The use of a psychiatric register in predicting the outcome "revolving door patient". A nation-wide cohort of first time admitted psychiatric patients

A nation-wide cohort of all first admitted patients to all Danish psychiatric institutions over a 1 year period and aged 15 years or more was followed for 10 years in the Danish psychiatric register. Revolving door patients were defined as patients with a minimum of four admissions and 1) no admission or discharge period lasting for more than 1/4 of the observation period or 2) at least four admissions over the first 1/4 of the observation period. The revolving door population comprised 1,397 patients with an incidence rate of 0.42 males and 0.32 females per 1,000. Forty-three point five percent belonged to the same diagnostic group at first and last diagnostic assessment ranging from 28.3% in "organic psychosis" to 57.6% in "neurosis". A multiple contingency analysis showed a number of variables at first admission significantly associated with the outcome "revolving door". Many were conditioned by others and the independent variables were "age group", "main diagnosis" and "sex". Patients aged 15-24 years constituted a high risk group among schizophrenics. The 15-24 age group was further at high risk among females with personality disorder or abuse and males with manic depressive and psychogenic psychosis. Living close to a psychiatric institution was in males associated with the outcome independently of age and diagnosis, in females it was restricted to personality disorder. Revolving door patients were significantly younger than others and more likely to suffer from schizophrenia or alcohol/substance abuse.     

Mortality in the long-stay population of Dutch mental hospitals

The cohort study by Giel et al. of mortality in Dutch mental hospitals is repeated. In the total cohort of 12,139 long-stay patients counted on prevalence day (31 December 1979) 1226 deaths occurred over a period of 2 years. Similar to the study of Giel et al. the overall death rate of long-stay patients in the 1979 cohort was approximately twice the expected death rates in the general population. The death rate of patients of both sexes and in each age group significantly exceeded the expected. In our study we found a different pattern of somatic causes of death. In the 1969 cohort respiratory disease was a major cause of death. In our long-stay cohort respiratory disease was a minor cause of death in all age groups. Another difference is the replacement of cardiovascular disease as a main cause of death by diseases of the cerebrovascular system.     

Care of "new" long-stay patients in a district general hospital psychiatric unit. The first two years of a hospital-hostel

The paper describes the need for long-term inpatient care in an English health district whose psychiatric services were based on a unit in a District General Hospital. Patients who became long-stay were placed in a new hospital-hostel in a city centre. Three quarters of those eligible could be managed in the hostel, with those rejected posing more control problems. Patients in the hostel became less withdrawn and increased their activity and use of community facilities.     

Effects of hospital closure on mortality rates of the over-65 long-stay psychiatric population

The closure of this 100-year-old hospital has allowed us to look at the effect on mortality of moving the whole over-65 long-stay population to other settings. Our results confirm that there is a slight excess of deaths during and immediately after these moves, but that there is no longer-term effect on mortality rates. Copyright © 1998 John Wiley & Sons, Ltd.     

Social and clinical correlates of the ‘new’long-stay

Out of a total admission cohort of 1,934 patients 162 and 101 patients remained continuously in hospital for 6 months and 1 year respectively. The study describes the characteristics of these patients and at each stage compares them with those who were discharged on a number of social and clinical variables. The findings confirm the importance of social factors in determining continued retention and support the suggestion of a process of early selection of “new” long-stay patients put forward by Mann & Sproule (1972). The findings are discussed and a case is argued in favour of continuing to provide for such patients in hospital.     

