Original article

Relapse rates and associated factors in patients with schizophrenia: a retrospective study from Brcko District, Bosnia and Herzegovina

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Abstract

Aim: To determine the proportion of patients with recorded psychiatric rehospitalisation within one year and examine crude associations with antipsychotic treatment patterns and documented medication adherence.

Methods: This retrospective cohort study included 87 patients with International Classification of Diseases, 10th Revision schizophrenia (F20.0–F20.9) hospitalised in Brčko District during 2014–2018 and with documented 12-month follow-up. Relapse was defined as recorded psychiatric rehospitalisation due to worsening psychotic symptoms. A separate audit described discharge treatment in 236 hospitalisation records. Exact tests and crude odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: Recorded rehospitalisation occurred in 32/87 patients (36.8%). First-generation antipsychotic exposure (OR 2.11, 95% CI 0.74–6.03; p = 0.215) and antipsychotic polypharmacy (OR 2.16, 95% CI 0.82–5.65; p = 0.164) were not significantly associated with rehospitalisation. Medication non-adherence (OR 11.33, 95% CI 3.58–35.87; p < 0.001) and documented non-cooperation (OR 10.00, 95% CI 3.16–31.62; p < 0.001) showed strong crude associations. In the audit, treatment was identifiable in 183/236 records; polypharmacy was documented in 73.8% and long-acting injectable/depot use in 32.8%.

Conclusion: Documented non-adherence and non-cooperation were strongly associated with recorded rehospitalisation. The findings support structured adherence assessment and post-discharge follow-up but do not establish causal effects of antipsychotic class or regimen complexity.

Keywords: antipsychotic agents, medication adherence, patient readmission, polypharmacy, schizophrenia