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The main goal of this project was to evaluate the clinical and sociodemographic characteristics of patients hospitalized with schizophrenia or bipolar disorder and the register of legal circumstances. A descriptive study was conducted using a nationwide hospitalization administrative database that contains all admissions registered in public hospitals across mainland Portugal. All discharges between 2008 and 2015 with a primary diagnosis of schizophrenia or bipolar disorder were selected. Legal problems (LP) at the moment of hospitalization were identified based on the presence of a secondary diagnosis of the ICD-9-CM code V62.5 ‘Legal circumstances: Imprisonment; Legal investigation; Litigation; or Prosecution’. A total of 25,835 and 20,807 hospitalizations with a primary diagnosis of schizophrenia and bipolar disorder were analysed, respectively. Approximately 11.8% (n = 3,005) of schizophrenia hospitalizations and 6.0% (n = 1250) of bipolar disorder hospitalizations were associated with registered legal circumstances. Legal circumstances were associated with younger patients, male sex, and a longer length of stay. One in four episodes linked to LP was associated with drug abuse and/or dependence. [ABSTRACT FROM AUTHOR]

To characterize all hospitalizations held in mainland Portugal (2010–2015) with dementia-related agitation based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding, and to investigate whether there is a relationship between agitation and hospitalization outcomes. A retrospective observational study was conducted using an administrative dataset containing data from all mainland Portuguese public hospitals. Only hospitalization episodes for patients aged over 65 years who have received a dementia diagnosis ascertained by an ICD-9-CM code of dementia with behavioral disturbance (294.11 and 294.21) and dementia without behavioral disturbance (294.10 and 294.20) were selected. Episodes were further grouped according to the presence of an agitation code. For each episode, demographic data and hospitalization outcomes, including length of stay (LoS), in-hospital mortality, discharge destination and all-cause hospital readmissions, were sourced from the dataset. Comparative analyses were performed and multivariable logistic methods were used to estimate the adjusted associations between agitation (exposure) and outcomes. Overall, 53,156 episodes were selected, of which 6,586 had an agitation code. These were mostly related to male, younger inpatients (mean 81.19 vs. 83.29 years, p < 0.001), had a higher comorbidity burden, stayed longer at the hospital (median 9.00 vs. 8.00 days, p < 0.001) and frequently ended being transferred to another facility with inpatient care. Agitation was shown to independently increase LoS (aOR = 1.385; 95%CI:1.314–1.461), but not the risk of a fatal outcome (aOR = 0.648; 95%CI:0.600–0.700). These results support the importance of detecting and managing agitation early on admission, since its prompt management may prevent lengthy disruptive hospitalizations. [ABSTRACT FROM AUTHOR]

Background: Pediatric Bipolar Disorder (BD) has been the focus of increased attention. To date, in Portugal, there is no evidence available for pediatricBD-related hospitalization rates. This study aimed to describe and characterize all pediatric hospitalizations with a primary diagnosis of BD registered in Portugal from 2000 to 2015.Methods: A retrospective observational study was conducted. Pediatric (< 18 years) inpatient episodes with a primary diagnosis of BD were selected from a national administrative database. The ICD-9-CM codes 296.x (excluding 296.2x, 296.3x and 296.9x) identified the diagnosis of interest. Additionally, age at discharge, sex, psychiatric comorbidities, length of stay (LoS), admission type and date, in-hospital mortality and hospital charges were analyzed.Results: A total of 348 hospitalizations, representing 258 patients, were identified. The overall population-based rate of hospitalizations was 1.18/100 000 youths. A non-linear increase throughout the study period was found. Patients were mostly female (60.6%), with a median age of 16 years (Q1-Q3:14-17). Admissions were mostly emergent (81%), and the median LoS was 14 days (Q1-Q3:7-24). Moreover, about 26% of all episodes were readmissions. Mean estimated charges per episode were 3503.10€, totalizing 1.20M€.Limitations: Limitations include the use of secondary data and the retrospective nature of the study.Conclusions: Annual rates of pediatric BD hospitalizations showed a non-linear increase. These findings may contribute to better understand the pediatric BD burden. Nevertheless, more research is warranted, to better characterize sociodemographic and clinical trends in pediatric BD to prevent the high number of acute hospitalizations and readmissions of these patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to use the Charlson Comorbidity Index (CCI) to assess the prevalence of medical comorbidities among hospitalization episodes with a primary Bipolar Disorder (BD) diagnosis, and to analyze its association with hospitalization outcomes.Methods: A population-based observational retrospective study was conducted using a Portuguese administrative database containing all mainland public hospitalizations. From 2008-2015, hospitalization episodes with a primary diagnosis of BD were analysed. Outcomes included: length of stay (LoS), in-hospital mortality and discharge destination.Results: Overall, 20807 hospitalization episodes were analysed. Mean±standard deviation age at admission was 47.9±14.3 years, and these episodes mostly refer to women's admissions (66.6%). Median (1st quartile; 3rd quartile) LoS was 16.0 (9.0; 25.0) days. A total of 2145 (10.3%) episodes had ≥1 CCI comorbidities registered, being diabetes the most prevalent. LoS was significantly higher for episodes with secondary diagnoses of congestive heart failure, cerebrovascular disease, dementia, diabetes, renal disease and malignancy (all p<0.05). Episodes with a registry of myocardial infarction, peripheral vascular disease, malignancy and renal disease diagnoses had higher in-hospital mortality.Limitations: Limitations include the use of data registered for administrative reasons rather than research purposes, and the analysis of hospitalization episodes, instead of patients.Conclusions: In this Portuguese nationwide study, greater comorbidity had a measurable impact on BD hospitalization outcomes. During the study period the prevalence of CCI comorbidities rose from 8.1% to 17.4%, which may reflect the overall increasing quality of hospital-coded data in Portugal throughout the years. The detection and timely management of medical comorbid conditions will likely prevent the high BD medical burden. [ABSTRACT FROM AUTHOR]