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.
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.
This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD.
A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD.
The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admission reason (46%), and mood disorder was the most common discharge diagnosis (29%). The median length of stay for patients with DD was 8 days, which did not differ meaningfully from the comparison sample. Variables that were significantly associated with length of stay among individuals with DD included sex, referral source, and diagnosis.
When individuals with DD are psychiatric inpatients, their length of stay is affected by some factors that have been identified in previous studies not specific to DD (for example, referral source and diagnosis). Our finding that male patients with DD have longer lengths of stay than do female patients in the same sample has not been reported in previous research.
The purpose was to measure the use of psychiatric treatment before and after the start of community psychiatry in a part of Copenhagen. The use was measured during the two years before and after starting for the first 45 patients entering the treatment facility. Number of patients taken in for in-patient treatment, of intakes, of in-patient days, of emergencyroom visits and out-patient attendances were measured. Data about treatment with medicine, committed intakes, suicide attempts and the profession of the case manager were recorded. The number of intakes was reduced from 98 in the two years before community psychiatry to 36 in the period with community psychiatry. In-patient days were reduced by 60%. The number of out-patient contacts was increased six-fold and contacts with psychiatrists two-fold during the period with community psychiatry. Two-thirds of the patients came for day treatment. The treatment contact became more stable. Use of medicine per day was the same, but total use increased because of the more stable contact. No difference in in-patient treatment use was seen according to the case manager's professional education. It is concluded that community psychiatry by increased use of outreach, patient contact, and psychological treatments can increase the stability of the contact and reduce the use of in-patient days.
Comment In: Ugeskr Laeger. 1993 Oct 18;155(42):33987639837
The aim of the study was to examine the admission of suicidal patients to a psychiatric hospital. Patients admitted to the emergency and intermediate departments of Sanderud psychiatric hospital in 1991 were included in the study. 39% of the admissions were suicidal patients. Comparison was made between patients who had recently attempted suicide and those who had not. Those who had recently attempted suicide spent a slightly shorter time in hospital than those who had not. The patients who were admitted, tended to be younger than those who actually committed suicide. The average time spent in hospital was not so short that there was evidence of a "revolving door psychiatry" despite there being many short-term stays.
The purpose of this investigation was to find out the number of hospitalizations of alcoholics in a department of psychiatry throughout one year. Further, some characteristics of the patients were noted. The information was gathered from case sheets of patients who had been hospitalized in the period 01.10.96-30.09.97, and who were given a F10.x diagnosis from the ICD-10 system. The investigation showed that about one fifth of the patients hospitalized in the department were alcoholics. Fore more than half of these patients, the reason for hospitalization was for treatment that according to guidelines should have been given in an outpatient setting. The study confirms that there is a need for facilities for inpatient treatment for alcoholics, and that offering outpatient detoxification is not sufficient.
This article describes the results of a one year follow-up investigation of patients suffering from psychiatric and mental diseases and psycho-social problems who were seen in general practice or by private practising psychiatrists and the psychiatric outpatient hospital clinic in a Danish county. 40-50% of the patients concluded treatment within the first year. The general practitioner and the private practising psychiatrist saw 10% of the patients more than 13 times. In the outpatient hospital clinic, 10% of the patients were seen more than 29 times. A psychotherapeutic approach to treatment was employed for 54-90% of the cases. Psychopharmacological medication was administered to 54-60% of the patients. Where patients in general practice and in the outpatient clinic were concerned, treatment in an emergency open unit and treatment in sheltered environments was required and supervision was necessary for 1/4 of the cases. The investigation demonstrates the role of the general practitioner in treatment and referral. After one year 25% of the patients were referred for other treatment. The general practitioner, private practicing psychiatrist and outpatient clinic treat different groups of psychiatric patients and work somewhat independently of one another.
Spontaneous reporting of adverse drug reactions (ADRs) is used for continuous risk-benefit evaluation of marketed pharmaceutical products and for signal detection. The Adverse Drug Event Manager (ADEM) is a service offered to clinicians employed at hospitals in the Capital Region of Denmark. The ADEM assists healthcare professionals in reporting suspected ADRs to the Danish Health Authority. The aim of this retrospective observational study was to quantify and describe ADRs reported via the ADEM in 2014.
All ADR reports handled by the ADEM in 2014 were recorded anonymously and analysed descriptively.
A total of 484 ADRs were reported through the ADEM in 2014 (the median number of reports per month was 37; range: 17-78). The majority of the reports came from departments of internal medicine (61%), psychiatry (14%) and dermatology, ophthalmology or otorhinolaryngology (11%). The drugs most frequently reported were lisdexamphetamine (n = 40), rivaroxaban (n = 16) and warfarin (n = 15) (vaccines excluded). In 13 out of 484 reports, the ADR was associated with a fatal outcome.
The findings of this study indicate that an ADEM promotes and facilitates spontaneous ADR reporting and helps raise awareness about ADRs, including how and why they should be reported. Hopefully, this will assist national and European spontaneous reporting systems in their work to increase patient safety nationally and abroad.
Information is scarce concerning the incidence of anorexia nervosa (AN) in psychiatric facilities in Iceland. The aim of this study was to describe the incidence of admissions, comorbidity and mortality of patients who were admitted to psychiatric units in Iceland, diagnosed with AN in 1983-2008.
The study is retrospective. 140 medical records with an AN or atypical eating disorder diagnosis according to the ICD-9 and ICD-10 were reviewed. Final sample was 84 patients with confirmed AN diagnosis.
Five men and 79 women were admitted to a psychiatric inpatient ward for the first time diagnosed with AN. Average age was 18.7 years. Incidence of admissions for both sexes in the first part of the study period (1983-1995) was 1.43/100.000 persons/year, 11-46 years old, but in the second part (1996-2008) 2.91. The increase was statistically significant (RR=2.03 95% CI 1.28-3.22) and can mainly be explained by an increased incidence of admissions to the children- and adolescent psychiatric wards (CAW). Mortality of women was 2/79 (2.5%) and standard mortality rate 6.25. The average length of stay was 97 days, 67.3 days in adult units and 129.7 days in CAW (p