BACKGROUND: Due to long-term capacity problems in the psychiatric acute ward, we tried to canalise acute admissions due to life crises (and not serious mental disease) to a new short-term in-patient crisis unit. Our hypothesis was that the opening of this unit would lead to fewer admissions to the psychiatric acute ward and that this change would be reflected by an increase of patients with a more severe psychopathology. MATERIAL AND METHODS: The study had a quasi-experimental design. Two patient groups in a psychiatric acute ward (from separate catchment areas) were compared before (2.1.2003-1.6.2003) and after (2.1.2004-1.6.2004) establishment of a community based short-term inpatient crisis unit in one of the catchment areas. RESULTS: 234 patients were included in the study. Admissions to the psychiatric acute ward did not decline from any of the catchment areas from the first to the second time-period . The second time-period was associated with less psychopathology, but only for men in the area with a crisis unit. The reduction was largest for self-harm and suicidal behaviour (p = 0.02) and depression (p = 0.01). INTERPRETATION: None of our hypotheses were confirmed. Our main conclusion is that patient flow in acute mental health services involves a multitude of complex and unpredictable factors. The services continuously reorganise. Different ways of organising mental health services are rarely studied systematically, and such studies are difficult and resource demanding.
This is a case study of 49 acute admissions to the Child Psychiatry Department at the Copenhagen County Hospital in Glostrup over the four year period 1.1.1990-31.12.1993. The aim is to appraise the concept of acute child psychiatric admission, examine the relation between definition and practice and evaluate the acute service and its viability. A retrospective analysis of the case notes shows that the 42 children involved constitute a selected group of mainly 11-14 years old girls, the most frequent diagnosis at referral- and at discharge-being anorexia nervosa. Most cases are referred from paediatric departments. Eighty percent of the acutely admitted children have had previous contact with one or more institutions. Time interval breakdown shows that more than a quarter of the cases were admitted some weeks after referral. The acute group had on average fewer hospital days than all other cases and only 12% were discharged without needing of further treatment. A further analysis revealed an inconsistency in terms of definition and practice. Only 39% of the patients were admitted within a 24-hour period after the acute referral, while 74% were admitted within the first week. The explanation is offered, that the definitions of and the indications for acute child psychiatric hospitalisation were loosely formulated and different from the more stringent medical terms and that some cases must be seen as being more of a subacute nature or representing clinical or social relapses. The question is raised whether the concept of acute admission in child psychiatric terms is viable.
During the period concerned, 50 children were admitted as emergencies to the Psychiatric Children's Hospital. These were compared with 90 children over the age of nine years who were admitted in the ordinary manner during the same period. The children admitted as emergencies were aged ten years or more, they were older than the control group and the sex distribution was more uniform. The emergency admissions were, as a rule, instigated by the parents. Half of the families involved had had contact with the Children's Psychiatric Hospital previously. The majority of the children in the control group were referred by school psychologists. The three most important reasons for emergency admission were psychotic symptoms, threats of suicide or attempted suicide and behavioural disorders. Nearly half of the children admitted as emergencies were hospitalized for less than three months and nearly one third were hospitalized for less than one month. Almost all of the children admitted as emergencies and all of the children in the control group had had contact with the social supportive agencies prior to admission. The recommendations on discharge did not differ essentially in the two groups.
U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization.
We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately.
We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-score-based matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.05-1.42), and readmission (HR = 1.38, 95% CI = 1.14-1.66), but not ED visits (HR = 1.14, 95% CI = 0.95-1.37).
Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use.
Only few research studies on psychotherapy in Denmark have been published. Our investigation summarizes the results of the psychotherapeutic treatment given 1982-1987 at the Outpatient Clinic for the treatment of Neuroses, Psychiatric Hospital in Aarhus. 45% of the 803 patients who were referred to the clinic commenced psychotherapy. 30% of the patients were students aged 20-39 years. Diagnostically, 60% of the patients had neurotic disturbances, 20% were borderline personality organised and the remainder included patients with higher level personality disturbances and psychotic patients. 85% of the patients were on the waiting list for less than six months. 42% of the men and 52% of the women had more than 25 psychotherapy sessions. 80% had individual psychotherapy. According to the opinions of the psychotherapists, 48% of the male patients and 44% of the female patients gained considerably from the treatment. Those who were helped by the treatment received treatment significantly longer than those in whom the condition did not change or deteriorated. The results of the investigation indicate the need for a prospective qualitative study of the therapeutic alliance, and this investigation is in preparation.
A multiaxial classification system has been developed in which three ICD-8 derived axes of psychiatric syndromes, personality disorders and somatic syndromes, and two DSM-III axes of psychosocial stressors and social functioning have been included. Global assessment scales were annexed the three ICD-8 axes. This DSM-III/ICD-8 system was used for registration of 880 consequetively admitted psychiatric patients in a general hospital setting. The results showed that six psychiatric syndromes (substance use disorders, schizophrenia, manic-depressive psychosis, reactive psychosis, neurosis, and adjustment reactions) were responsible for 80% of the diagnostic variance. Of these syndromes, manic-depressive psychosis had the highest improvement rate both concerning symptoms and social functioning. Manic-depressive psychosis had also the lowest coefficient of variation in the stay in hospital indicating a high degree of homogeneity in accordance to the diagnose-related group system. However, patients within the categories of reactive psychosis and neurosis who received antidepressants also had a low coefficient of variation, although the neurotics were significantly more depressed than the manic-depressives at discharge from hospital.
BACKGROUND: The Personal Crisis Support Team at Bergen Accident and Emergency Department offers open access interventions for individuals that have experienced a psychosocial crisis. The aim of the study was to investigate contacts to the personal crisis support team, causes of contact and referrals. MATERIAL AND METHODS: All contacts in 2006 were included in the study. Variables such as patients' gender, age, cause of contact, number of consultations and to whom the patients were referred were recorded from the medical records. RESULTS: The Personal Crisis Support Team handled 2090 contacts and received 901 patients; 602 of whom were women. Nearly every third patient (n = 186) were between 19-30 years old. The patients presented with many different causes of contact, but the majority (n = 590) came due to psychosocial crises, such as unexpected life events or worries about own children. 267 patients presented with symptoms of possible mental disorders. Most patients were further referred to various public or private health services. INTERPRETATION: The Personal Crisis Support Team at Bergen Accident and Emergency Department was approached by patients of all ages with various psychosocial crises. This support team is an example of community-based early intervention after crisis.
