Three-year follow-up of child psychiatric inpatient treatment

 Eighty child psychiatric inpatients with behavioral and emotional disorders were evaluated from multiple perspectives on admission and at 5-month and 3-year follow-ups. A majority of the patients showed a significant improvement in functioning during the 3-year follow-up. About half of the patients were functioning within clinical range at 3-year follow-up on parental (CBCL) and/or teacher (TRF) ratings. A less favorable outcome was predicted by disruptive behavioral disorder, severity of initial dysfunction, high antisocial and hyperkinetic symptoms, adoptive household and postdischarge institutional placement. Pure anxiety or affective disorder was associated with favorable outcome. Age, sex, place of treatment, and length of hospital treatment were not related to outcome variables. Received: 24 February 1997 Accepted: 3 October 1997     

Child psychiatric short-term inpatient treatment: CGAS as follow-up measure

The present study reports the outcome and follow-up data of 50 children and pre-adolescents consecutively admitted to a short-term child psychiatric inpatient treatment programme. Children were evaluated with the CGAS on admission, at discharge, and at 5-month and one-year follow-up after discharge.     

Involuntary medication in psychiatric inpatient treatment.

The aim of this study was to examine involuntary medication in psychiatric inpatient treatment. A retrospective chart review of 1543 consecutive admissions of working aged civil patients from well-defined catchment areas to three psychiatric centres were evaluated regarding events of involuntary medication. 8.2% of the admissions included involuntary medication episode(s). Involuntary medication was associated with a diagnosis of schizophrenia, involuntary legal status and having previously been committed. One of the studied centres used less involuntary medication than the other two, even if patients with schizophrenia were over-represented in that centre. Although involuntary medication mainly takes places in the treatment of patients who are conceptualised most ill and perhaps resist treatment most, treatment culture obviously also plays a role. In future, it is important to study the aspects of treatment culture to fully understand the use of involuntary medication in psychiatry.     

A model for acute psychiatric inpatient treatment of latency-age children.

Beginning with the premise that acute inpatient treatment of severely disturbed latency-age children offers enormous advantages over other types of interventions, the author describes a model for such treatment. The model consists of three phases: initial, working-through, and termination. It has a psychoanalytic basis and takes into account changing factors, such as the child's symptoms and the attitudes of both the child and his parents throughout different stages of the hospitalization. A case history illustrates the various phases and the treatment interventions used.     

Aggression in mentally handicapped psychiatric patients during inpatient psychiatric stay. Preliminary results of a 2-year follow-up study

The preliminary results of a 2-year study of aggressive behaviour in psychiatric patients with an additional learning impairment or mental retardation in a specialized department of a psychiatric hospital are introduced. The study is concerned about the correlation between aggressive behaviour and different factors, as quality of life, number of patients in the ward, age, duration of stay, self-assessment and assessment by the CGI on admission.     

Short-term follow-up after brief inpatient treatment.

A total of 110 patients admitted to the inpatient unit of a community mental health center in Philadelphia were followed up between 90 and 120 days after discharge to determine their level of functioning after an average hospital stay of 21 days. All but five of the patients were referred for aftercare, and 80 received outpatient or day hospital care after their release. Sixteen patients were readmitted to inpatient care within 90 days after discharge. The author describes the patients' social and community adjustment at follow-up, based on information obtained from aftercare therapists.     

Coercion and restrictions in psychiatric inpatient treatment.

To find out to what extent coercion and restrictions are used in psychiatric inpatient treatment and with which patient characteristics the use of coercion is associated. To this end, the hospital records of 1,543 admissions (six-month admission samples) to the psychiatric clinics in three Finnish university towns were evaluated by retrospective chart review. The study clinics provide all psychiatric inpatient treatment for the working-age population in their catchment areas. Use of coercion and restrictions was recorded in a structured form. Coercion and restrictions were applied to 32% of the patients. Mechanical restraints were used on 10% of the patients, and forced medication on 8%. Compared to international statistics the figures in the current study are high.     

The Utrecht comparative study on psychiatric day treatment and inpatient treatment

A prospective randomized comparative study on the effectiveness of psychiatric day treatment and inpatient treatment is described. The target population consisted of patients who would normally have been admitted to an open inpatient unit. Outcome indicators were psychopathology, social functioning, interpersonal functioning, social network and social support. No differences in effectiveness were found between the two forms of treatment, although more patients accepted and completed day treatment, and day patients were more satisfied. Although a uniform treatment programme for both departments was established, distinct differences did arise in the actual treatment programme offered to the patients. The duration of treatment for the day patients was considerably longer, and the intensity of treatment was more low-key. No striking differences in the amount of medication prescribed and in the occurrence of crisis situations (including suicide) were found. Day treatment turns out to be a realistic alternative for 33% of all patients admitted for inpatient treatment. It was not possible to predict which type of patient in particular is suitable for day treatment.     

Changing aspects of psychiatric inpatient treatment

This paper presents data obtained in a one-day census investigation in five European countries (Austria, Hungary, Romania, Slovakia, Slovenia). The census forms were filled in for 4191 psychiatric inpatients. Concerning legal status, 11.2% were hospitalised against their will (committed) and 21.4% were treated in a ward with locked doors. There was only a small correlation between commitment and treatment in a locked ward. More frequent than treatment of committed patients in locked wards was treatment of committed patients in open wards (Austria, Hungary) and treatment of voluntary patients in closed wards (Slovakia, Slovenia). Concerning employment, 27.7% of patients aged 18-60 held a job before admission. The vast majority of patients (84.8%) had a length of stay of less than 3 months. A comparison of these data with the results of a study performed in 1996 and using the same method shows a decrease of rates of long-stay patients. In 1996 the rates of employment were significantly higher in Romania (39.3%) and Slovakia (42.5%) compared to Austria (30.7%). These differences disappeared in 1999 due to decreasing rates of employment in Romania and Slovakia. The numbers of mental health personnel varies between types of institution (university or non-university) and countries, being highest in Austria and lowest in Romania. A considerable increase in the numbers of staff was found in Slovakia.     

Functional encopresis: psychiatric inpatient treatment

Encopresis can be considered an indication for psychiatric hospitalization in the multiproblem child, such as the one described in this report. Integration of observations from multiple treatment modalities were helpful in assessing the patient's progress and guiding interventions.     

Variables affecting length of psychiatric inpatient treatment

To discover whether variables such as gender, ethnicity, pay code, and diagnostic category affect length of psychiatric inpatient treatment, patient records for a recent 18-month period (January 1988 to June 1989) in a Midwestern teaching hospital setting were examined and statistically analyzed. Variables that emerged as related to length of stay are ethnicity, Axis I diagnosis of adjustment disorder, and presence of any Axis II diagnosis. Comparisons with length of stay statistics from an earlier period (1981) lead to conclusions about inpatient psychiatric services since the implementation of diagnosis related groups. Further, implications of this study's findings are discussed in relation to mental health service delivery.