Day hospital treatment for mood disorders

An increasing proportion of psychiatric patients are treated in day hospital settings, which are an effective alternative to hospital admission. The aim of this study was to determine the effectiveness of an intensive day program for patients with mood disorders. A series of 185 patients (102 women and 83 men with an average age of 55 years) who were consecutively referred to the psychiatric day hospital at A. Gemelli Hospital in Rome, Italy, and who met DSM-IV diagnostic criteria for mood disorders were evaluated at admission, at discharge, and after six months. The study participants reported a significant reduction in symptoms as well as improvements in social adaptation and overall functioning.     

Day hospital vs. home treatment

Abstract. Background: Acute home treatment services, providing short-term intensive input as an alternative to in-patient admission, have been recommended by the Department of Health as part of a spectrum of care. The lack of research evidence for such services is in contrast to acute day hospital care which has been better researched, but not widely adopted. This paper compares the patients treated in a randomised controlled trial (RCT) of day hospital vs. in-patient care with patients treated several years later in the home treatment service which developed from the original acute day hospital. Method: In the original RCT, patients were randomised at the point of admission to day hospital or in-patient care. The home treatment sample consisted of a consecutive series of admissions. Severity of illness was assessed at admission using the Comprehensive Psychopathological Rating Scale (CPRS). Both samples were followed up for 12 months to monitor service use and costs. Results: Symptom severity among the home treatment sample (n = 71) was greater than the day hospital sample (n = 94) (mean CPRS score 31.6 vs. 25.5, p < 0.0001). This difference remained significant following adjustment for other socio-demographic and illness variables. Secondary care costs for the home treatment sample (including in-patient, home treatment and out-patient costs) were intermediate between the costs for the day hospital and in-patient samples from the RCT, but the differences were not statistically significant. Conclusions: Extending the remit of an acute day hospital to provide 24-h care and a choice of treatment location is associated with an increase in the severity of illness treated. The impact on costs is unclear and the total cost of the new service may not be significantly less than in-patient care. The results need to be interpreted with caution because of differences in recruitment methods.     

Early subjective reactions predicting the outcome of hospital treatment in depressive patients

Early statements by 41 depressive inpatients about a subjective change in their condition and about their attitude to proposed treatment were examined. These statements, made on the day after admission, were found to correlate with the outcome of the treatment. It was found that early subjective reactions can indicate to some extent, not only the result of hospital treatment for depressive symptoms, but also the outcome measured by objective and subjective criteria, after a 3 to 4 month follow-up.     

Day hospital versus outpatient treatment: A controlled study

This study compares day hospitalization with traditional outpatient treatment effecting rehospitalization, symptomatology, mood, community, and vocational adjustment for 30 recently discharged schizophrenic patients. Results indicate day hospital patients were significantly more involved in work and training activities, but had no significant difference in the other areas of measurement.     

Predictors of depressive symptoms at hospital discharge in patients with major depressive disorder

Abstract

Objective. Often patients with major depressive disorder (MDD) leave the hospital with continued significant symptomatology. This study sought to evaluate demographic, clinical, and psychosocial predictors of the presence of clinically significant depressive symptoms, defined as a Modified Hamilton Rating Scale for Depression score of ≥ 14, immediately following hospitalization for MDD. Methods. The study enrolled 135 patients with MDD as part of a larger clinical trial investigating the efficacy of post-hospitalization pharmacologic and psychosocial treatments for depressed inpatients. Structured clinical interview and self-report data were available from 126 patients at hospital admission and discharge. Results. Despite the significant decreases in depressive symptoms over the course of hospitalization, 91 (72%) displayed clinically significant depressive symptoms at discharge. Multivariate logistic regression analysis revealed that female sex, earlier age of onset, and poorer social adjustment were unique predictors of symptom outcome. Conclusions. Results suggest that a large proportion of patients leave the hospital with continued significant symptomatology, and the presence of such symptoms following hospitalization for MDD is likely to be explained by a combination of factors.     

Day treatment for alcoholism in a general hospital psychiatric service

In this paper a time limited, cost effective day treatment program for alcoholics, and characteristics of patients entering this treatment program, are described. The advantages of this day treatment program are discussed with special emphasis on its relationship with other community service agencies, with the community at large and, with a General Hospital Mental Health service, of which it is a part. The implications for planning cost effective treatment services for alcoholics are discussed.     

Day hospital rehabilitation a six-year study

Summary This paper describes the performance of a day hospital whose specific aims are the rehabilitation and work resettlement of disabled psychiatric patients. The results are reported and discussed in relation to other relevant studies.     