A five-year follow-up study of older long-stay clients with intellectual disability using the Disability Assessment Schedule

The emphasis on community care means closure of the long-stay institutions for people with intellectual disability. Studies have indicated that older people with intellectual disability in particular may not be adequately cared for because of poor monitoring of their changing needs and inadequate provision of services. The use of rating instruments to monitor changes, and to predict outcome or needs in this population may help to improve care by assisting with planning and projection of service requirements. In 1991, all residents of a long-stay hospital for people with intellectual disability were assessed using the Disability Assessment Schedule (DAS). Five years later, the 1991 scores of the older residents (aged > 50 years) were reviewed and compared under three outcome groups: in-patients, discharged and deceased. Furthermore, all older people resident in the hospital in 1996 were reassessed using the DAS. Out of the 144 older clients resident in 1991, five years later, 78 were still in-patients, 38 had been discharged into the community and 28 were deceased. In 1991, the deceased group had the greatest problems with continence and symbolic behaviour, while the discharged group had the greatest problems with self-help, vision, hearing, communication, social interaction, echolalia and repetitive speech. In comparison with 1991, the 1996 DAS scores of older residents showed that there were increasing problems with vision, hearing, communication, behaviour and symbolic activities. The present study suggested that the DAS is a useful instrument for monitoring change and predicting outcome in older people with intellectual disability.     

Using direct observation to record the behaviour of long-stay patients with dementia

This article describes the development of a direct observation system for the assessment of the behaviour of elderly demented long-stay patients. The technique of recording behaviour in real time has high face validity, and in conjunction with portable computers was found to be very reliable. The technique was used to assess the behaviour of patients during their waking day on seven wards. The findings suggest that almost two-thirds of the day is spent doing nothing, with aimless or disruptive behaviours also accounting for a significant period of the day. Only a small proportion of the day was spent in self-care or social behaviours.     

Prenatal stress and affective disorders in a population birth cohort

Kleinhaus K, Harlap S, Perrin M, Manor O, Margalit‐Calderon R, Opler M, Friedlander Y, Malaspina D. Prenatal stress and affective disorders in a population birth cohort.
Bipolar Disord 2012: 00: 000–000. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd. Objectives: Pregnant women exposed to an acute traumatic event are thought to produce offspring with an increased incidence of affective disorders. It is not known whether there are specific times in pregnancy which confer increased vulnerability, or if psychosocial stress alone can increase the incidence of affective disorders in offspring. We examined the relationship of the timing of an acute psychosocial threat during pregnancy to the incidence of affective disorders in offspring using data from a large birth cohort. Methods: Using data on 90079 offspring born in Jerusalem in 1964–1976 and linked to Israel’s psychiatric registry, we constructed proportional hazards models to evaluate the link between gestational age during the Arab–Israeli war of June 1967 and incidence of mood disorders. Results: Those in their first trimester of fetal development during the war were more likely to be admitted to hospitals for any mood disorders [relative risk (RR) = 3.01, 95% confidence interval (CI): 1.68–5.39, p = 0.0002]; for bipolar disorder the risk was doubled (RR = 2.44, 95% CI: 0.996–5.99, p = 0.054) and for all ‘other’ mood disorders the risk was tripled (RR = 3.61, 95% CI: 1.68–7.80, p = 0.001). Mood disorders were also increased in offspring whose mothers had been in the third month of pregnancy in June of 1967 (RR = 5.54, 95% CI: 2.73–11.24, p < 0.0001). Conclusions: A time‐limited exposure to a severe threat during early gestation may be associated with an increased incidence of affective disorders in offspring. The third month of fetal development was a moment of special vulnerability.     

Predictors for the social adjustment of first admitted psychiatric patients

Summary In a prospectively designed follow-up study of 258 first admitted psychiatric patients, 1 year after discharge 224 patients and 175 significant others were asked about the social adjustment of these patients and some predictors for this aspect of outcome could be identified. The sample consisted of five different diagnostic groups: organically caused psychiatric diseases, schizophrenic psychoses, affective psychoses, neurotic or personality disorders and alcohol or drug dependency. The study shows that statements about the social adjustment of psychiatric patients largely depend on the diagnostic group, both with respect to degree of adjustment and the predictors. Schizophrenic patients were found to be less well socially adjusted than the other patients, with the exception of the alcohol- and drug-addicted patients. For schizophrenic patients, post-hospital social adjustment was primarily determined by indicators of mental illness, such as psychopathological symptoms and length of hospitalization. The social adjustment of addicted patients was primary influenced by vocational variables. For the patients with organic psychiatric disorders, affective psychoses or neurotic/personality disorders, prediction by pre-hospital or hospital variables did not prove to be very useful.This work was supported by the research grants from the Deutsche Forschungsgemeinschaft alloted to the Sonderforschungsbereich 129 at Ulm University, Federal Republic of Germany     

