Due to limited inpatient care resources and high healthcare expenditures, understanding factors that affect lengths of stay (LOS) is highly relevant. We aimed to investigate associations between metabolic disturbances and LOS in a psychiatric hospital and to identify other clinical and sociodemographic LOS predictors.

Patients admitted to one of the units of the general psychiatric or psychogeriatric departments between January 1, 2007 and December 31, 2020, were included. Metabolic disturbances (i.e., the metabolic syndrome and its five components) were defined using the International Diabetes Federation definition. Cox frailty regression models with time-varying coefficients were used to investigate the association between metabolic disturbances and LOS. Hazard ratios (HR) >1 and HR < 1 indicated the relative likelihood of shorter and extended LOS, respectively.

A total of 7,771 patients for 16,959 hospital stays throughout 14 years of follow-up were included. Central obesity (HR = 0.82; 95% confidence interval [CI] = [0.76–0.89]), hyperglycemia (HR = 0.83; 95% CI = [0.78–0.89]), hypertriglyceridemia (HR = 0.87; 95% CI = [0.80–0.92]), and the metabolic syndrome (HR = 0.76; 95% CI = [0.70–0.82]) were associated with an increased risk of extended LOS in the psychiatric hospital, while underweight (HR = 1.30, 95% CI = [1.09–1.56]) and HDL hypocholesterolemia (HR = 1.10, 95% CI = [1.03–1.18]) were associated with a higher likelihood of shorter LOS. In first-episode psychosis patients, hypertriglyceridemia (HR = 0.82; 95% CI = [0.67–0.99]) and hypertension (HR = 0.76, 95% CI = [0.58–0.99]) were associated with extended LOS when considering all stays, while no association was found when considering the first stay per patient.

Future studies should determine whether better metabolic monitoring and treatment of metabolic disturbances can contribute to reducing LOS.

Frequently associated with early psychosis, depressive and manic dimensions may play an important role in its course and outcome. While manic and depressive symptoms can alternate and co-occur, most of the studies in early intervention investigated these symptoms independently. The aim of this study was therefore to explore the co-occurrence of manic and depressive dimensions, their evolution and impact on outcomes.

We prospectively studied first-episode psychosis patients (N = 313) within an early intervention program over 3 years. Based on latent transition analysis, we identified sub-groups of patients with different mood profiles considering both manic and depressive dimensions, and studied their outcomes.

Our results revealed six different mood profiles at program entry and after 1.5 years follow-up (absence of mood disturbance, co-occurrence, mild depressive, severe depressive, manic and hypomanic), and four after 3 years (absence of mood disturbance, co-occurrence, mild depressive and hypomanic). Patients with absence of mood disturbance at discharge had better outcomes. All patients with co-occurring symptoms at program entry remained symptomatic at discharge. Patients with mild depressive symptoms were less likely to return to premorbid functional level at discharge than the other subgroups. Patients displaying a depressive component had poorer quality of physical and psychological health at discharge.

Our results confirm the major role played by mood dimensions in early psychosis, and show that profiles with co-occurring manic and depressive dimensions are at risk of poorer outcome. An accurate assessment and treatment of these dimensions in people with early psychosis is crucial.

While specialized early intervention programs represent the gold standard in terms of optimal management of first-episode psychosis (FEP), poor medication adherence remains a predominant unmet need in the treatment of psychosis. In this regard, an interaction between insight and adherence in FEP patients has been hypothesized but has been challenged by multiple pitfalls.

Latent profile analysis and trajectory modeling techniques were used to evaluate insight and adherence of 331 FEP patients engaged at the beginning, middle, and end of a 3-year specialized early psychosis program. A Bayesian model comparison approach was used to compare scores of clinical, functional, and socioeconomic outcomes at the end point of the study.

Nearly one-third of the patients maintain a high level of insight and adherence during the entire program. At the end of the 3-year follow-up, more than three-quarters of patients are considered adherent to their medication. Patients with low levels of insight and adherence at the beginning of the program improve first in terms of adherence and then of insight. Furthermore, patients with high levels of insight and adherence are most likely to reach functional recovery and to experience an increase in environmental quality of life.

Latent FEP subpopulations can be identified based on insight and adherence. Medication adherence was the first variable to improve, but a gain in insight possibly plays a role in the reinforcement of adherence.