A census of psychiatric patients in an urban community

Summary The background and purpose of the Salford Psychiatric Case Register are described. Initial results are presented of the census in which all Salford adults and children receiving care from hospital or local authority psychiatric and subnormality services on the 1st January, 1968, were enumerated. The distribution by age, sex and type of care, the length of stay of hospital in-patients and the contact of patients with medical and social work psychiatric personnel discussed. Comparison is made with data from case registers in other areas.

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Zusammenfassung Der Hintergrund und der Zweck des Psychiatrischen Fallregisters von Salford werden beschrieben. Es werden die ersten Ergebnisse des Census dargestellt, bei dem alle Erwachsenen und Kinder von Salford gezählt werden, die von klinischen oder lokalen kommunalen psychiatrischen Diensten und Einrichtungen für Minderbegabte am 1. Januar 1968 versorgt wurden. Die Verteilung bezogen auf Alter, Geschlecht und Versorgungsart, die Aufenthaltsdauer von stationären Patienten und der Kontakt von Patienten mit medizinischem und fürsorgerischem psychiatrischem Personal werden diskutiert. Es wird mit Daten von Fallregistern aus anderen Gebieten verglichen.

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Résumé On décrit le matériel et le but du registre des cas psychiatriques de Salford. On présente les premiers résultats du recensement dans lequel ont été énumérés tous les adultes et les enfants de Salford qui, le 1er janvier 1968, recevaient des soins de l'hôpital ou des services psychiatriques locaux. On discute la distribution des cas selon l'âge, le sexe et le type de soins, la durée du séjour en hôpital et le contact des patients avec le personnel médical et social en psychiatrie. On compare ces données avec celles des registres de cas d'autres régions.

     

Prevalence of psychiatric disorders in an urban community in Bangladesh

There is a critical lack of information on the epidemiology of mental health problems in Bangladesh. The present study aimed at assessing the prevalence and pattern of psychiatric disorders in an urban community in Dhaka, Bangladesh, and identifying associated socio-demographic factors. A total of 1145 respondents aged 18 years and above were screened for psychiatric disorders using the Self Reporting Questionnaire (SRQ), a stratified random sub-sample that were assessed by a psychiatrist. A structured questionnaire was also used to collect socio-demographic information. We found that the prevalence of psychiatric disorders was 28%. Somatoform disorders were the most common among the respondents, followed by mood, sleep, anxiety, and substance related disorders. Females and persons from the higher socio-economic classes were more likely to have a psychiatric disorder. Psychiatric morbidity is a significant and unrecognized public health problem in urban Bangladesh.     

Associations between community characteristics and psychiatric admissions in an urban area

Purpose

Neighbourhood characteristics are known to be associated with higher rates of hospital admission for psychiatric disorders.

Methods

An ecological study with aggregated data was carried out. All cases for schizophrenia and depression in the 42 city districts of Augsburg were identified over a 4-year-period (2006–2009) and neighbourhood variables were obtained. Negative binomial regression adjusted the effects for year of admission and accommodation in inpatient centres.

Results

There was significant association of high unemployment rate, low proportion of working population and high population density with higher rates of admission for schizophrenia. An increase of 1 % in unemployment rate [incidence rate ration (IRR) 1.0451, 95 % CI 1.0175–1.0734] was associated with 5 % raise of admission rates for schizophrenia and an increase of 1 % in working population (IRR 0.9793, 95 % CI 0.9605–0.9985) with a decrease of admission rates by 2 %. High proportion of single households and high percentage of persons eligible for social security increased admission rate for depression. Thus 1 % increase in the proportion of single households (IRR 1.0095, 95 % CI 1.0030–1.0162) and of the proportion of persons eligible for social security (IRR 1.0148, 95 % CI 1.0002–1.0297) both independently were associated with an increased rate of admission for depression of 1 %.

Conclusion

Our analysis demonstrated that measures of social isolation in neighbourhoods and social contacts at work influenced admission for schizophrenia and depression: in neighbourhoods with less social contacts and with a higher proportion of persons not working the admission rates increased. The problem of confounding in ecological studies need to be considered.     

