Epidemiological survey of psychiatric disorders of Japanese school children. Part 2. Prevalence of psychiatric disorders in school children

An epidemiological survey of mental health of Japanese regular public school children was performed using both Rutter's teacher's and parent's questionnaires as a screening instrument and a diagnostic interview as a definitive method. A total of 592 junior high and elementary school children, average age 13.2 years old and ranging from 10 to 15 years old, were examined in the preliminary survey. Purposes were to study survey methodology and to determine the prevalence of psychiatric disorders. In part 1, the Japanese version of Rutter's questionnaire was found to be satisfactory for screening, and the diagnostic interview by pediatricians in this survey was shown to be a reliable tool for the diagnosis of psychiatric disorders of the adolescent. In the present study, psychiatric disorder prevalence and characteristics were studied. The 592 school children were divided into 3 groups by the Rutter's questionnaires: 1) 55 positive children by Rutter's method, 2) 424 negative children having no risk factors by Rutter's method, 3) 112 negative children by Rutter's method having some risk factors such as "school problems", "visits to school nurse", and "not being liked by peers". All of the 55 positive children and 144 children randomly selected from the negative group were interviewed and diagnosed by pediatricians, and estimates of prevalence rates for mental disorder were determined for the 3 children groups. It was 51% in the positive group, 11% in the negative group having no risk factors, and 25% in the negative group having some risk factors. Thus, the prevalence rate for the total group of 591 children was 17%, with one case of mental retardation being excluded.(ABSTRACT TRUNCATED AT 250 WORDS)     

重症患者不同负荷剂量替考拉宁早期谷浓度的监测

目的了解给予不同负荷剂量替考拉宁的重症感染患者治疗3 d后的血清药物谷浓度(Cmin)及目标Cmin达标情况,旨在探讨理想的负荷剂量。方法选取2016年2月1日—2017年2月28日入住某院重症医学科重症感染患者,按不同药物负荷剂量(替考拉宁标准剂量6 mg/kg;高剂量10 mg/kg)和不同尿肌酐清除率(Ccr:以50 mL/min为标准线)水平分为4个亚组:标准剂量正常肌酐清除率组(G_(SD1)组)、标准剂量低肌酐清除率组(G_(SD2)组)、高剂量正常肌酐清除率组(G_(HD1)组)、高剂量低肌酐清除率组(G_(HD2)组),比较替考拉宁血清Cmin、目标Cmin达标情况以及不良反应情况。结果共入选患者49例,标准剂量组17例,其第4 d用药前Cmin为(5.98±2.67)mg/L;高剂量组32例,Cmin为(9.05±4.25)mg/L;高剂量组Cmin高于标准剂量组,差异有统计学意义(t=3.10,P=0.003)。G_(SD1)、G_(SD2)、G_(HD1)、G_(HD2)组Cmin分别为(5.78±2.72)、(6.34±2.78)、(8.21±3.77)、(12.07±4.81)mg/L,4组间Cmin比较,差异有统计学意义(F=4.766,P=0.006),G_(HD2)组高于G_(HD1)组、G_(SD2)组和G_(SD1)组;Cmin达标率分别为9.09%(1/11)、16.67%(1/6)、28.00%(7/25)、71.43%(5/7),差异有统计学意义(χ~2=8.766,P=0.033)。各组治疗期间均未发现明显药物相关性皮疹、肝肾功能损害。结论不论患者Ccr正常与否,给予标准负荷剂量的替考拉宁早期均不能达到目标Cmin;低Ccr者给予高负荷剂量替考拉宁早期可达目标Cmin;而正常Ccr者,则需进一步提高负荷剂量。     

