Indian Journal of Private Psychiatry

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VOLUME 12 , ISSUE 2 ( July-December, 2018 ) > List of Articles


Study of Sociodemographic and Clinical Profile of Admitted Patient Leaving Against Medical Advice from Psychiatry Ward of a Teaching Hospital

Prosenjit Ghosh, Jayanta Kurmi

Keywords : Faith healer, Leaving against medical advice, Substance abuse

Citation Information : Ghosh P, Kurmi J. Study of Sociodemographic and Clinical Profile of Admitted Patient Leaving Against Medical Advice from Psychiatry Ward of a Teaching Hospital. Ind J Priv Psychiatry 2018; 12 (2):39-45.

DOI: 10.5005/jp-journals-10067-0018

License: CC BY-NC 4.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Leaving against medical advice (LAMA) meaning a patient choosing to leave the hospital before the treating physician recommends discharge may result into inadequate treatment, relapse and prolonged duration of illness. Aim and objectives: The aim of this study was to assess the prevalence, reasos for LAMA, sociodemographic variables and clinical profile of such patients. Materials and methods: Retrospectively data were obtained from indoor register of a Psychiatry department of a teaching hospital for patients opting LAMA, during a period of 18 months from January 2017 up to June 2018. International Classification of Disease (ICD)-10 criteria was used for the diagnosis purpose. Results: Out of 569 patients admitted during the study period total 60 patients fulfilled the criteria for LAMA. The frequency of LAMA was found to be 10.5%. LAMA was found to be more common in those below age 40 years (85%), in those from nonurban background (75%), who were educated up to high school (71%), who were suffering from neurotic, and psychotic and substance abuse disorders. The commonest reason cited for LAMA was going to faith healer and most of the LAMA occurred within first four days of hospitalization. Conclusion: Leaving against medical advice (LAMA) is a frequent problem in psychiatric inpatients and is a matter of great concern for the treating doctors

