomized trial of medication to first
schizophrenia-related hospital admission.
RESULTS: In 869 person-years of follow-up, 203 patients were hospitalized. Increased risk of hospital admission was associated with early age (≤ 17 years) of first
antipsychotic treatment (adjusted hazard ratio [AHR]=2.16, 95% confidence interval [CI]=1.49-3.11), psychiatric hospitalization in past year (AHR=2.99, CI=2.23-4.00), having had DSM-IV alcohol (AHR=1.56, CI=1.16-2.10) or drug (AHR=1.50, CI=1.13-2.00) use disorders in the past five years, and baseline severe symptoms according to the Clinical Global Impressions Scale (AHR=1.54, CI=1.04-2.27), presence of
tardive dyskinesia (AHR=1.55, CI=1.07-2.23), a high score on the positive symptoms subscale of the Positive and Negative Syndrome Scale (AHR=1.52, CI=1.07-2.15), and low social function (AHR=1.45, CI=1.03-2.04). As compared with
olanzapine, the drugs
quetiapine (AHR=2.14, CI=1.39-3.31),
perphenazine (AHR=1.80, CI=1.11-2.94), and
ziprasidone (AHR=2.70, CI=1.64-4.44) were associated with increased hospitalization risk.
Risperidone was associated with a lower hospitalization risk than
quetiapine (AHR=1.50, CI=1.01-2.22) and
ziprasidone (AHR=1.89, CI=1.19-3.01).
CONCLUSIONS: Efforts to lower hospital admission risk among individuals with
schizophrenia should focus on history of early onset, recent inpatient admission, severe positive symptoms, poor social function, high global illness severity, and comorbid
substance use disorders and on selection of an appropriate
antipsychotic medication.