Psychiatric hospitalizations in a cohort of Danish polio patients

Although previous polio infection remains a considerable cause of long-term morbidity worldwide, few studies have examined the psychiatric consequences of poliomyelitis. The authors followed 4,660 polio patients hospitalized at the primary infectious disease hospital in Copenhagen, Denmark, between 1922 and 1954 as well as 19,017 age- and gender-matched Danes for psychiatric hospitalizations from January 1, 1977, to December 31, 1993. Incidence rates of all psychiatric disorders combined and of separate diagnostic groups of psychiatric diseases in the two cohorts were compared, yielding the incidence rate ratio, a measure of relative risk. Overall, polio patients had a 40% increased risk of being hospitalized for a psychiatric disorder (incidence rate ratio = 1.43, 95% confidence interval: 1.23, 1.66). Apparently, the overall increased risk of psychiatric hospitalizations could not be confined to specific groups of psychiatric disorders but seemed to be explained by slightly increased risks of several different disorders, especially milder psychiatric disorders. Finally, psychiatric morbidity did not differ between paralytic and nonparalytic polio patients. History of hospitalization for polio might be associated with subsequent risk of hospitalization for psychiatric disorders. The underlying mechanism for this association remains uncertain.     

Diagnosis of psychiatric disorder in clinical evaluation of chronic fatigue syndrome

The overlap of symptoms in chronic fatigue syndrome (CFS) and psychiatric disorders such as depression can complicate diagnosis. Patients often complain that they are wrongly given a psychiatric label. We compared psychiatric diagnoses made by general practitioners and hospital doctors with diagnoses established according to research diagnostic criteria. 68 CFS patients referred to a hospital fatigue clinic were assessed, and psychiatric diagnoses were established by use of a standardized interview schedule designed to provide current and lifetime diagnoses. These were compared with psychiatric diagnoses previously given to patients. Of the 31 patients who had previously received a psychiatric diagnosis 21 (68%) had been misdiagnosed: in most cases there was no evidence of any past or current psychiatric disorder. Of the 37 patients who had not previously received a psychiatric diagnosis 13 (35%) had a treatable psychiatric disorder in addition to CFS. These findings highlight the difficulties of routine clinical evaluation of psychiatric disorder in CFS patients. We advise doctors to focus on subtle features that discriminate between disorders and to use a brief screening instrument such as the Hospital Anxiety and Depression Scale.     

Relationship of weight and eating disorders in type 2 diabetic patients: a multicenter study

OBJECTIVE: Previous work suggested that the degree of psychiatric symptomatology evidenced in overweight individuals was related to the severity of binge eating problems and not related to the severity of overweight. In a multicenter study, we investigated the relationship between weight and eating disorders (EDs) in a sample of type 2 diabetic patients. METHODS: Three hundred twenty-two patients with type 2 diabetes were stratified to various weight categories. Glycemic control, eating and body-related psychological problems, self-esteem, depressive, and general psychopathology of diaetic patients with and without an ED were compared. RESULTS: Eighty-one percent of all type 2 diabetic patients were overweight or obese. Prevalence rates of EDs ranged from 6.5% to 9.0%. Binge eating disorder was the most diagnosed ED. There was a strong relationship between body mass index (BMI) and eating disturbance-related variables and a weak or no relationship between BMI and depression or general psychopathologic variables. Patients with an ED showed a greater psychopathology compared to patients without an ED. The diagnosis of an ED did not seem to have a specific influence on glycemic control. CONCLUSIONS: Our results in a type 2 diabetic sample indicate that weight might have an impact on body and eating-related psychological distress in type 2 diabetic patients, but is of minor or no importance for depressive symptomatology, lower self-esteem, and general psychiatric symptomatology. Type 2 diabetic patients with an ED, however, suffer from considerable psychiatric symptomatology.     

Detecting emotional and behavioural problems in paediatric clinics

BACKGROUND: Children with chronic illness have increased rates of mental health problems and psychological difficulties often present as physical conditions. This prevalence survey aims to determine whether children attending general paediatric out-patient clinics are at increased risk of suffering from emotional and behavioural disturbance and whether there is an unmet need for psychiatric liaison to paediatric clinics. METHODS: Participants were 307 children aged 5-15 years attending a representative sample of paediatric out-patient clinics in one UK hospital. A national community sample of 10,438 children aged 5-15 years was used as a comparison group. Parental ratings of child behaviour were obtained using the Strengths and Difficulties Questionnaire (SDQ). Doctors rated the extent of any emotional difficulties using a modification of the SDQ 'impact supplement'. RESULTS: Children attending paediatric out-patient clinics were more than twice as likely (OR = 2.3, 95% CI 1.7-3.1) to score in the abnormal range of the SDQ. Of the 60 (20%) children with a probable psychiatric disorder only 15 had received specialist help from Child Mental Health Services. There were no gender differences in the profile of difficulties with emotional symptoms being particularly evident in both boys (OR = 2.85, 95% CI 1.97-4.11) and girls (OR = 3.04, 95% CI 1.92-4.70). The risk of psychiatric disorder was highest among those children with brain disorders attending neurological clinics (OR = 5.8, 95% CI 2.5-11.3). Clinicians only identified emotional or behaviour problems in a quarter of those children with parent-rated disorder. CONCLUSION: There is an increased prevalence of emotional and behavioural disturbance in children attending paediatric out-patient clinics. The SDQ could be added to routine paediatric assessments to aid appropriate referral of children with a possible psychiatric disorder to child mental health services.     

