Predictors of outcome of short-term child psychiatric inpatient treatment

In this study, 85 children were prospectively followed after discharge from short-term inpatient treatment. Outcome was defined as functioning within normal range at the follow-up or as improvement in the child's behavior problems. Rutter Parent's Questionnaire was used as a measure on admission and at the 5-month follow-up after discharge. The child's more frequent individual behavior problems, antisocial behavior and disengaged family interaction on admission predicted both functioning outside normal range and less improvement at follow-up. Previous treatment because of developmental or behavioral problems and hyperkinetic symptoms on admission predicted functioning outside normal range. Parent's previous psychiatric hospital treatment was negatively associated with improvement. Pure emotional disorder predicted normal range functioning at follow-up. The child's age, gender, place of treatment and length of short-term treatment were not related to outcome. The results also stress the importance of taking into account both parents' and teachers' evaluations on admission.     

Characteristics of people with intellectual disability admitted for psychiatric inpatient treatment

The present prospective study describes the demographic, medical and psychosocial characteristics of 40 people with intellectual disability who were referred for psychiatric inpatient treatment in the special psychiatric unit of the Special Welfare District of South-west Finland. Three different control groups were used to study: (1) demographic variables (n = 122); (2) medical history (n = 39); and (3) psychosocial factors (n = 20). The symptoms leading to an admission to inpatient care and the connections of these clinical signs with the discharge diagnosis were evaluated. The typical inpatients were young males with mild intellectual disability, psychosis and a previous psychiatric diagnosis. They had lived in several places during their lives and their economic situation was poor. Affective and/or disruptive symptoms were the most common causes of an admission to inpatient care. The largest diagnostic group at discharge consisted of patients with psychotic disorders. The people with intellectual disability who were admitted for inpatient care formed a subgroup with certain psychiatric symptoms and social problems. Specialist psychiatric expertise is absolutely necessary for the treatment of this subgroup.     

Contribution of adverse drug reaction to admission rates in an acute psychiatric ward

The relative contribution of adverse drug reactions (ADR) to the admission rate of an acute psychiatric ward was examined prospectively. Among 321 patients hospitalized over a period of 17 months, adverse drug reactions were the main cause for hospitalization in 7.5%. Extrapyramidal side effects - mainly resistant akathisia - account for half of these patients. The population at high risk was that of the elderly and those suffering from organic brain syndromes.     

Cost variation in child and adolescent psychiatric inpatient treatment

Publicly available costs data for child and adolescent psychiatric inpatient services do not allow links to be made with patients’ needs and outcomes. Without this information commissioners may reduce the role of inpatient services on the basis of budgetary impacts alone. This study estimates the support costs before, during and after an inpatient admission and explores the associations between costs, needs and outcomes. A detailed prospective cohort study of eight child and adolescent units was undertaken in which participants were assessed at referral, admission, decision to discharge and 1 year later. Mean admission costs were ￡24,120, although the range was wide. Associations were found between costs and patients’ global impairment, age and exclusion status. Support costs after admission were similar to pre-admission costs, but there was some evidence to suggest that services were better targeted. Moves in England to develop national tariffs for inpatient psychiatric episodes should be based on the likely cost of the episode of treatment rather than costs per day, and good commissioning requires more information on the predictors of such costs.     

Crisis intervention program: an alternative to inpatient psychiatric treatment for children

This study evaluated the impact of a Crisis Intervention program as an alternative to use of psychiatric treatment beds for young children. A multidisciplinary community-based intervention was utilized, including family therapy, psychiatric intervention, and school consultations. The impact of the service was evaluated in relation to the use of psychiatric treatment beds by the population of children eligible for Medicaid or uninsured. In comparison to an historical control group, the program resulted in a 23% reduction in the use of psychiatric treatment beds. A cost-minimization analysis indicated that in addition to the program reducing the use of psychiatric treatment beds, the cost of treatment was also slightly reduced.     

