During a period of 20 years (1968-1988) all inpatients admitted for the first time to the adolescent psychiatric unit in Copenhagen (n = 841) were classified in accordance with social and psychiatric variables, to describe the clientele as a group and, furthermore, to investigate changes occurring during that period. The total clientele had a broad age range (12-21 years), with as many as 36% less than 15 years old. Eleven percent of the patients had attempted suicide before admission. Fifty-six percent of the total group were diagnosed as psychotic or as borderline cases. The patients came predominantly from lower social levels, and almost half the group had a child debut defined as symptoms that had resulted in referral for further investigation during childhood. Moreover, among the schizophrenic patients 35% had an early onset. The age of onset may have some clinical significance, as this item was related to several sociodemographic variables. Finally, an increase in the rate of psychoses and lower social class was recorded during the period.
A register investigation was carried out as of December 31, 1980, with the aim of giving a broad description of a child psychiatric clientele 30 years after admission to hospital. The material consists of 322 patients--189 boys (59%) and 133 girls (41%)--who were admitted during the period 1949-1951 to the only 2 child psychiatric departments at that time in Denmark. We succeeded in identifying 93% of the patients. The mean age at the time of analysis was 38.6 years (range 32-46). The material was compared with the age-related Danish population by marital status, vocational education, and socioeconomic class. A total of 115 patients (36%) had been admitted to an adult psychiatric department, and 50 patients only once. A total of 95 patients (30%) had committed criminal offences and 12 had only committed traffic offences. A total of 60 patients (19%) had obtained disability pensions. During the 30-year follow-up period, 19 patients (6%) had died. A statistically significant extra mortality was found only for women. Four patients had committed suicide. By logistic regression analysis, a statistically significant correlation was found between criminal record and admission to psychiatric department and the variables: divorce, no vocational education, and lowest socioeconomic class. About 54% had managed well, judging by the variables employed.
Psychiatric morbidity, expressed as hospital admissions during a 30-year follow-up period, was studied among 322 former child psychiatric patients, who were admitted from 1949-1951, and who were followed up as of December 31, 1980. A total of 115 patients (36%)--55 boys (29%) and 60 girls (45%)--had been admitted to an adult psychiatric department, with 50 patients having only one admission. The mean age at the time of the study was 39 years. The former child psychiatric patients were admitted to adult psychiatric hospitals 50 times more often than comparable age groups from the general population. At all times women had a higher prevalence of admission. The cumulative percentage of first admissions of men was almost unchanged during the last 10 years of the follow-up period, and the figure for women was gradually increasing. The longitudinal course of mental disorders in the sample, measured as psychiatric admissions, was studied in relation to age at the time of admission to the child psychiatric department. The results consistently showed that older age of admission as a child meant fewer psychiatric admissions as an adult during the follow-up period. A total of 39 of the psychiatrically admitted patients (34%) had been granted a disability pension. A total of 7 patients (6%) died during the study period, including 2 patients who committed suicide. By the variables employed, 37% of the sample were judged to have had a good overall outcome, with diagnosis being an inconsistent predictor of outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
The first modern psychiatric day hospital founded over 40 years ago has gone through a number of re-organizations which reflect utilization patterns representative of day hospitals in general. The author traces chronologically the dynamic movement from self-contained settings emphasizing group integration to expanded structures providing individualized treatment approaches. The day hospital's unique location at the interface of the institution and the community has important implications for today's mental health policy.
The object of this investigation was registration of all requests for access to case records in 1987 in all departments for child and adolescent psychiatry in Denmark. A total of 34 requests were made concerning child psychiatric departments and 55 concerning departments for adolescent psychiatry. This corresponds to requests for access to case records in 0.8% of all patients admitted to departments of child psychiatry, and also 0.8% of the outpatients. In the departments for adolescent psychiatry, access to the case records was desired concerning 16.5% of the hospitalized adolescents. No complaints have been made concerning access to the case records and it is concluded that the new Danish law functions satisfactorily also where parents were concerned, where the possibility of providing limited insight for adolescents or parents may be of value. The significance of introduction of a period of limitation for access to case records in departments for child and adolescent psychiatry is emphasized.
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.
Organizational forms of health care delivery for patients with combined somatic and mental pathology have been analyzed. The characteristics of the system of referrals, hospital admissions and treatment in psychiatric departments for patients with combined severe somatic and mental pathology is described. The basic tasks and functions of such departments are listed. Somatic diseases are presented according to the groups of diseases, most frequently occurring in mentally ill patients.
Analysis of the work of the ++somato-psychiatric departments entering a multiple-discipline hospital has shown that admission to these departments of patients with concomitant mental and somatic pathologies may be viewed as an episode for such patients. The latter ones cannot be regarded as a permanent group to be treated at the above departments. The duration of the stay at hospital is largely determined by the character of somatic pathology and, in a considerable number of cases, represents a stage in the psychiatric inpatient treatment. The data indicate that the present-day bed capacities in such departments (0.65 per 10 thousand adult and adolescent population) are insufficient. It is highly advisable that the number of such departments be increased.