The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study.

OBJECTIVES: This study examined the prevalence and public health impact of chronic fatigue and chronic fatigue syndrome in primary care patients in England. METHODS: There were 2376 subjects, aged 18 through 45 years. Of 214 subjects who fulfilled criteria for chronic fatigue, 185 (86%) were interviewed in the case-control study. Measures included chronic fatigue, psychological morbidity, depression, anxiety, somatic symptoms, symptoms of chronic fatigue syndrome, functional impairment, and psychiatric disorder. RESULTS: The point prevalence of chronic fatigue was 11.3%, falling to 4.1% if comorbid psychological disorders were excluded. The point prevalence of chronic fatigue syndrome was 2.6%, falling to 0.5% if comorbid psychological disorders were excluded. Rates did not vary by social class. After adjustment for psychological disorder, being female was modestly associated with chronic fatigue. Functional impairment was profound and was associated with psychological disorder. CONCLUSIONS: Both chronic fatigue and chronic fatigue syndrome are common in primary care patients and represent a considerable public health burden. Selection bias may account for previous suggestions of a link with higher socioeconomic status.     

Psychiatric correlates in chronic fatigue syndrome

PURPOSE: This study presents psychiatric correlates in Chronic Fatigue Syndrome (CFS) that emerged from the CDC's Surveillance Study. It seeks to determine the time of onset and rates of syndromal psychiatric disorders and identify the predominant disorder. Other goals are to ascertain whether depression is associated with CFS symptomatology, compare syndromal to self- reported depression, and test for the specificity of the 1988 CDC case definition for CFS.METHODS: All 565 enrolled subjects had fatiguing illnesses and were evaluated for CFS. They completed the Diagnostic Interview Schedule for the DSM-III-R and the Beck Depression Inventory. Prevalence estimates for current syndromal psychiatric disorders were calculated. CFS symptoms were compared by depression status. Syndromal and self-reported depression were contrasted. Groups that did and did not meet the case definition were compared by three outcome variables.RESULTS: Rates of current psychiatric disorders were high in CDC subjects compared to the community. The predominant disorder was depression. Although prior disorders tended to persist (75%), many disorders were incident to the fatiguing illness (57%). Depression was not associated with increased CFS symptomatology. There was only weak agreement between measures of syndromal and self-reported depression (kappa = 0.3219). Subjects designated as CFS had similar rates of syndromal psychiatric disorders, syndromal depression, and self-reported depression as did non-CFS subjects.CONCLUSIONS: Current syndrome; psychiatric disorders appear associated with fatiguing illnesses. While prior psychiatric disorders are risk factors for current, the onset was largely concurrent with the fatiguing illnesses. The BDI should probably not be used as a measure for psychiatric morbidity in CFS subjects. Regardless of outcome, there was no evidence of specificity of psychiatric features to the CDC case definition.     

Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 Northern Finland general population birth cohort

We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982–1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77.0%) vs 6687 out of 10 630 (62.9%) (OR = 2.0, 95% CI = 1.6−2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7−99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5–38.1) and schizophrenics more than a 30-fold risk (OR = 37.5, 95% CI = 19.1–73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2–4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2–4.2), vertebral column disorders (OR = 4.2, 95% CI = 1.8–9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2–3.6) and induced abortions (OR = 1.8, 95% CI = 1.2–2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0–31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1–5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8–42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable physical morbidity in their patients.     

