Patient satisfaction with hospital health care on acute psychiatric units: Development and validation of the PSYQUEST questionnaire

Introduction:Bipolar disorder (BD) has been reconceptualized as a disorder with a progressive developmental pattern that evolves in stages with different forms of clinical presentation. A previous study developed a staging model for BD: the Empirically Developed Clinical Staging Model (EmDe-5). The present study aims to validate the model using a larger and more representative sample of the Spanish population. Material and methods:183 outpatients with BD from 11 centers in Spain were included. Clinical characteristics of BD (number of hospitalizations, number of suicide attempts, comorbid personality disorders), physical health aspects (BMI, metabolic syndrome, number of physical diseases), cognitive performance (SCIP), functioning (permanent disability due to BD, FAST) and quality of life (SF-36) were evaluated. The scores on the CGI-S and VAS-S scales and the pattern of psychopharmacological treatment were used as external validators of the model. Results: Ten patients (51.5%) were classified as stage 1; 33 (18%) as stage 2; 93 (50.8%) as stage 3; 37 (20.2%) as stage 4 and 10 (5.5%) as stage 5. All variables included in the model, except the number of suicide attempts (p = 0.311) and comorbid personality disorders (p = 0.061), showed a pattern of deterioration from stage 1 to 5. As expected, scores on the VAS-S and CGI-S scales were worse in the later stages. Regarding treatment, early stages (1-2) were associated with the use of 1 to 3 drugs, while late stages (4-5) were associated with the use of 4 or more drugs (p= 0.002).