A large population cohort provides normative data for investigation of temperament

OBJECTIVE: We evaluated the psychometric properties of widely used scales for assessing temperament in a large birth cohort. We simultaneously compared the properties of the temperament dimensions of the Tridimensional Personality Questionnaire (TPQ) and of the Temperament and Character Inventory (TCI). METHOD: As part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort, the TPQ and TCI temperament questions were filled in by 4349 subjects (1974 males, 2375 males). Factor analysis and Cronbach's alpha were used to explore the psychometric properties of the scales. RESULTS: Of the three higher-order dimensions the reward dependence (RD) was the only one performing poorly in our study sample. Cronbach's alpha was higher in the TCI than in the TPQ. CONCLUSION: The results indicate good performance of the TCI and TPQ. Factor analysis support adoption of four temperament dimensions and suggest that developmental work is still needed in the RD dimension.     

Distress in the relatives of psychiatric patients admitted for the first time.

Seventy-three relatives of psychiatric patients aged 18-49 years admitted for the first time from a well-defined catchment area were interviewed using the Social Behaviour Assessment Schedule to determine the distress elicited by the patients' illness. The patients were interviewed with the Present State Examination, 10th edition, development version. Regardless of sex and age, frequency of contact and relation to the patient, the relatives experienced distress from symptoms, lowered social performance and the adverse effects of the illness. Informant's social class, male sex of patient and duration of illness significantly predicted distress. No differences were found in a comparison of the level of distress between non-organic psychotic disorders, mood disorders, anxiety disorders and psychoactive substance use disorders, but specific distressful areas within each disorder could be delineated.     

Half-way services in the rehabilitation of chronic mental patients

The importance of adequate community facilities in the rehabilitation of chronic mental patients is stressed. In view of the common reluctance of relatives to accept this type of patient back home again, a residential programme was designed to obviate this problem. The rehabilitation unit described, achieved reintegration into the community of 36.1 % of the patients through the use of hostels and sheltered accommodation. In all, 58.4 % of the patients were discharged. Finally, inention is made of the advantages of the system, especially its economy, availability, and helpful collaboration of land-ladies.     

Association Between Parental Hospital-Treated Infection and the Risk of Schizophrenia in Adolescence and Early Adulthood

It has been suggested that infection during perinatal life may lie at the etiological root of schizophrenia. It has thus been hypothesized that the origin of schizophrenia may lie either in direct fetal infection and/or in a generally increased familial susceptibility to infections, some of which may occur during pregnancy. We explored these 2 hypotheses by assessing maternal infection during pregnancy and maternal as well as paternal infection in general as predictors of schizophrenia in their offspring. We found a slightly increased risk to be associated with prenatal infection exposure. However, the effect of prenatal infection exposure was not statistically significantly different from the effect of infection exposure in general. Parental infection appeared to be associated with development of schizophrenia in adolescence and early adulthood. Our study does not exclude a specific effect of infection during fetal life; yet, it does suggest that schizophrenia is associated with an increased familial liability to develop severe infection.     

