Psychiatric episodes in general hospitals without psychiatric units

Forty percent of inpatient psychiatric episodes are treated in general hospitals without psychiatric units, but little is known about these patients and their treatment. A survey of medical records personnel at 452 hospitals without psychiatric units revealed that the hospitals' psychiatric patients typically lived at home, were admitted through the emergency room because of a substance abuse disorder, received active medical treatment, were discharged back home after about four days, and paid with private insurance. The hospitals that treated primarily substance abusers provided a significantly different mix of treatments than did those that treated primarily patients with traditional diagnoses. The data suggest that general hospitals without psychiatric units may provide appropriate treatment for psychiatric patients, especially those with a substance abuse disorder.     

Psychiatric units in Brazilian general hospitals: a growing philanthropic field

BACKGROUND: Some countries, mainly in North America and Europe, have adopted psychiatric wards in the general hospital as an alternative to the classic psychiatric hospital. In Brazil there are 6,169 general hospitals, 1.3% of which with a psychiatric unit. This service strategy is scarcely developed in the country and comprises only 4% of all psychiatric admissions. There was no information on the facilities and functioning of the psychiatric units in general hospitals. OBJECTIVE: To determine the main characteristics of psychiatric units in Brazilian general hospitals and to assess the current trends in the services provided. METHOD: A mailing survey assessed all 94 Brazilian general hospitals which made psychiatric admissions. A two-page questionnaire was designed to determine the main characteristics of each institution and of the psychiatric unit. RESULTS: Seventy-nine (84%) questionnaires were returned. In contrast to the 1970s and 1980s, in the last decade the installation of psychiatric units has spread to smaller philanthropic institutions that are not linked to medical schools. A fifth of hospitals admit psychiatric patients to medical wards because there is no specialist psychiatric ward. They try to meet all the local emergency demands, usually alcohol-dependent patients who need short term admission. This could signal the beginning of a program through which mental health professionals may become an integral part of general health services. CONCLUSION: The inauguration of psychiatric wards in philanthropic hospitals, as well as the admission of psychiatric patients in their medical wards, is a phenomenon peculiar to this decade. The installation of psychiatric services in these and other general hospitals would overcome two of major difficulties encountered: prejudice and a lack of financial resources.     

Psychiatric consultations in short-term general hospitals

We investigated the use of psychiatric consultations in short-term general hospitals using a national sample of 327 hospitals and examining the hospital experience of approximately 263,000 patients discharged from these hospitals. We found that the demographic characteristics of patients receiving psychiatric consultations in the national sample were roughly similar to those reported for patients receiving consultations in earlier, single-hospital studies. Rates of consultation were considerably lower, however: 0.9%, compared with a median rate of 3.3% reported in the literature. We also found that patients receiving psychiatric consultations used more hospital resources than other patients.     

Psychiatric consultations in two Israeli general hospitals

Data were gathered on 479 inpatients of two Israeli general hospitals for whom psychiatric consultations were requested over a 1-year period. The data presented here include age and sex of referred patients, source of referral, reason for referral, psychiatric and physical diagnoses, and consultant's recommendation. Emergency ward consultations are included. Additional data were collected on patients transferred to psychiatric wards. Our findings are similar in general to those reported from other countries, although such comparisons are limited by the lack of uniformity in the classifications used by the various workers.     

Psychiatric services in general hospitals. Rational and irrational considerations

The structure of a psychiatric service in an urban general hospital is complex. Varied intrainstitutional and extrainstitutional relationships create stress, which can lead to rational and irrational reactions, often in combination. Psychologic mechanisms that exist in individuals also occur as shared defense mechanisms in an institutional setting, serving to reduce anxiety and stress but often at the expense of accurate reality perception. Good communication can play a vital role in reducing reality distortions but is itself often blocked or impaired by the same defense mechanisms that led to the distortions. An awareness of how these mechanisms operate in an institutional setting can aid the psychiatric administrator in correcting distortions and maintaining good channels of communication.     

Psychiatric disorders in two general hospitals: a survey of prevalence and treatment by nonpsychiatrist physicians.

