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.
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
With standard community resources, managing some patients with long-term mental illness can prove difficult, given the high level of care required. How many beds do such patients require? The study examined the prevalence, diagnostic and behavioral characteristics, and residential arrangements of a cohort of these patients in a semirural area of Canada (population of 291,500). The area has always functioned without a psychiatric hospital.
A cross-sectional inquiry was made of all relevant institutions and residential facilities (including the local jail and shelters). Key stakeholders were interviewed and provincial databases were accessed in an effort to identify all adults aged 18 to 65 originating from the catchment area who displayed both a psychotic illness and severe behavioral disturbance necessitating ongoing close supervision. The Riverview Psychiatric Inventory was used to describe and quantify behavioral problems.
Thirty-six patients met the study criteria, for a prevalence of 12.4 per 100,000 in the general population. Most resided in a publicly funded nursing home or a well-staffed rural group home. Four (prevalence of 1.4 per 100,000) had a forensic profile, needed secure settings, and were long-term residents on acute care wards. Only one patient had transferred to a psychiatric hospital outside the catchment area.
Care for this population can be provided outside conventional psychiatric institutions but requires highly supervised long-term residential services in the range of ten to 40 per 100,000 in the population, depending on area characteristics, with urban, socially deprived areas likely having higher needs.
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.
INTRODUCTION: In a Danish register study the incidence of children aged 0-3 years referred to child psychiatric services in Denmark increased by 30% during 1996-1998. The objective of this study was to further describe 0-3 year-old children referred to child psychiatric departments with a view to distribution of diagnoses, age, sex, and parental mental illness. MATERIAL AND METHODS: Children 0-3 years of age referred to child psychiatric departments in the County of Copenhagen in 1998 and 1999 were described on the basis of the clinical database and hospital records. RESULTS: A total of 159 children were admitted over a two-year period corresponding to an incidence of 0.4%. The ratio boys: girls were 1.3:1. However, with regard to pervasive developmental disorders boys dominated 6:1. Among girls, eating disorders were dominating in the youngest children with ratio girls: boys 5:2. Pervasive developmental disorders were the most common diagnoses in children aged 2-3 years, and the overall incidence of this diagnosis was 0.25 per 1000 per year. The most common diagnosis of the youngest children was Z-diagnoses, and most often these children had mentally ill parents. Attachment disorders, eating disorders, and adjustment reactions were common diagnoses in children with mentally ill parents, but more than half of these children did not have any diagnosis at all. DISCUSSION: The incidence of children with pervasive developmental disorder was found twice as high as observed in a register study covering referrals of children aged 0-3 years from all psychiatric departments in Denmark during 1996-1998. Reactive attachment disorder, eating and adjustment disorder, and Z-diagnosis are the most common diagnoses in the youngest children, and most often these children have mentally ill parents.