The authors describe an external crisis intervention service in a general hospital. This service is intended for a clientele presenting acute mental health problems, referred, in the majority of cases, from the emergency department. They present demographic data, diagnostic data, data on the factors precipitating the crises and data which can be used to qualify and quantify the clientele. In addition, they describe the therapeutic approach and the treatment philosophy, the number of follow-up sessions, and the guidance provided to the clientele after follow-up. Finally, the authors suggest prerequisites considered essential to the effective operation of a crisis intervention module in an external psychiatric clinic.
On the basis of a prospective random sample investigation of 611 alcohol-related visits to the four psychiatric emergency units of the City of Copenhagen, demographic variables, referral sources and dispositions of treatment are described. On every 10th day throughout 1985 all visits were registered. The distribution of all variables except age and sex deviate significantly from those of non-alcohol-related visits. Thus fewer alcoholics cohabit and more are divorced. 25% of the alcohol-related visits resulted in an overnight stay in the unit, while 10% resulted in admission to the psychiatric ward. For non-alcohol-related visits the proportions were the reverse.
Frequent users of the psychiatric emergency service (PES) place a heavy burden upon the mental health care delivery system. The aim of this study was to identify distinct temporal or geographical patterns of PES use by these patients as potential markers for their early detection.
Diagnostic profiles were obtained for patients making an intermediate (4 to 10) or a high (11 or more) number of visits to a general hospital PES in Montreal (Canada) between 1985 and 2004. Between-group comparisons were made with regards to several parameters. These included the time intervals between consecutive visits, visit clustering (single, repeating, and the time interval to the first cluster) and visits made to three other services where data was similarly acquired from 2002 to 2004.
The two multiple visit groups differed with regards to diagnostic profiles and actual time between consecutive visits (significantly shorter in patients with 11 or more visits). Patients with 11 or more visits were more likely to have a single cluster (3 or more visits/3 months) or repeating clusters (4 visits/3 months) in their patterns of use. Personality disorders were more prevalent in patients with single clusters as they were, along with schizophrenia, in those with repeating clusters. In addition, clusters were found to occur sufficiently early so as to be potentially useful as markers for early detection. Ten percent of those with 11 or more visits and 16% of those with an intermediate number of visits frequented at least one other PES. A small number of patients, primarily those with substance abuse, made over 50% of their visits to other services.
Temporal and geographical patterns of use differed significantly between the multiple visit groups. These patterns, combined with distinct diagnostic profiles, could potentially lead to the more rapid identification and treatment of specific sub-groups of multiple visit patients.
Immigrants from non-Western countries occupy a fifth of the beds in an acute psychiatric department. There is a prevailing clinical impression that they have higher morbidity than the traditional Norwegian population. MATERIAL: A one-year cohort of patients, n = 415, was retrospectively investigated, 80 of whom had a non-Western background. RESULTS: The proportion of immigrant patients from the department's catchment area was 49 in 10 000, compared to 52 in 10 000 for traditional Norwegian patients, p = 0.72. Significantly more of the immigrants were men, they were younger, they got more compulsory treatment, and more often a diagnosis of psychosis, but they had less substance abuse problems. Suicidality was evenly distributed in both groups. INTERPRETATION: Our clinical impression of a higher frequency of referral of immigrants was not substantiated. However, it is suggested that immigrants have greater difficulties in presenting their psychiatric problems to a general practitioner; hence they probably develop more severe symptoms before referral. The low incidence of referral of female immigrants could indicate a higher level of functioning, or cultural barriers to exhibiting problems.
Comment In: Tidsskr Nor Laegeforen. 2004 May 6;124(9):1278; author reply 127815131720
From 18.4.1988 to 17.6.1988, 374 emergency referrals were registered and 495 other referrals to the psychiatric admission department, Frederiksberg Hospital. The two main reasons for the referrals, in both men and women, were alcoholism and/or psychosis. Compared to a similar study from the same period in 1983, the number of emergency referrals was stabilized while the number of other referrals increased by 63%. The majority of the 495 other referrals were chronic psychotic patients and/or addicts who were, as a rule, already under treatment in the day-care hospital or out-patient clinic. Previously, part of this group of patients remained in state mental institutions for long periods. After the change to district psychiatric treatment, the admission department acts as a semi-acute asylum, since suitable resorts outside the psychiatric institution are not available.
Knowledge on psychiatric emergencies in children and adolescents is limited. The Psychiatric Emergency Departments (PED) in Copenhagen enable the acute examination of children and adolescents 24 h a day, 7 days a week. However, very little is known about who presents to the PED, and the reason for their visit.
To describe the prevalence and characteristics of presentations in PED and treatment provided.
A retrospective population based study comprising data of more than 4000 visitors presenting to PED from 2001-2010. In 2003 and 2006, two randomly chosen years, a more thorough analysis was performed, based on the individual emergency charts. Inter-rater reliability was high.
Visits increased nearly threefold during the period. Symptom score for 2003 and 2006 revealed that more than one third of the visitors had suicidal ideation. Depressive and anxiety symptoms together with suicidal ideation rose significantly (P
The study identified clinical and sociodemographic characteristics of patients making multiple visits to a psychiatric emergency service.
Information was obtained for patients visiting a hospital psychiatric emergency service in Montreal from 1985 to 2000. Profiles were determined for four groups: one visit, two visits, three to ten visits, and 11 or more visits. To determine whether the profile for those with 11 or more visits was generalizable, data for patients visiting the main site and three other such services from 2002 to 2004 were similarly analyzed.
At the main study site (1985 to 2000), patients with single visits accounted for 36% of the 29,569 visits. The 292 patients with 11 or more visits accounted for almost 21% of total visits. Timing of the visit-time of day and day of the week-did not differentiate between groups. However, time itself was important in identifying patients with 11 or more visits: use of 30-month observation periods resulted in identification of only 8% of this group. Patients with 11 or more visits were more likely to be diagnosed as having schizophrenia and as having a comorbid diagnosis and were generally younger at the index visit and more economically impaired than those in the other groups. Overall, and at two of the three other sites, schizophrenia was overrepresented in the highest user group.
Most visits to the psychiatric emergency service were made by frequent users who had distinctive profiles, which are potentially useful for developing clinical strategies to reduce the impact of this patient group on this service.