The total demand for psychiatric service in an island community

Data are given on the total demand for psychiatric service by the population of an island community where such service is promptly available, geographically accessible, and within the economic means of all. Without the existence of such circumstances, psychiatric patient counts are likely to be underestimates of the real demand. The data provided on admission rates by age, sex, and diagnosis may be useful in predicting the service demands of communities where new facilities are to be opened.The investigation reported in this paper was supported by grant MH-14900 of the National Institute of Mental Health.     

Case-control study of frequent visitors to an urban psychiatric emergency service

OBJECTIVE: The purpose of this study was to identify risk factors for people who use psychiatric emergency services repeatedly and to estimate their financial charges. METHODS: The authors used interviews and chart reviews to compare 74 patients who had six or more visits to an urban psychiatric emergency service in the 12 months before an index visit with 74 patients who had five or fewer visits. Multivariate logistic regression was used to identify independent risk factors. RESULTS: Independent risk factors for frequent visitors were self-reported hospitalization in the past 12 months, need for medications as the self-reported reason for seeking care, being homeless or living in an institution, and not giving the name of a friend or family member for interview. The level of burden for support of persons who were interviewed was low and did not differ between frequent and infrequent visitors. Compared with infrequent visitors, frequent visitors had greater utilization of inpatient and outpatient behavioral health services, general emergency services, and crisis residential services in the 12 months before the index visit and greater utilization of general emergency services and psychiatric emergency services in the three months after the index visit. Frequent visitors' median financial charge for those services was 16,200 US dollars greater (5.9 times greater) than that of infrequent visitors. CONCLUSIONS: Frequent visitors represent resource-poor mentally ill persons who have high levels of utilization of health care facilities besides psychiatric emergency services. Possible clinical interventions for these patients include focused medication reviews.     

Use of an in‐patient psychiatric service by learning disabled children

Despite recent political commitment to increasing access to all levels of health service provision for learning disabled people, there is still limited access to in‐patient child psychiatric care for learning disabled children. This article describes the experiences of an in‐patient unit integrating learning disabled children into a peer group, the majority of whom have normal intellectual function. A case note review was undertaken of all children with a global learning disability admitted to the Collingham Gardens in‐patient Unit between January 2000 and December 2001. We discuss how similar services may be developed to be more inclusive for learning disabled children.     

South Verona's psychiatric service: an integrated system of community care

Italy's mental health law of 1978 mandated the closing of state mental hospitals to new and former patients and the creation of comprehensive community-based service systems. The authors describe the organization, facilities and services, and treatment principles of one system created in accordance with the law--the South Verona Community Psychiatric Service, which serves a population of 75,000. Case register data for South Verona for the years 1978 to 1984 reflect the changes mandated by the law. They also indicate that despite an increase in admissions to the psychiatric ward in the general hospital following the closing of the state hospital, there was a substantial overall decrease in the number of hospital beds occupied per day by South Verona residents after passage of the law, and that a substantial proportion of patients with functional psychosis were able to be treated as outpatients.     

The development of an integrated psychiatric service in a Scottish community

ABSTRACT– The deployment of a specialist psychiatric team and closer integration with primary health care practitioners has led to a greater proportion of first contacts as out-patients being seen compared with national data, and a relatively lower in-patient admission rate. The increase was in those patients seen in health centres rather than in additional out-patient clinics. Despite this there is evidence of a slow accumulation of patients with psychosis whose main requirements is suitable supported accommodation. Such a deployment into the community is a more economic use of resource and can, with advantage, assist the traditional hospital-based services in the transition from a custodial role.     

Patterns of substance use among patients in an urban psychiatric emergency service

Data from patients visiting an urban psychiatric emergency service in California were examined to document incidence and patterns of substance use and ethnic differences among users. A total of 392 patients were randomly assigned to receive a drug screen (N = 198) or to receive usual care (N = 194). Forty-four percent of the mandatorily screened patients had positive screens for any substances: 37 percent were positive for any drugs, and 7 percent were positive for alcohol only. Cocaine was present in 62 percent of the drug-positive screens. Blacks were two and a half times more likely than whites to have positive screens for drugs and five times more likely to have positive screens for cocaine.     