Suicide among psychiatric in-patients in Stockholm,Sweden

Abstract

The aim of this study was to analyse how sex, age, ethnicity and psychiatric disorders influence the suicide rate and to describe the methods used when committing suicide. The study was designed as a prospective follow-up study from 23 October 1984 to 31 December 1986. The study population was comprised of in-patients in psychiatric care from 23 October 1984 to 23 October 1985 living in the southern part of Stockholm, Sweden. Women had significantly higher standardised mortality ratios (SMR = 33.7. CI -31.6-35.8) of suicide (determined and undetermined) than men (SMR = 21.4, CI = 19.7-23.1), and the SMR of total mortality were 4.0 and 3.8 respectively. The suicide rate was 15.5 per 1000 patients and 2.6 during the hospitalisation period. For men and women aged under 50, suicide accounted for 60% and 75% respectively of the total mortality. Men had a higher (p < 0.0001) hospitalisation rate than women, 1082 and 1004 (per 100.000 and year) respectively. One-third of those who committed suicide died from an overdose and 35% were diagnosed as psychotic. Foreign-born individuals ran a twofold risk of committing suicide compared to Swedes. These findings are imponant and need to be further analysed in studies based on larger population samples.     

Age distribution curve in psychiatric admissions inversely correlates with Life Satisfaction

A strong inverse correlation was found between the age-distribution curve of psychiatric admissions and the U-bend Life Satisfaction curve. It may indicate that the peak of mental disorders at midlife reflects a less satisfactory period of life or, conversely, that the mental health load burdens of Life Satisfaction.     

Immigration,moving house and psychiatric admissions

This study was designed to elucidate psychiatric admission rates for native Swedes and foreign-born individuals during the period 1991–1994, when Sweden had a great influx of refugees. During the same period, and even earlier, psychiatric in-patient care had been reduced. Tests of differences between Swedes and foreign-born individuals in first psychiatric admission rates were performed using Poisson regressions, and the risk of a readmission was assessed using a proportional hazard model. Foreign-born individuals and native Swedes, both males and females, showed a similar admission pattern with regard to the number of admissions. Foreign-born males under 55 years of age and foreign-born females under 35 years of age had significantly higher admission rates than native Swedes. In total, native Swedes, both males and females, were hospitalized for a significantly longer period than the foreign-born subjects. About 43% of the patients were readmitted. The risk of a readmission was significantly increased among those with a high rate of internal migration. The high admission rates for young foreign-born individuals might be explained by a high incidence of mental illness owing to the trauma of being violently forced to migrate, acculturation difficulties, or unsatisfactory social circumstances such as high unemployment. The shorter hospitalization time could be due to undertreatment or less serious mental illness.     

Increase in involuntary psychiatric admissions of minors

Abstract. Objective: The aim of this study was to assess the frequency and trend over time of involuntary psychiatric admissions of minors, and to examine the psychiatric diagnoses in involuntary admissions of minors as compared to those admitted on a voluntary basis. Method: A retrospective register study was made during the period 1996–2000 of a nationally representative hospital discharge register in Finland. Results: Involuntary admissions of children (aged < 12) and adolescents (aged 12–17) increased vastly over the study period, both in absolute figures and in proportion to all admissions in the age groups. Although some disorders were more likely to be linked to compulsory admission than others, a variety of individual diagnoses were represented under compulsory admission. Conclusion: More comprehensive guidance for clinicians is needed regarding the involuntary admission of minors. More theoretical and empirical research is needed on minors competence to consent to or refuse treatment.     

The school behaviors of children in three psychiatric treatment settings: An outpatient clinic,a day hospital,and an inpatient hospital

Compares teachers' ratings of the school behaviors of children entering an outpatient clinic, a day psychiatric program, and an inpatient psychiatric hospital. Many of the ratings did not discriminate among the three groups. Children starting outpatient versus day treatment were rated as higher in aggression, anxiety, and hostile withdrawal, and children beginning outpatient and day treatment versus inpatient treatment, were reported as more skilled socially.     

