Reinternações psiquiátricas e uso de antipsicóticos no tratamento de pacientes com transtornos mentais graves.

Abstract

Introduction: Evaluation of the comparative effectiveness of antipsychotics using readmission as an outcome of maintenance treatment failure can contribute to clinical decision-making and the definition of public polices in the area of mental health. Objective: To carry out a pharmacoepidemiological evaluation of a cohort of patients diagnosed with severe and persistent mental disorder who were discharged from the main reference hospital for psychiatric hospitalization in the public health network of Brasília / DF, from 2012 to 2017. Method: This is a non-concurrent cohort study, based on the review of medical records. The study included patients with severe mental disorders who were discharged from January to December 2012 (entry into the cohort), with longitudinal follow-up until December 2017. Descriptive statistical analyzes of the patients' sociodemographic and clinical characteristics were performed. Cox regression was used to assess factors that could influence readmissions. Results: Of the 1,273 patients with severe mental disorder who were discharged at the time of entry into the cohort, 625 participants were selected (49.1%). The group of typical antipsychotics was the most used in maintenance treatment (62.9%), with haloperidol being the most prescribed (54.3%). Non-adherence rate to treatment was 34.2%. The regression analyzes showed an increase of 25.0% in the risk of readmission for patients who underwent treatment with typical antipsychotics compared to those who used atypical antipsychotics, and for those who did not adhere to the treatment, the increase was 96.0%. Patients who adhered to outpatient treatment and use atypical antipsychotics had fewer admissions and, consequently, lower cost. Conclusions: The study demonstrates that for patients with severe mental disorders, adherence to treatment and the option for atypical antipsychotics are determining factors in ensuring greater effectiveness of outpatient treatment. It is observed in the study that typical antipsychotics, mainly haloperidol, were the most used, although this option presents a greater risk of readmission compared to treatment with atypical antipsychotics.