Meeting community service needs of discharged psychiatric patients

There is a growing recognition that the chronically mentally ill are a heterogeneous population with a multiplicity and diversity of needs. But inadequate information concerning the extent of the population service needs and the degree to which aftercare services meets these needs has contributed to the minimization of the problem. This article reports on the extent to which aftercare services meets the needs of discharged patients.Most discharged patients had a need for basic maintenance aftercare services such as individual counseling, chemotherapy, and financial assistance. However, there was also a high need for more rehabilitative services such as socialization services, social and vocational rehabilitation, and supportive residential services. Although almost half had their basic service needs met by aftercare services, few had their rehabilitative ones met.This study was funded by Grant 81–326 from the Office of Program Evaluation and Research, Ohio Department of Mental health.The authors wish to acknowledge Anne Mason, Paula Fishbein and Barry Gordon, Ph.D. for all their assistance.     

Cultural factors in the training of psychiatric residents in an Hispanic urban community

This paper describes a resident's experience with his first Puerto Rican patient who practiced spiritualism, also elaborating on the major problems encountered, in so far as training for psychiatric residents is concerned. Furthermore, an attempt is made to analyze the role that residency training programs should play in preparing the student psychiatrists to assume a more sophisticated role when confronted with such patients, who are so common in the urban ghettoes of the United States.Both authors are with the Albert Einstein College of Medicine, Bronx, New York, where Dr. Griffith is a Second-Year Psychiatric Resident and Dr. Ruiz, Associate Professor of Psychiatry and Director of the Lincoln Community Mental Health Center.     

Home assessment and treatment in a community psychiatric service

The work of a new community-based crisis intervention team is described. 326 psychiatric emergencies were seen over a period of 3 years. An increasing proportion of these were acutely psychotic at the time of assessment. Home treatment was effective for a significant number of patients, including those with a previous history of hospital admission. Some practical and theoretical aspects of the service are discussed.     

Use of neurological and psychiatric information in selective service

Psychiatric Quarterly -     

Lifetime and 6-month prevalence of DSM-III-R psychiatric disorders in an urban community in Japan

We conducted a community-based interview survey of a random sample of residents aged 20 years or older in an urban community in Japan using the University of Michigan Version of the WHO Composite International Diagnostic Interview for selected mood and anxiety disorders and alcohol abuse/dependence according to DSM-III-R. The final sample consisted of 1029 respondents (response rate, 57%). The lifetime and 6-month prevalences of selected mood, anxiety and alcohol use disorders were low in general. Alcohol abuse/dependence was more prevalent in men than in women. Younger respondents had a greater risk of generalized anxiety disorder and alcohol dependence. A greater risk of mood, anxiety and alcohol use disorders was observed among a recent birth cohort. We confirmed a lower prevalence of mood and anxiety disorders and alcohol use disorders in a community population in Japan than in Western countries, observations that were similar to previous ones in East-Asian countries. The patterns of demographic correlates and comorbidity are similar to those of most other countries.     

The impact of a new community mental health team on an inner city psychogeriatric service

The introduction of a multidisciplinary mental health team for the elderly, providing comprehensive assessment and support for elderly people with mental health problems in an area of inner London, has represented a major change in the way in which psychogeriatric referrals are dealt with locally. The new service replaced a traditional hospital-based system with a consultant making domiciliary visits. Characteristics of 109 referrals to the consultantbased service over six months are compared to 193 referrals over a similar period following the introduction of the team. Demographic patterns in both groups were similar, as were diagnoses made, with the exception of acute organic confusional states of which a slightly larger proportion were seen under the old service. More detailed assessment of cases and more input both to cases and their carers were possible with a community team. The implications of a community team based service for psychogeriatrics are discussed.