The determinants and outcomes of long-stay psychiatric admissions

BACKGROUND: Acute psychiatric admissions lasting over 6 months (long-stays) continue to occur in England. Previous studies have suggested an association between long-stay and both schizophrenia and challenging behaviour, as well as rehousing or placement difficulties, but no UK study to date has compared such cases with control admissions. METHODS: We performed a case-control study. All long-stay patients present on acute general psychiatric wards serving the London Boroughs of Croydon, Lambeth, Lewisham and Southwark on November 1st 2004 were compared with a group of 'next admitted' controls. We followed up long-stay cases 1 year later to determine whether they were still in hospital, and, if not, where they were living. RESULTS: In unadjusted comparisons long stay was associated with schizophrenia, non-white ethnicity, admission not due to suicidality, violence, severe illness and need for rehousing. A logistic regression was used to adjust for associations among exposures and only violence, severity of illness and need for rehousing remained associated with long-stay. After 1 year, two-thirds of cases were living out of hospital. CONCLUSIONS: Case-control studies may usefully contribute to the study of the complex social phenomenon of long-stay. Further research should address how the combination of individual and socially-determined effects that we found operate together over the course of admission to generate long-stays.     

Modelling the frequency of psychiatric admissions

The analysis of readmissions has important implications in psychiatric research, particularly in the areas of emergency-room administration, diagnostic classification, treatment and policy planning. Although many studies have attempted to evaluate possible predictors of readmission, commonly employed statistical techniques generally ignore the fit of probability distributions of readmissions to the data. One type of probability distribution – the negative binomial – has previously been successfully fitted to readmission data and has been found to give a closer fit than a commonly employed distribution, the Poisson. Employing a form of generalized linear model – negative binomial regression – we extend these findings to another set of readmission data, using readily available statistical software. Copyright © 1998 Whurr Publishers Ltd.     

Differences in younger,middle, and older children admitted to child psychiatric inpatient services

Sociodemographic, family-environmental, clinical, and service use differences among younger (3–6 years), middle (7–10 years), and older (11–16 years) children admitted to a child psychiatric inpatient service were examined. Data was collected retrospectively on 327 children using a 152-item chart abstraction form from the children's medical charts in years 1993, 1995, 1996, and 1997. The results suggest that younger children compared to their older counterparts come from poorer functioning families and that family-environmental, rather than clinical, diagnostic variables differentiate these groups. Implications of the findings for future research and practice are discussed.     

Typologies of psychiatric admissions and length of inpatient stay in Italy

Objective: To describe admissions to an inpatient psychiatric unit in Italy over a two-year period and explore the influence of demographics, clinical variables and organisational and context-related factors on length of stay. Methods: Data were obtained from clinical records and recorded by a psychiatrist through a proper checklist. Results: Shorter admissions involved patients with personality disorders and substance use disorders. Greater illness severity and difficulties in setting a post-discharge programme were associated with longer admissions. Conclusions: Clinical, organisational and context-related factors all had significant effects on length of stay.     

Factors associated with frequent admissions to an acute geriatric psychiatric inpatient unit

As a first step toward developing strategies to reduce the frequency of psychiatric hospitalizations, the authors retrospectively collected and analyzed demographic and clinical variables from 424 consecutive admissions to a university-based geriatric psychiatry inpatient unit over a 20-month period. The study sample was dichotomized into patients who were admitted more than one time (35.6%) versus those with a single admission. Factors associated with rehospitalization were examined with multivariate logistic regression analysis. The great majority of readmissions (81%) occurred in the first 3 months after discharge. The logistic regression model indicated that significant predictors of rehospitalization were single relationship status, male gender, and bipolar disorder diagnosis. Our findings overlap with findings from previous similar studies and suggest that information readily obtainable on admission to an acute geriatric psychiatry inpatient unit may provide a useful indication of risk for frequent psychiatric hospitalizations and may contribute to readmission prevention strategies.     

Juvenile and adult problems in 20 forensic psychiatric rapists in Sweden

The purpose of this study was to assess the pattern of background variables of 20 convicted rapists. The sample comprised two distinct forensic psychiatric subgroups undergoing different treatments. Data were extracted from forensic psychiatric files. The study variables were juvenile and adult problems of the offenders, related by previous research to the occurrence of rape. Records of juvenile problems and juvenile psychological disturbances tended to co-occur with adult problems of aggressiveness, alcoholism and extensive criminality. The correlation analysis further supports the notion that psychosocial disturbances have a persistent character: in our sample, different problems in young age are linked to each other as well as to adulthood problems. The results are discussed in the light of empirical research and the need for early and proper individual treatment programmes.