Prevalence of psychiatric disorders in patients with chronic work-related musculoskeletal pain disability

The cost and prevalence of chronic work-related musculoskeletal pain disability in industrialized countries are extremely high. Although unrecognized psychiatric disorders have been found to interfere with the successful rehabilitation of these disability patients, few data are currently available regarding the psychiatric characteristics of patients claiming work-related injuries that result in chronic disability. To investigate this issue, a consecutive group of patients with work-related chronic musculoskeletal pain disability (n = 1595), who started a prescribed course of tertiary rehabilitation, were evaluated. Psychiatric disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. Results revealed that overall prevalences of psychiatric disorders were significantly elevated in these patients compared with base rates in the general population. A majority (64%) of patients were diagnosed with at least one current disorder, compared with only 15% of the general population. However, prevalences of psychiatric disorders were elevated in patients only after the work-related disability. Such findings suggest that clinicians treating these patients must be aware of the high prevalence of psychiatric disorders and be prepared to use mental health professionals to assist in identifying and stabilizing these patients. Failure to follow a biopsychosocial approach to treatment will likely contribute to prolonged pain disability in a substantial number of these patients.     

妊娠期高血压疾病患者并发肺栓塞的高危因素分析

目的:分析妊娠期高血压疾病患者并发肺栓塞的高危因素,为孕产期肺栓塞的预防提供理论依据。方法:妊娠期高血压疾病并发肺栓塞患者25例为研究组,未并发肺栓塞者25例为对照组。比较研究组和对照组各患者的年龄、血细胞比容(HCT)、甘油三脂(TG)、纤维蛋白原(FBG)、D-二聚体、尿白蛋白等指标,对数据进行Logistic多元回归分析。结果:只有FBG和D-二聚体可纳入回归方程。结论:FBG和D-二聚体是妊娠高血压疾病患者并发肺栓塞的危险因素。     

A mortality risk index for men in a Veterans Administration extended care facility

the purpose of this study was to develop (phase I) and validate (phase II) a mortality prognostic index, based on the annual clinical data base, for the men of this Veterans Administration extended care facility. The study population during phase I consisted of 123 men who were residing in three of the seven wards of the facility in August 1984. Sixty-six of these individuals were institutionalized because of a chronic neurologic (50) or medical (15) disorder ("nonpsychiatric group"). In 57 men, the reason for institutionalization was a chronic psychosis (schizophrenia, 53; manic depressive illness, 4) ("psychiatric group"). During August to October 1984, a comprehensive clinical data base comprising 70 attributes (including diagnoses and drugs) was collected. Deaths were recorded during the next 14 months. Death rate during the 14 months of observation was 33.3% in the nonpsychiatric group, and only 1.7% in the psychiatric group. In the nonpsychiatric men, univariate analysis yielded six attributes significantly correlated with death rate: serum cholesterol level, hematocrit, hemoglobin, midarm muscle circumference, triceps skinfold, and number of morbidity episodes. After serum cholesterol and hematocrit had been entered into a multivariate analysis model, none of the other four attributes contributed significant information about death rate. The multivariate analysis led to a mortality risk index (MRI) for nonpsychiatric patients, MRI = [hematocrit in %] + 10% [serum cholesterol in mg/dl]. As MRI varied from less than 50 to greater than 65, death rate in the nonpsychiatric group varied in parallel from 86-11%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Strategies for the prevention of psychiatric disorder in primary care in south London.

STUDY OBJECTIVE: To compare the potential impact of high risk and population based approaches to the prevention of psychiatric disorder, using a representative sample of general practice attenders as the target population. DESIGN: This was a prospective cohort study. SETTING: A health centre in south London. PARTICIPANTS: Three hundred and seven consecutive attenders aged 16-65, recruited at randomly selected general practice surgeries. MAIN RESULTS: A linear association was found between the number of different types of socioeconomic adversity reported at recruitment (T1) and the prevalence of psychiatric disorder one year later (T2). The population attributable fraction (PAF) for socioeconomic adversity at T1 was 37.4%. In theory, social interventions for high risk individuals at T1 would reduce the prevalence of psychiatric disorder at T2 by 9% at most, compared with a reduction of 18% if just one item of socioeconomic adversity were eliminated among those with any socioeconomic risk factors. CONCLUSIONS: Social interventions targeted at individuals at highest risk of the most common mental disorders are likely to be extremely limited in their capacity to reduce the prevalence of these conditions. A population based risk reduction strategy, modified according to individual risk, represents a potentially feasible and effective alternative.     

