To see, if voluntary admission for treatment in first-episode psychosis results in better adherence to treatment and more favourable outcome than involuntary admission.
We compared consecutively first-admitted, hospitalised patients from a voluntary (n = 91) with an involuntary (n = 126) group as to psychopathology and functioning using Positive and Negative Syndrome Scale and Global Assessment of Functioning Scales at baseline, after 3 months and at 2 year follow-up. Moreover, duration of supportive psychotherapy, medication and number of hospitalisations during the 2 years were measured.
More women than men were admitted involuntarily. Voluntary patients had less psychopathology and better functioning than involuntary patients at baseline. No significant difference as to duration of psychotherapy and medication between groups was found. No significant difference was found as to psychopathology and functioning between voluntarily and involuntarily admitted patients at follow-up.
Legal admission status per se did not seem to influence treatment adherence and outcome.
A total of 107 chronic in-patients in a catchment area of 106,000 inhabitants were rated for psychopathology on the Brief Psychiatric Rating Scale expanded version (BPRS-E), for level of functioning on the Rehabilitation Evaluation Hall And Baker (REHAB), and for geriatric problems on the Geriatric Rating Scale (GRS). The results showed low levels of severe psychopathology and low to moderate levels of functioning, indicating that the main obstacle to community placement was the lack of functioning. Global assessment by ward nurses with regard to the future level of care needed divided the patients into three categories: 40 patients in need of a psychiatric nursing home, 30 patients in need of a general nursing home, and 37 patients who could potentially be discharged to apartments with community support. This study indicates that the REHAB may help to identify patients who are potential candidates for community placement, while the BPRS-E may help to identify patients who are still in need of care in a psychiatric institution.
Over the past 40 years, a marked deinstitutionalisation in favour of social and community psychiatry has taken place in many countries. During this same period of time, there has been an increase in the number of mentally ill criminals. The purpose of this study is to analyse the correlations between the reorganization of the psychiatric treatment system, the growing number of forensic patients and the increase in serious crime, homicide, arson and violence associated with the mentally ill.
Using registers and other data sources, we estimated the annual positive or negative growth rate of consumed psychiatric beds and in social and community psychiatry (explanatory variables) and in prevalence and incidence of forensic patients, homicide, arson and violence (response variables) from 1980 to 1997 for each of the Danish counties. We analysed the immediate effect of the changing treatment structure by relating response variables to explanatory variables. The long-term effect was analysed in the form of between county analysis with both single and multiple regressions.
Bed closure had no immediate effect on either the number of forensic patients or serious criminality. The between county analysis shows, however, that over time the (negative) growth rate in number of consumed beds is significantly correlated with the (positive) growth rates for forensic patients, homicide and arson. Social and community psychiatry have little effect, if any.
The study is based on historical data, but the results are still valid. We have used two sets of data firstly the number of forensic patients and, secondly the reported number of crimes associated with the mentally ill. The uniformity of the results leads us to consider them for certain: That the decreasing effort invested in inpatient treatment is causing an increase in the crime rate among the mentally ill.
Many forensic patients suffer from schizophrenia. These patients are not only offenders, but also the victims of an inadequate treatment system. Modern inpatient treatment facilities should be established.
To perform a retrospective survey of discharge medications at a tertiary care psychiatric facility in an attempt to gain insight into, and perhaps an understanding of, the most recent pattern of antipsychotic utilization in patients with a diagnosis not restricted to schizophrenia.
This is a retrospective survey that used the Department of Pharmacy's computer database to obtain relevant discharge information on all non-geriatric patients discharged from Riverview Hospital between 1 January and 31 December 2000. The records of 372 patients met the inclusion criteria and formed the database for the survey.
The results of this survey revealed a relatively high prevalence of antipsychotic polypharmacy (the use of two antipsychotics). Perhaps surprisingly, the highest rate of antipsychotic polypharmacy was found in individuals diagnosed with schizoaffective disorder (49.3%), followed by schizophrenia (44.7%), bipolar disorder (29.9%), and psychosis not otherwise specified (22.5%).
Although antipsychotic polypharmacy is not a new phenomenon in schizophrenia, this study is the first to document its employment among other diagnoses.
We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia (n=88) and other schizophrenia spectrum cases (n=27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1-14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00-20.41) and familial risk of psychosis (OR 3.36; 1.09-10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92-48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response.
A comparative clinical-epidemiological study was made in groups of schizophrenics with onset in adolescence hospitalized for the first time at the Regional Tomsk Mental Hospital in 1948-1951 (period I), in 1958-1961 (period II), in 1968-1971 (period III) and in 1978-1981 (period IV). A primary hospitalization rate in patients with adolescent schizophrenia has been stable for the last 30 years. In general population of schizophrenics hospitalized for the first time, a reliable proportional reduction of adolescent schizophrenics from the first till consequent periods (from 31.1% till 17.7%) was observed. Group I patients show reliable differences by severity of psychopathological disorders and lower level of socio-occupational adaptation in comparison with the other groups. According to 6-year follow-up data, clinical and socio-occupational characteristics of the patients show more frequent dissociation between clinical and social levels of adaptation which in half of the cases is manifested by low level of socio-occupational adaptation.