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  1. Schaefer GR, Matus H, Schumann JH, Sauter K, Vekhter B, Meltzer DO, Arora VM. Financial responsibility of hospitalized patients who left against medical advice: medical urban legend?. Journal of general internal medicine. 2012 Jul 1;27(7):825-830.
  2. Ibrahim SA, Kwoh CK, Krishnan E. Factors associated with patients who leave acute-care hospitals against medical advice. American journal of public health. 2007 Dec;97(12):2204-2208.
  3. Levine LJ, Schwarz DF, Argon J, Mandell DS, Feudtner C. Discharge disposition of adolescents admitted to medical hospitals after attempting suicide. Archives of pediatrics & adolescent medicine. 2005 Sep 1;159(9):860-866.
  4. Franks P, Meldrum S, Fiscella K. Discharges against medical advice: are race/ethnicity predictors?. Journal of general internal medicine. 2006 Sep 1;21(9):955-960.
  5. Fiscella K, Meldrum S, Barnett S. Hospital discharge against advice after myocardial infarction: deaths and readmissions. The American journal of medicine. 2007 Dec 1;120(12):1047- 1053.
  6. Al Ayed I. What makes patients leave against medical advice?. Journal of Taibah University Medical Sciences. 2009 Jan 1;4(1):16-22.
  7. Okoromah CN, Egri-Qkwaji MT. Profile of and control measures for paediatric discharges against medical advice. The Nigerian postgraduate medical journal. 2004 Mar;11(1):21-25.
  8. Eze B, Agu K, Nwosu J. Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions. Patient Intelligence. 2010 Mar 1;2: 27-31.
  9. Tawk R, Freels S, Mullner R. Associations of mental, and medical illnesses with against medical advice discharges: the National Hospital Discharge Survey, 1988–2006. Administration and Policy in Mental Health and Mental Health Services Research. 2013 Mar 1;40(2):124-32.
  10. Alfandre DJ. “I'm going home”: discharges against medical advice. In Mayo Clinic Proceedings 2009 Mar 1 (Vol. 84, No. 3, pp. 255-260). Elsevier.
  11. Youssef A. Factors associated with discharge against medical advice in a Saudi teaching hospital. Journal of Taibah University Medical Sciences. 2012 Aug 1;7(1):13-18.
  12. Moyse HS, Osmun WE. Discharges against medical advice: a community hospital's experience. Can J Rural Med. 2004 Jul 1;9(3):148-153.
  13. Baptist AP, Warrier I, Arora R, Ager J, Massanari RM. Hospitalized patients with asthma who leave against medical advice: characteristics, reasons, and outcomes. Journal of allergy and clinical immunology. 2007 Apr 1;119(4):924-929.
  14. Jeffer EK. Against medical advice: Part I, a review of the literature. Military medicine. 1993 Feb 1;158(2):69-73.
  15. Jeffer EK. Against medical advice: part II, The Army experience 1971–1988. Military medicine. 1993 Feb 1;158(2):73-76.
  16. Hayat AA, Ahmed MM, Minhas FA. Patients leaving against medical advice: an inpatient psychiatric hospital-based study. J Coll Physicians Surg Pak. 2013 May 1;23(5):342-346.
  17. Brook M, Hilty DM, Liu W, Hu R, Frye MA. Discharge against medical advice from inpatient psychiatric treatment: a literature review. Psychiatric services. 2006 Aug;57(8):1192-1198.
  18. Sarkar S, Balhara YP, Gautam N, Singh J. A retrospective chart review of treatment completers versus noncompleters among in-patients at a tertiary care drug dependence treatment centre in India. Indian journal of psychological medicine. 2016 Jul;38(4):296-301.
  19. Alfandre DJ. “I'm going home”: discharges against medical advice. In Mayo Clinic Proceedings 2009 Mar 1 (Vol. 84, No. 3, pp. 255-260). Elsevier.
  20. Karimi SA, Saravi BM, Farahabbadi EB, Zamanfar D, Fallah M, Abokheily MA. Studying the rate and causes of discharge against medical advice in hospitals affiliated to mazandaran university of medical sciences. Materia socio-medica. 2014 Jun;26(3):203-207.
  21. Greenberg WM, Otero J, Villanueva L. Irregular discharges from a dual diagnosis unit. The American journal of drug and alcohol abuse. 1994 Jan 1;20(3):355-371.
  22. Baekeland F, Lundwall L. Dropping out of treatment: a critical review. Psychological bulletin. 1975 Sep;82(5):738-783.
  23. Beck NC, Shekim W, Fraps C, Borgmeyer A, Witt A. Prediction of discharges against medical advice from an alcohol and drug misuse treatment program. Journal of Studies on Alcohol. 1983 Jan;44(1):171-180.
  24. Fabrick AL, Ruffin JW, Denman SB. Characteristics of patients discharged against medical advice. Mental hygiene. 1968 Jan;52(1):124-128.
  25. Tehrani E, Krussel J, Borg L, Munk-Jorgensen P. Dropping out of psychiatric treatment: a prospective study of a firstadmission cohort. Acta Psychiatrica Scandinavica. 1996 Oct;94(4):266-271.
  26. Pages KP, Russo JE, Wingerson DK, Ries RK, Roy-Byrne PP, Cowley DS. Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital. Psychiatric Services. 1998 Sep;49(9):1187-1192.
  27. Tuckman J, Lavell M. Psychiatric patients discharged with or against medical advice. Journal of clinical psychology. 1962 Apr;18(2):177-180.
  28. Atkinson RM. AMA and AWOL discharges: a six-year comparative study. Psychiatric Services. 1971 Oct;22(10): 293-296.
  29. Heinssen RK, McGlashan TH. Predicting hospital discharge status for patients with schizophrenia, schizoaffective disorder, borderline personality disorder, and unipolar affective disorder. Archives of general psychiatry. 1988 Apr 1;45(4): 353-360.
  30. Phillips MS, Ali H. Psychiatrie Patients who Discharge Themselves against Medical Advice. The Canadian Journal of Psychiatry. 1983 Apr;28(3):202-205.
  31. Senior N, Kibbee P. Can we predict the patient who leaves against medical advice: The search for a method. Psychiatric Hospital. 1986;17:33-36.
  32. Wylie CM, Michelson RB. Age contrasts in self-discharge from general hospitals. Hospital formulary. 1980 Apr;15(4):273-276.
  33. Brush RW, Kaelbling R. Discharge of psychiatric patients against medical advice. The Journal of nervous and mental disease. 1963 Mar 1;136(3):288-292.
  34. Johnson DT, Beutler LE, Neville CW. Effects of therapist sex, patient sex, and time on rates of discharge of psychiatric inpatients against medical advice (abstract). Catalog of Selected Documents in Psychology. 1978;8:88.
  35. LaWall JS, Jones R. Discharges from a ward against medical advice: search for a profile. Psychiatric Services. 1980 Jun;31(6):415-416.
  36. Kecmanovic D. Patients discharged against medical advice from a lock-and-key psychiatric institution. International Journal of Social Psychiatry. 1975 Dec;21(4):274-281.
  37. Raynes AE, Patch VD. Distinguishing features of patients who discharge themselves from psychiatric ward. Comprehensive Psychiatry. 1971 Sep;12:473-479.
  38. Long JP, Marin A. Profile of patients signing against medical advice. The Journal of family practice. 1982 Sep;15:551-552.
  39. Chandrasena R. Premature discharges: a comparative study. The Canadian Journal of Psychiatry. 1987 May;32(4):259-263.
  40. Planansky K, Johnston R. A survey of patients leaving a mental hospital against medical advice. Psychiatric Services. 1976 Dec;27(12):865-868.
  41. Akhtar S, Helfrich J, Mestayer RF. AMA discharge from a psychiatric inpatient unit. International Journal of Social Psychiatry. 1981 Jun;27(2):143-147.
  42. Chandrasena RD, Miller WC. Discharges AMA and AWOL: a new” revolving door syndrome.”. Psychiatric journal of the University of Ottawa. 1988 Sep;13:154-157.
  43. Syed EU, Mehmud S, Atiq R. Clinical and demographic characteristics of psychiatric inpatients admitted via emergency and non-emergency routes at a university hospital in Pakistan. Journal-Pakistan Medical Association. 2002 Oct;52(10):456-458.
  44. Tessier WG. The impact of ward atmosphere on patient discharge status from locked psychiatric units. Dissertation Abstracts International. 1990;50:3178.
  45. Shirani F, Jalili M, Asl-e-Soleimani H. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. European Journal of emergency medicine. 2010 Dec 1;17(6):318-321.
  46. Greenwald AF. Some contributive factors in psychiatric discharges against medical advice. Psychiatry Digest.1963;24: 21-26.
  47. Daniels RS, Margolis PM, Carson RC. Hospital discharges against medical advice: I. Origin and prevention. Archives of general psychiatry. 1963 Feb 1;8(2):120-30.
  48. Lewis JM. Discharge against medical advice: The doctor's role. Psychiatric Services. 1966 Sep;17(9):266-270.
  49. Laurttsen R, Frus S. Self-rated therapeutic alliance as a predictor of drop-out from a day treatment program. Nordic Journal of Psychiatry. 1996 Jan 1;50(1):17-20.
  50. Alebiosu CO, Raimi TH. Discharge against medical advice. Tropical Doctor 2003;33:191-192.
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