Predictors of short-term deterioration and compliance in psychiatric emergency patients: a prospective study of 457 patients referred to the emergency room of a general hospital.

The aim of this study was to identify predictors of (1) short-term outcome and (2) short-term compliance with treatment (for non-hospitalized patients) in psychiatric emergency patients. Subjects comprised 457 patients referred to the emergency ward of a French general hospital and requiring examination by a psychiatrist. Clinical and therapeutic assessments were carried out at baseline, using DSM-IV diagnoses and overall psychopathological scoring scales [Brief Psychiatric Rating Scale (BPRS) and Symptom Checklist-90 Revised]. Clinical outcome and compliance were assessed 3 weeks after entry. For each of the two issues assessed, stepwise logistic regression analysis was performed following univariate comparisons. The three best predictors of deterioration at 3 weeks were lack of compliance to treatment, presence of a previous psychiatric history, and a low BPRS hebephrenic factor score. The best predictors of compliance in non-hospitalized patients were a previous psychiatric history, marital status, a low BPRS hostility factor score, and older age. The main predictor of deterioration was non-compliance. Thus, we emphasize the importance of improving compliance, especially among young patients with no previous psychiatric history.