Plasma catecholamine levels after fluoxetine treatment in depressive patients

It is known that selective serotonin reuptake inhibitors, widely used as antidepressive drugs, act by inhibiting the cell reuptake of serotonin, but their effect on the catecholaminergic system is not yet completely understood. In this study, we investigated plasma concentrations of norepinephrine, epinephrine and dopamine after acute and chronic administration of fluoxetine in depressive patients. Twelve patients affected by major depression received a single oral dose of fluoxetine in the morning, 5 mg in the first 5 days, 10 mg from the 6th to the 10th day and 20 mg from the 11th to the 40th day. Twelve healthy subjects received a placebo under identical testing procedures. Blood samples were collected at baseline and 7, 10 and 24 h after drug administration on the 1st day of fluoxetine administration at a dose of 5 mg, and on the 1st and the 30th day of fluoxetine administration at a dose of 20 mg (days 11 and 40 of treatment, respectively). We found that plasma norepinephrine, epinephrine and dopamine levels significantly increased after acute and chronic treatment (p < 0.001), reaching the highest concentrations on the last day. No significant changes of these parameters were observed in control patients.     

Amitriptyline and oxaprotiline in the treatment of hospitalized depressive patients

Summary Amitriptyline (AT) and the noradrenaline reuptake inhibiting antidepressant oxaprotiline (OT = hydroxymaprotiline) were compared in 59 primary depressive inpatients in a 4-week double blind parallel group design. In the Hamilton Depression Rating Scale and 2 self-rating scales AT proved to be more efficient than OT, mainly with respect to disturbances of appetite and sleep. Agitated patients receiving OT needed more additional tranquilizing medication. The number of side-effects did not differ. Both drugs increased heart rate and skin resistance level (SRL) to about the same degree and did not influence the number of spontaneous fluctuations of SRL, habituation of SRL orienting responses (OR), frequencies of respiration and blinking. Salivation was temporarily more impaired by AT. All physiological variables differed between patients and 30 healthy controls during the whole 4-week trial. Clinical outcome showed a linear relation to OT plasma levels. For AT a therapeutic window was confirmed for concentrations of AT and its metabolite nortriptyline between 125 and 200 ng/ml. Patients whose SRL-OR habituated rapidly had a better outcome than slow habituators. Urinary excretion of 3-methoxy-4-hydroxyphenylglycol was lower in patients than in controls but could not predict outcome with either drug.     

Satisfaction with treatment among patients with depressive and bipolar disorders

BACKGROUND: Patients' satisfaction with care may be an important factor in relation to adherence to treatment and continued psychiatric care. Few studies have focused on satisfaction in patients with depressive and bipolar disorders. METHOD: A comprehensive multidimensional questionnaire scale, the Verona Service Satisfaction Scale-Affective, was mailed to a large population of patients with depressive or bipolar disorders representative of outpatients treated at their first contact to hospital settings in Denmark. RESULTS: Among the 1,005 recipients, 49.9% responded to the letter. Overall, patients were satisfied with the help provided, but satisfaction with the professionals' contact to relatives was low. Younger patients (age below 40 years) were consistently more dissatisfied with care especially with the efficacy of treatment, professionals' skills and behaviour and the information given. There was no difference in satisfaction between genders or between patients with depressive disorder and patients with bipolar disorder. CONCLUSION: There is a need to strengthen outpatient treatment for patients discharged from a psychiatric hospital diagnosed of having affective disorders, focusing more on information and psychoeducation for patients and relatives.     

综合医院与精神专科医院抑郁障碍患者的临床特征比较

目的 比较不同性质医疗机构精神科门诊抑郁障碍患者的临床特征和治疗情况.方法 使用一般情况调查表和简明国际神经精神访谈对综合医院和精神专科医院精神科门诊100例抑郁障碍患者进行调查,对不同性质医疗机构患者的临床特征和治疗情况进行比较分析.结果 综合医院精神科门诊抑郁障碍患者的年龄和首次抑郁发作的年龄都大于精神专科医院患者(P ＜ 0.01).综合医院患者抑郁发作时有不典型症状的比例高于精神专科医院(P ＜ 0.05),而精神专科医院患者中有焦虑症状(P ＜ 0.05)、复发性抑郁(P ＜ 0.01)和有精神病性症状(P ＜ 0.05)的比例均高于综合医院,自杀风险的等级也高于综合医院(P ＜ 0.05).综合医院精神科门诊抑郁障碍患者使用苯二氮类药物的比例较高(P ＜ 0.05),而精神专科医院心境稳定剂的使用比例较高(P ＜ 0.05).两类医院中抗精神病药物的使用和是否有精神病性症状的内部一致性均不高(Kappa ＜ 0.4).结论 综合医院的抑郁障碍患者的临床表现更多不典型的特征,抑郁障碍的药物治疗情况也与专科医院不同,值得临床注意和深入分析.