Mortality in a population-based cohort of patients treated with antiparkinsonian drugs

Objectives - A number of studies have been focused on the mortality of parkinsonian patients, as compared with the rest of the population. In these studies, a mortality greater than expected on the basis of mortality of the general population has been shown. Nevertheless, just a few of these studies have investigated in detail the specific causes of death, probably as a consequence of both small cohort sizes and a short time period of observation. The aim of this study was to estimate cause-specific mortality in a cohort of patients treated with antiparkinsonian drugs. Methods - The study was performed on a wide population-based cohort of patients identified and followed-up through the computerized health databases of the Italian province of Rome (about 3,800,000 inhabitants). The follow-up lasted from January 1987 to December 1994. Standardized Mortality Ratios (SMR) were calculated for each specific cause of death, using the Rome province population as reference. Results - A cohort of 10,322 subjects, receiving antiparkinsonian drugs, were identified. There were 4328 deaths on an average follow-up of 5.7 years. This figure was 17% higher than was expected. A gradual decrease in SMR was observed in the oldest age groups. Statistically significant (95%) excesses of death were related to the nervous system (SMR=1037; 95% CI 964–1110), mental disorders (SMR=182; 95% CI 129–246), and endocrine and metabolic diseases (SMR=117; 95% CI 102–133). Lower than expected mortality was found to be caused by malignant neoplasms (SMR=56; 95% CI 51–61). Conclusions - Apart from deaths specifically related to Parkinson's disease, the main differences between our cohort of patients and the general population were related to mortality due to malignant neoplasms and mental disorders. The gradual decrease in SMR for the oldest age groups, seems to indicate a greater reduction of life expectancy for patients with early onset of symptoms. This age-related trend could explain the relatively small excess of mortality, as in our cohort the median age of patients at entry was 74 years.     

Characteristics of elderly patients admitted for the first time to a psychiatric facility

There has been little investigation of patients admitted to a psychiatric facility for the first time late in life. We therefore examined characteristics of a group of 100 consecutive patients over the age of 65, admitted for the first time to the psychiatric service of a private, university-affiliated hospital. Almost two thirds of these patients received a primary discharge diagnosis of major depression, while another one fourth received a diagnosis of dementia. Patients with dementia were significantly older and more likely to be men. The frequency of dementia climbed with each decile affecting 15% of those less than 75 years, 39% of those 75 to 84, and 47% of those over age 85. Thirty-six percent of all patients were psychotic on admission, including 28% of those with major depression and 48% of those with dementia. Visual hallucinations were significantly more common in the group with dementia. In turn, eye disease was significantly more common in those with visual hallucinations. Nine patients were admitted with a history of recent assaultive behavior. Four of these were psychotic and eight of nine were demented. Five patients had attempted suicide prior to their admission. All were diagnosed as having major depression.     

The incidence of first provoked and unprovoked seizure in pediatric patients with and without psychiatric diagnoses

PURPOSE: To estimate the rate of new-onset afebrile provoked and unprovoked seizure in a general pediatric population and subgroups of patients with and without psychiatric diagnoses other than attention deficit hyperactivity disorder (ADHD). METHODS: A retrospective cohort study of 133,440 pediatric patients, between the ages of 6 and 17 years, and without history of seizure or prior use of anticonvulsant medications, with follow-up during 2003. The data source for this study was Ingenix's research database containing pharmacy and medical claims for members of a large US-based managed care organization. The main outcome measure was new-onset nonfebrile seizure. Incidence rates of seizure and 95% confidence intervals (CI) were calculated and expressed as rates per 100,000 person-years. RESULTS: There were 132 new-onset provoked and unprovoked seizures in 78,423 person-years of follow-up among the general pediatric population sample. The incidence rate of seizure among the general pediatric population was 168 per 100,000 p-y (95% CI 141-200). The incidence rate of seizure among patients without psychiatric diagnoses was 149 per 100,000 p-y (95% CI 122-180). The incidence rate of seizure among patients with psychiatric diagnoses other than ADHD was 513 per 100,000 p-y (95% CI 273-878). There were increases in the incidence rates of seizure in all of the seizure risk factor groups, but this was more pronounced among males ages 6-12 with psychiatric diagnoses. CONCLUSIONS: The results of this study are consistent with previous reports showing that pediatric patients with psychiatric disorders have a higher incidence rate of seizure than the general pediatric population.