A retrospective study of adolescents' visits to a general hospital psychiatric emergency service

Characteristics of 100 visits by adolescents (less than 18 years old) to a psychiatric emergency service were examined and compared with those of 100 visits by adults. Adolescents were less likely than adults to receive diagnoses of psychosis and personality disorder but more likely to receive diagnoses of adjustment and conduct disorders, were less likely to have had previous psychiatric treatment but equally likely (40%) to be in current treatment, and required more time to evaluate. Self-destructive ideation or behavior was present in 40% of the adolescents. Nearly all visits were judged to have represented genuine emergencies.     

Attenders of a university hospital psychiatric emergency service in Belgium

OBJECTIVE: The aim of this study was to provide a clinical and epidemiological profile of patients consulting the psychiatric emergency team (PET) of an emergency service of a Belgian university hospital. METHOD: Of all PET patients (N = 1050), demographic characteristics, axis I diagnosis, any axis II diagnosis, presenting problems, psychiatric antecedents, and patterns of referral were assessed. RESULTS: Male patients presented more with hostility or violence towards others (10%) and substance abuse (23%); female patients presented more with suicidality (31%) and depressed mood (24%). Male patients had more psychoactive substance use disorders (21%); female patients had more mood (21%) and adjustment disorders (19%). About 50% of the patients were unemployed and had sought psychiatric help in the past. Female patients were more often referred by the emergency physician (35%) and health care professionals (29 %); male patients were more often self-referred (23%) and referred by the police (9%). CONCLUSION: A PET could overcome the discrepancy between the need of treatment and the effective use of mental health services. Male and female PET patients presented different complaints and were given different axis I diagnoses; they also had different pathways to care.     

Nurses as psychiatric consultants in a general hospital emergency room

Psychiatric nurses' experience in milieu therapy, home treatment, community aftercare, and psychotherapy can be the basis for new roles in mental health. This study used psychiatric nurses as consultants to general physicians in a general hospital emergency room. Psychiatric nurses successfully managed 66% of the psychiatric referrals in the emergency room and required only telephone consultation in a majority of the remaining cases to develop and implement a satisfactory treatment plan. The resistance to using nurses in this new role seems a result of anxiety generated in the emergency room staff and physicians. Sensitivity to these discomforts reduces “undermining” behavior and provides the opportunity for new roles to develop, be defined, and be accepted.     

The benefits of a psychiatric consultation--liaison service in a general hospital

In this period of increased governmental regulation and decreased reimbursement for psychiatric services by third-party carriers, a fully staffed and financially stable psychiatric consultation-liaison service in the general hospital may still generate significant benefits for patients, hospital administrators, and psychiatrists: an increased rate of diagnosis of psychiatric and medical disorders, a reduction in the length of stay of medical or surgical patients, a decreased utilization of medical services and the development of innovative consultation-liaison activities. This article summarizes these benefits and outlines training obstacles that must be overcome to increase cooperation between psychiatry and medicine so that these benefits may be realized.     

Establishing a nurse-based psychiatric CL service in the accident and emergency department of a general hospital in Germany

Introduction

Patients with mental health problems in accident and emergency departments (A&E) are frequent users and often difficult to handle. Failure in managing these patients can cause adversities to both patients and A&E staff. It has been shown that nurse-based psychiatric consultation–liaison (CL) services work successfully and cost effectively in English-speaking countries, but they are hardly found in European countries. The aim of this study was to determine whether such a liaison service can be established in the A&E of a German general hospital. We describe structural and procedural elements of this service and present data of A&E patients who were referred to the newly established service during the first year of its existence, as well as an evaluation of this nurse-led service by non-psychiatric staff in the A&E and psychiatrists of the hospital’s department of psychiatry.

Subjects and methods

In 2008 a nurse-based psychiatric CL-service was introduced to the A&E of the Königin Elisabeth Herzberge (KEH) general hospital in the city of Berlin. Pathways for the nurse’s tasks were developed and patient-data collected from May 2008 till May 2009. An evaluation by questionnaire of attitudes towards the service of A&E staff and psychiatrists of the hospital’s psychiatric department was performed at the end of this period.

Results

Although limited by German law that many clinical decisions to be performed by physicians only, psychiatric CL-nurses can work successfully in an A&E if prepared by special training and supervised by a CL-psychiatrist. The evaluation of the service showed benefits with respect to satisfaction and skills of staff with regard to the management of psychiatrically ill patients.