A collaborative care program for management of common mental disorders among diabetic patients in a primary healthcare setting

Aims

Type 2 diabetes mellitus (T2DM) is a chronic condition with high and increasing prevalence. Psychiatric disorders are very common among these patients. We aimed to assess the effect of a collaborative care program for management of common mental disorders among T2DM patients on their metabolic outcomes.

Subjects and methods

In this before-after study, a group of T2DM patients was enrolled from nine chronic care centers of a primary healthcare service. A trained team managed both the psychiatric and metabolic conditions according to evidence-based guidelines. The primary care team was in collaborative contact with a specialized service at a Community Mental Health Center. Patients’ glycemic measures, lipid profile, and weight were measured 3 months after the psychiatric intervention.

Results

Among 2757 diabetic patients visited, 536 (19.44 %) were diagnosed as having a common mental disorder. Mean age of included patients (435) was 56.5?±?9.74. Major depressive disorder and generalized anxiety disorder were the most common mental disorders with a frequency of 219 (50.3 %) and 197 (46.7 %), respectively. There was no statistically significant improvement in glycemic and metabolic control after the psychiatric intervention; however, control of blood pressure was improved. Moreover, significant improvements were observed in average glycosylated hemoglobin (HbA1c) (p?<?0.001) and fasting plasma glucose (FPG) (p?<?0.01) in patients with previously poor glycemic control.

Conclusion

Although management of psychiatric conditions in a collaborative care program yielded no significant effect on metabolic outcomes and glycemic control in the total sample, patients with poor glycemic control experienced significant improvement in FPG and HbA_1c levels.

     

Psychiatric morbidity, stressors, impact, and burden in juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is a chronic painful disorder conceivably with adverse psychological sequelae that might influence the outcome of the disease and its treatment. This study was designed to detect the presence of psychiatric disorders and associated abnormal psychosocial situations among children and adolescents with JIA and to evaluate their impact on and burden for their caregivers. Forty subjects with JIA suffering for at least one year were included in the study. Forty age- and sex-matched healthy subjects were included as controls. Clinical psychiatric assessment was carried out blindly, and psychiatric disorders and stressors on abnormal psychosocial situation were assigned on the basis of ICD-10 clinical diagnoses of multiaxial classification of child and adolescent psychiatric disorders. Chronicity, distress, social impairment, and burden for others were rated with the impact supplement of the strengths and difficulties questionnaire (SDQ). Of the 40 cases of JIA, 24 were boys and 16 were girls aged 10-18 years, with a mean age of 13.25 years. The frequency of psychiatric disorders was 35% in the JIA and 12.5% in the control group (p<0.001). The long duration of illness was associated with a higher proportion of cases with psychiatric disorders. In the JIA group, the diagnoses in decreasing order were depressive disorder (15%), somatoform disorder (12.5%), adjustment disorder (5%), and mixed anxiety and depressive disorder (2.5%). Significantly higher stressors, perceived difficulties, distress, social impairment, and burden for caregivers were reported in the JIA group with psychiatric morbidity. The presence of psychiatric disorders was associated with substantial impairment of learning, peer relationship, and leisure activities. Early psychiatric intervention might increase the likelihood of satisfactory outcome of treatment in JIA.     

Effect of sociodemographic factors, cancer, psychiatric disorder on suicide: gender and age-specific patterns]

