INTRODUCTION: There are long-term patients in psychiatric hospitals, who are often referred to as new long-stay patients: the heavy users consumers of psychiatric services and difficult-to-place patients. MATERIAL AND METHOD: Social characteristics, diagnosis, need for care, function, and admission patterns were compared in a group of heavy user patients (N = 39) and a group of difficult-to-place patients (N = 14). RESULTS AND DISCUSSION: The difficult-to-place patients were more often men, more often had a diagnosis of schizophrenia, had a lower socio-economic status, and lower GAF scores. The difficult-to-place patients rated the same amount of need for care as did the heavy users, but were assessed by the staff to have a greater need for care. The results support the view that the difficult-to-place patients comprise a distinct group. Services for the difficult-to-place patients must combine highly differentiated care with few demands and greater tolerance with respect to problem behaviour.
To investigate into the use of the term 'psychotic' as defined by ICD-10 or by the concept of impaired reality testing, among psychiatric staff members.
Questionnaire investigation using 11 short case vignettes.
Responses were received from 266 psychiatric staff members: psychiatrists, nursing staff and psychologists. When using ICD-10, patients were identified as psychotic with a sensitivity ranging from 90% to 55%. Specificity ranged from 60% to 75%. According to the concept of impaired reality testing, all three groups showed a sensitivity of about 60%, whereas specificity ranged from 65% to 50%. The combined use of the terms correlated significantly with responses regarding indication for legal detention for psychiatrists and nursing staff.
In identifying a patient as 'psychotic' a broad concept of impaired reality testing was widely used particularly in cases with legal issues. Psychotic symptoms, however, were identified with high sensitivity and specificity.
This study demonstrates a simple epidemiological method to evaluate the changes in service pattern for a defined catchment area after the establishment of a hospital-based community psychiatry service in Denmark. It measures the number of patients in contact with the service on 2 census days, before the new service was introduced and 3 years later, and deals with quantitative measures of sex, age, diagnosis and type of service contact. The services for 2 other areas are used as controls. A new community psychiatry service with an office situated outside the hospital is described and is shown to be superior to both the psychiatry service from the hospital and the rest of the hospital service: the number of inpatients and day patients were reduced by 42% vs 12% and 16% respectively. The number of outpatients increased by 104% in the new service compared with 23% for the service located at the hospital. The increase in outpatient care for the service outside the hospital was mainly caused by contact with middle-aged women with personality disorders.
BACKGROUND: The gatekeeper function of the general practitioner (GP) in the pathway to specialized psychiatric services was investigated in this study, which is part of the Nordic Comparative Study on Sectorized Psychiatry. The question addressed in this paper is whether different sociodemographic and clinical factors as well as factors related to service utilization are associated with referral from the GP compared with self-referrals (including referrals from relatives). METHODS: The study comprised a total of 1413 consecutive patients, admitted during 1 year to five psychiatric centres in four Nordic countries. The centres included in this study were those that accepted non-medical referrals. Only new patients (not in contact with the service for at least 18 months) were included. RESULTS: Increasing age was the only sociodemographic factor significantly associated with referral by the GP. The clinical factors (psychosis, being totally new to psychiatry and being in need of in-patient treatment) and some treatment characteristics (planned out-patient treatment and involuntary in-patient treatment), were all significantly associated with referral by the GP. Some indication was found that self-referred patients have shorter episodes of care. CONCLUSIONS: The findings were remarkably stable across the different centres indicating a general pattern. This study extends previous work on the role of GPs in the pathway to specialized psychiatric services and indicates that the GP has an important gatekeeper function for the most disabled patients.
As part of a Nordic Comparative Study on Sectorized Psychiatry, accessibility of psychiatric services and degree of urbanization in seven catchment areas were related to treated incidence. One-year treated incidence cohorts were used. Accessibility was assessed according to referral practice, existence of a round the clock emergency service and geographical location of the services. Accessibility was surprisingly weakly associated with treated incidence. Easy access to the psychiatric services was not related to a high treated incidence of less severe psychiatric problems at the expense of patients suffering from severe illness. Geographical distance to the services did not predict the demand for services. A positive correlation was found between the degree of urbanization and treated incidence of psychoses but not of other diagnostic groups.
As a part of a Nordic comparative study on sectorized psychiatry, treated incidence was related to the resources and dynamic qualities of psychiatric services in 7 catchment areas. One-year treated incidence cohorts were used. Data was collected concerning number of beds and staff, number of long-term patients and turnover rate of patients in the services and availability of specialized services. A positive correlation was found between rates of outpatient staff and treated incidence. No statistically significant correlation was found between the dynamic qualities of the services and treated incidence. Treated incidence of dependence was the highest in a center that had a special service unit for abusers. Special services for young and old people were not clearly reflected in treated incidence in respective patient groups.
As part of a Nordic comparative study on sectorized psychiatry, sociodemographic characteristics (gender, age and marital status) were studied in relation to treated incidence in eight diagnostic subgroups. One-year incidence cohorts in seven sectorized psychiatric services were used. Women with a neurosis diagnosis had a significantly higher relative probability of contact with all services. Men with a dependence diagnosis had a significantly higher relative probability of contact with four of the seven services. Older people had a significantly higher relative risk for affective psychosis in six of the seven centres, and younger individuals had a significantly higher relative risk for personality disorders in six of the seven centres. Unmarried people showed a higher relative risk for functional psychosis and personality disorders in five of the seven services.