Conclusion

Nurse-based psychiatric CL-services in A&E departments of general hospitals, originally developed in English-speaking countries, can be adapted for and implemented in a European country like Germany. Open access: This article is published with open access at link.springer.com.     

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.     

Crisis intervention in the emergency service of a general hospital

Two general hospitals of Brussels tapped, in 1977, 47% of all the emergency ambulance traffic. More than 50,000 patients were examined there in one year. A randomized sample of 12,000 records were analyzed. From this file, 1707 psychosocial cases were carried out. The study will follow the progression of the patients during this crisis situation. Statistic tests pinpoint that the most determining variable is the symptoms. Seven symptoms cover more than 95% of the interventions. These symptoms are: alcoholism, suicide attempts, abnormal behavior, psychologic complaints, somatic complaints, violence, drug-addiction. Statistical analysis reveals that the two most important variables to draws crisis interventions at the emergency room were the time used by patient and the frequency of call of the psychiatrist. Other variables used to draw up the progression of the patients were: way of arrival, diagnosis and final destination.     

Effects of a smoking ban on a general hospital psychiatric service

After a private general hospital announced plans to ban smoking inside the hospital, the authors initiated a study on the psychiatric units to identify anticipated and actual patient-related problems associated with the ban and to assess staff and patient attitudes toward the ban. Data were obtained through pre- and post-ban surveys of medical and nursing staff and predischarge interviews with patients. The findings showed that staff anticipated more smoking-related problems than actually occurred and that patients who smoked were able to reduce their tobacco use during their hospital stay. No evidence was found to suggest that hospitalized psychiatric patients are less capable of cutting down on smoking than the general population.     

Former state hospital patients in private general hospital psychiatric emergency settings

Increasing numbers of patients formerly hospitalized in state facilities are using private general hospital psychiatric emergency services. To define their clinical needs, the authors compared the characteristics of patients hospitalized in state institutions to those hospitalized privately and to those never hospitalized. They found that two discrete clinical groups exist: those from state and those from private systems. Clinicians reacted most negatively to former state patients. This was also reflected by differences in the dispositions of voluntary patients from the emergency room. Those not hospitalized or privately hospitalized were more likely than former state hospitalized patients to be sent to private facilities.     

综合医院精神科会诊患者失眠的临床研究

目的：探讨综合医院精神科会诊患者失眠的临床特征及与其它精神障碍的关系。方法：对168例精神科会诊患者进行分析。结果：128例(76、2％)会诊患者有失眠．其中61．7％(79／128)为慢性失眠。原发性失眠仅占5．5％(7／128)，85．1％(109／128)是与其它精神障碍有关的失眠。常见的精神障碍诊断为焦虑障碍、心境障碍和谵妄。60．9％的失眠患者在会诊前得到了处理。结论：应对临床医师进行精神卫生教育，提高他们对失眠等常见精神障碍的识别和处理能力。     

Hospitalisation profile in a psychiatric service within a general hospital (author's transl)

The first part of the study indicates that this small unit has a rapid turnover, that the population is young and that there are fresh cases. The main reason for admission in males are first alcoholism and secondly schizophrenia, and for women first depression and neurotic troubles and secondly endogenous depressions. The second part of this study deals with length of stays and shows that it behaves like random variables of Pascal, with a mean stay of 34 days and a peak within the three first days of hospitalisation.     

Seclusion practice in a Canadian forensic psychiatric hospital

In this study, seclusion practice was examined in a multilevel, secure psychiatric hospital, serving federally sentenced individuals in the Prairie Region, as defined by the Correctional Service of Canada. Between August 1996 and February 1999, 183 patients (27.7% of total admissions) were secluded on 306 occasions. The mean duration of seclusion was 90.3 hours (minimum I hour; maximum 908 hours). A higher proportion of female patients (60%) was secluded than of male patients (25%). Sixty-five percent of the patients were secluded once, 29.5 percent two to four times, and 5.5 percent more than four times. Suicidal threats and self-harm gestures were the reasons for initiating seclusion in 27.4 percent of cases. Patients with diagnosed substance-related disorders accounted for 40.8 percent of all seclusion episodes, whereas those with schizophrenia and related psychoses accounted for 28.1 percent. These findings suggest that seclusion remains a relatively common intervention in some disturbed patients in a forensic setting.