Vlad Dionisie ^1,2* Maria Gabriela Puiu ^1,2 Mihnea Costin Manea ^1,2 Emanuel Moisa ^1,3 Ana Maria Dumitru ⁴ Leila Ibadula ² Aliss Madalina Mares ^1,2 Corina Ioana Varlam ² Mirela Manea ^1,2

• ¹ Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
• ² Prof. Dr. Alexandru Obregia Psychiatry Hospital, Bucharest, Romania
• ³ Elias University Emergency Hospital, Bucharest, Romania
• ⁴ Reteaua Medicala Victoria, Bucharest, Romania

Background: The revolving door phenomenon refers to patients with frequent hospital admissions and emerged after deinstitutionalization reforms have been implemented. Schizophrenia is a severe and debilitating mental disorder and has frequently been identified as one of the most prevalent disorders among revolving door patients. Therefore, this research aimed to identify sociodemographic and clinical factors associated with the revolving door phenomenon in patients with schizophrenia.Methods: We conducted an observational and retrospective cohort study and collected data from the medical records of individuals admitted to the largest psychiatric hospital in Romania during a 2-year period. Patients with three or more admissions during a 12-month period were identified as revolving door.Results: Of the total of 635 patients included in this study, 108 met the criteria for revolving door. Patients had a mean age of 44.55±12.83 years and most of them were single (81.7%) and receiving a disability pension (68.7%) and had an illness duration of more than 5 years (81.9%). Male gender (p=0.000), younger age (p<0.05), presence of psychiatric comorbidity (p<0.05), substance use disorder (p=0.000) and alcohol use disorder (p<0.01) were associated with the revolving door patients. A binary linear logistic regression revealed that male gender (OR=1.92, 95%CI:1.21-3.08), shorter hospitalization (OR=0.982, 95%CI:0.964-1.000), substance use disorder (OR=2.47, 95%CI:1.16-5.26), verbal (OR=1.44, 95%CI:1.05-1.98) and physical (OR=1.331, 95%CI:1.017-1.744) aggression were predictive factors for frequent use of inpatient services.Conclusions: The results may facilitate development of future reform policies aimed at reducing the revolving door phenomenon, including implementing transitional care intervention between hospital and community services. Deleted: Schizophrenia is a severe mental disorder with a slightly 110 decreased global prevalence and incidence between 1990 and 2019 111 but with no change in disease-associated burden 112 Deleted: Moreover, schizophrenia implies great costs to the 113 healthcare systems since it is a chronic disease that starts to affect 114 patients usually during early adulthood 115 Deleted: Therefore, research into access of hospital services and 116 patterns of care of this patient population is important.