OBJECTIVES: We examined the effect of sociodemographic factors, cancer, and psychiatric disorders on suicide by gender and age-specific patterns in South Korea. METHODS: The study is a case-control study. Claim data was obtained from the national health insurance database and national death registration database. The number of people who committed suicide was 11,523, which was matched with a control group consisting of ten times as many people at 115,230 selected from the national health insurance and medical aids beneficiaries. The medical utilization of the case group was one year before death and that of the control group was from July 1,2003 to June 30, 2004. Four variables-address, economic status, presence of a psychiatric disease, and cancer-were used in multiple logistic regression analyses. RESULTS: Living in cities or in rural areas showed a greater risk for suicide than living in a metropolitan city. Low economic status, the presence of a psychiatric disorder, and cancer were also statistically meaningful risk factors for suicide. The three major psychiatric diseases, schizophrenia, alcohol abuse, and bipolar disorder, were meaningful in all age groups, but the scale of the odds ratio differed by the age group. Only the psychiatric disorder variable was meaningful in the adolescent group, whereas a psychiatric disorder and economic status were meaningful for the young adult group, and all variables were meaningful for the middle-aged group. A psychiatric disorder and cancer were meaningful in the elderly group, economic status was meaningful for male subjects, and address was meaningful for female subjects. CONCLUSIONS: Factors such as living in city or rural areas, low economic status, the presence of a psychiatric disorder, and cancer were statistically meaningful risk factors in suicide. These factors also differed by age group. Therefore, policymakers should establish policies for suicide prevention that are relevant for each age group.     

糖化血红蛋白变异指数与2型糖尿病患者糖尿病慢性并发症的相关性研究

目的 探讨2型糖尿病(T2DM)患者糖化血红蛋白变异指数(HGI)与糖尿病慢性并发症发病的关系.方法 采用整群随机抽样的方法,从常熟市34个乡镇中随机抽出12个乡镇,选取在抽中乡镇登记并纳入国家基本公共卫生服务管理的T2DM患者为研究对象.根据HGI数值,采用三分位数法将患者分为低HGI组、中HGI组和高HGI组,探索...     

Depression als komorbide Störung in der primärärztlichen Versorgung

As part of the DETECT study, a nationwide representative clinical-epidemiological study, the frequency and associated problems of comorbid depression with a wide range of somatic illnesses were studied in N = 51,000 primary care patients. Further the association with health related quality of life and disability is examined. Depression was assessed with the Depression Screening Questionnaire (DSQ) with an ICD-10 algorithm. RESULTS: (1) 7.5 % of all primary care patients met criteria for ICD-10 depressive disorders. (2) Depression risk was increased whenever any somatic disorder was present and increased in a dose-response relationship by number of comorbid conditions. (3) Elevation of depression risk was fairly independent of type of diagnosis, although associations with coronary heart disease (OR: 1.7), diabetic complications (OR: 1.7- 2.0), stroke (OR: 2.5) and pain-related chronic disorders (OR: 1.5) were particularly pronounced. Moderate associations were found for hyperlipidaemia (OR: 1.1). (4) Associated with the increasing number of comorbid conditions, patients with comorbid depression had increasingly more disability days and lower health related quality of life. It is concluded that the degree to which the frequency and the deleterious effects of comorbid depression is underestimated and unrecognized is alarming. The use of comorbidity indices might improve recognition.     

Seclusion of admitted psychotic patients: later in the case of antipsychotic use and also possibly less often

OBJECTIVE: To establish the incidence and determinants of seclusion and to gain insights into the use of antipsychotics before and after the seclusion of acutely admitted patients. DESIGN: Retrospective cohort analysis. METHOD: We collected data from a consecutive sample of 996 patients in adult psychiatric admission wards for the period 1997-1999. Secluded patients were compared with non-secluded patients and the correlations between antipsychotic use and seclusion were calculated. RESULTS: The average age of the 996 patients (507 men and 489 women) was 38.0 years (median: 37.0; range: 16-84). Seclusion was applied in the case of 285 patients (28.6%). Young age (< 30 years), low Global Assessment of Functioning score (< 55), involuntary hospitalisation and bipolar disorder (manic episode) were significantly associated with seclusion. For patients with psychotic disorders who used antipsychotics during the first week, the median time from admission to seclusion was 7 days (in patients not using antipsychotics this was 2.5 days). Furthermore, the use of antipsychotics was, although not significant, associated with a lower risk of seclusion (relative risk: 0.7; 95% CI: 0.5-1.2). In a substantial number of the psychotic patients, antipsychotic treatment was initiated during or shortly after seclusion; they used these drugs more often than psychotic non-secluded patients (relative risk: 2.0; 95% CI: 1.2-3.4). CONCLUSION: The use of antipsychotics is associated with a later application of seclusion as well as its possible delay. For a considerable number of patients, treatment with antipsychotics was started either during or shortly after seclusion.