This study reports an opinion survey of 211 nonpsychiatrist physicians in two general hospitals who estimated that 16.1% of their patients have psychiatric disorders and that they spent 13.8% of their time in treating the psychiatric components of their patients' illnesses. Physicians indicated that anxiety and psychosomatic and depressive illness were the most frequent psychiatric disorders and that one-third of them would personally treat such disorders without referral to psychiatric consultation. The findings also suggest that adequate undergraduate psychiatric education was associated with increased recognition of psychiatric disorders and more preference for their personal treatment. In addition, it provides a possible explanation for the discrepancy between the high prevalence of psychiatric disorders in general hospital patients and the low referral rate to psychiatric consultation.     

Psychiatric hospitals in motion

Papers in respect to the topic "On the possibility of influencing the course of psychiatric illness" which were presented at the 5th Steinhof Symposium, October 1979 in Vienna, are summarized with the aim to focus on and to support necessary efforts for an improvement of psychiatric care. Investigations in inpatient populations (Str?mgren, E.: Past and future changes in inpatient population; Gabriel, E.: Modifications in inpatient populations of big psychiatric hospitals) showed the importance of institutional differentiation and the similarity of problems in different countries, e.g. Denmark and Austria is mentioned. The papers of Ciompi (Prognosis in rehabilitation of chronic psychiatric patients) and Pfolz et al. (Factors preventing discharge of long-term inpatients from hospital) summarize concepts of inpatient care. In the papers of Sch?ny et. al. (Ward group therapy--its importance for the opening of psychiatric wards) and Lyon (Supervision of community--auxiliary lay workers) modern concepts of a pragmatic psychiatry are described. Trends in psychiatric inpatient care are becoming apparent which raise the hope that psychiatric hospitals will provide--through the aforementioned differentiation--more adequate care for the individual patient.     

Psychiatric referrals in general practice.

A major option available to the nonpsychiatric physician in dealing with patients who have psychiatric problems is to refer them to psychiatrists. A group of 93 nonpsychiatric physicians indicated that they have positive attitudes toward making such referrals where appropriate, and make extensive use of this mechanism with psychiatric patients. There are, however, great differences of opinion with respect to the appropriateness of psychiatric referrals for neurotic patients, those with alcohol and addiction problems, and those with other personal problems (marital, vocational, etc).     

Utility and sufficiency of psychiatric inpatient units in general hospitals: a cross-sectional study in Tokyo

In order to investigate the utility and sufficiency of psychiatric beds in general hospitals (GHP beds), a cross-sectional study was performed in general hospitals all over Tokyo. Reasons for admission were acute-phase treatment (43%), medical comorbidity (15%), electroconvulsive therapy (13%), differential diagnosis (12%), and others (17%). The number of patients who could not be admitted to GHP beds despite appropriate reasons for admission was estimated to be greater than that of inpatients without indispensable reasons for admission to GHP beds on the day of the survey. GHP beds played the expected roles, and were in short supply.     

Psychiatric services in Soviet general outpatient clinics.

The author believes that the first level of psychiatric care in the U.S.S.R.--the general polyclinics (outpatient clinics) and the medical-sanitary units--have not been adequately studied. He describes this level of care, which is considered useful and progressive in that the clinics are supposed to make psychiatric care available to the population, lighten the load placed on psychiatric facilities, and improve follow-up therapy. However, he also points out the shortcomings in this first level of psychiatric care in the U.S.S.R., including the bureaucratic nature of the system and the uneven quality of service the clinics render to various social groups in urban and rural areas.     

The setting of psychiatric care for medicare recipients in general hospitals with specialty units

This study examined the patient and hospital characteristics associated with whether patients with psychiatric disorders were treated on the psychiatric unit or on medical wards after admission to general hospitals with psychiatric units. Medicare data for 169,798 beneficiaries who had psychiatric disorders and were admitted to general hospitals with psychiatric units were used to estimate logistic regressions of the probability of treatment on the unit. Results showed that beneficiaries who had more than one psychiatric diagnosis (except for substance use disorders), state buy-in coverage such as Medicaid, or previous psychiatric hospitalizations or who had ever been eligible for Medicare through disability were more likely to be treated on the unit. Those who were older, admitted through the emergency department, or had greater medical morbidity or primary diagnoses other than schizophrenia or bipolar or major affective disorders were less likely to be treated on the unit.