Screening for domestic violence among patients admitted to a French emergency service.

OBJECTIVE: The authors assessed the prevalence of domestic violence among patients examined in the emergency service of a general hospital. They compared the socio-demographic status and psychiatric comorbidity of victims of domestic violence and other patients. METHOD: An assessment was made on 126 consecutive patients received by the emergency service of Bichat-Claude Bernard hospital (Paris, France). Assessment of domestic violence was made through the use of a specific questionnaire. RESULTS: The prevalence rate of domestic violence was 18% among patients examined by the emergency service. Thirty-five percent of the cases were physical violence, 22% sexual violence, 17% psychological violence and 26% multiple forms of domestic violence. Domestic violence had been going on for less than 1 month in only one case. In 74% of the cases, violence lasted for more than 1 year. No differences were found in terms of socio-demographic characteristics (age, marital status, rate of unemployment, sex ratio) and psychiatric comorbidity between victims of domestic violence and others. CONCLUSION: Patients seen in an emergency service must be identified as a population at risk for domestic violence (18%). These situations can be identified only by a systematic assessment using a standardized questionnaire.     

Psychiatric emergency service

The psychiatric emergency service of the Karolinska Hospital is the only facility of this kind for an urban-suburban population of 150,000 people. The policies and procedures of the emergency ward as well as its staff and background facilities are described. During the years 1967 to 1970, 20,567 consultations were made, and 4,557 of these patients were admitted to the ward. The patients were studied with respect to sex, age versus marital status, psychiatric diagnosis versus reason for admission, days in the ward and marital status.     

Alcohol dependence among patients admitted to psychiatric emergency services

We assessed the prevalence of alcohol dependence among patients examined in the psychiatric emergency service of a general hospital. We compared socio-demographic data and psychiatric status of patients with and without alcohol dependence. One-hundred and four consecutive patients received by the psychiatric emergency service of Bichat-Claude Bernard Hospital (Paris, France) were assessed. Diagnosis of alcohol dependence, acute alcohol intoxication, and antisocial personality was determined according to DSM-IV criteria. Other psychiatric disorders were identified using a structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI). Prevalency rate of alcohol dependence was 37.5% among patients examined by the psychiatric emergency service. Alcohol-dependent patients were more often men than women and more often unemployed than non-alcohol-dependent psychiatric emergencies. They presented more dysthymia, acute alcohol intoxication, and antisocial personality than non-alcoholic patients followed by the psychiatric emergency service. Attempted suicide was as frequent in alcohol-dependent patients (23%) as in other patients (29%). Alcohol-dependent patients consumed alcohol more often when alone, and their alcohol consumption began more frequently in the morning. Patients seen in a psychiatric emergency service must be identified as a population at risk for alcohol dependence (37.5%). Alcohol-dependent patients are more often men and have a higher rate of unemployment. They present significantly more often dysthymia and acute alcohol intoxication associated to alcohol dependence.     

Medical disorders among patients admitted to a public-sector psychiatric inpatient unit

Active and important physical disorders are common among public-sector psychiatric patients and are frequently undetected. A total of 289 patients who were consecutively admitted to a public psychiatric hospital were screened for physical disorders and given medical evaluations when screening results suggested an active and important physical disorder. Twenty-nine percent of the patients had such disorders. Of the 119 disorders detected, 24 (20 percent) were newly diagnosed for 23 patients (8 percent). Physical disorders that may have caused or exacerbated patients' psychiatric symptoms affected 2 percent and 3.5 percent of the patients, respectively. Patients admitted to psychiatric inpatient units should be carefully evaluated for physical disease.     

Psychotic disorders among homeless subjects attending a psychiatric emergency service

Background Homelessness is an increas- ing problem among subjects with severe mental illnesses and little is known about the characteristics of homeless subjects with psychosis using emergency psychiatric services. The aims of the present study were to assess the frequency of psychotic disorders among subjects attending a psychiatric emergency service and to explore the clinical and demographic characteristics of these subjects and the management proposed by the emergency staff. Methods All homeless patients (n = 104) consecutively attending a psychiatric emergency service were included over a 6-month period. Patients were categorised according to ICD-10 diagnoses as presenting with psychotic disorder (schizophrenia and other non-affective psychotic disorders) versus other disorders. A random sample of matched non-homeless controls (n = 71) was included over the same period. Results Nearly one out of three homeless subjects (32.7%) presented with a psychotic disorder, a higher proportion than that found in non-homeless subjects (15.7%). Compared to non-homeless subjects with psychosis, homeless subjects with psychosis were more likely to be male and to present with drug use disorder. The likelihood of being hospitalised after attending the psychiatric emergency services did not significantly differ between the two groups. Compared to homeless subjects with other psychiatric disorders, homeless subjects with psychosis were more likely to be single, to have a history of psychiatric hospitalisation and presented less frequently with anxiety or depressive symptoms motivating admission. Conclusion Most homeless subjects with psychosis attending a psychiatric emergency service were already identified as suffering from a severe mental illness, suggesting that homelessness was a consequence of a break in contact with mental health services. Since homelessness is incompatible with the adequate management of psychosis, strategies have to be developed in mental health organisations in combination with outside partnerships, to drastically reduce the frequency of this condition in subjects with psychosis.     

Psychiatric consultation to a general hospital medical evaluation service

Psychiatric consultation to a general hospital medical evaluation service was reviewed and compared with consultation patterns for general hospital inpatients and psychiatric emergency service patients. Results of a questionnaire survey indicated nearly 1 in 5 patients admitted to this acute medical service (24-hour maximum stay) required psychiatric consultation. A study of those patients seen by psychiatric consultants is reported. The prevalence of depressive illness as well as the psychiatric hospitalization referral rate was substantially greater than in general hospital inpatient or psychiatric emergency service evaluations. The implications of this relatively new area of consultation-liaison for hospital staffing and medical education are discussed.     

Substance use disorders among psychotic patients admitted to inpatient psychiatric care

Previous epidemiological and clinical studies have shown high rates of substance use disorders in patients with psychotic disorders. There are few studies from the Scandinavian countries. The aim of this study was to investigate the rate of substance use disorders in a group of Norwegian psychotic inpatients from a specific catchment area. Sixty patients, aged 18–40 years, were interviewed through standardized methods: the Addiction Severity Index (EuropASI) and the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I). Urine toxicology screens confirmed patients’ self-report of recent substance use. The lifetime rate of substance use disorders was 70% when all psychotic disorders were included and 62.5% when substance-induced psychotic disorders were excluded. Fifty percent of all the patients studied had current substance use disorders. The majority of substance use disorders were dependence disorders. Alcohol, amphetamine and cannabis were the dominant substances. The level of comorbidity found in this study is comparable with that found in American studies, despite lower prevalence of substance use in the Norwegian population. The high rate of substance use disorders in psychotic inpatients has implications for the treatment and the organization of psychiatric care for these patients.     

Psychiatric disorders among adults seeking emergency disaster assistance after a wildland-urban interface fire

OBJECTIVE: This study estimated the prevalence of psychopathology at a three-month follow-up among persons seeking emergency relief services after a wildfire and identified a practical screener for use in these disaster assistance settings to aid early identification of persons at risk of subsequent psychopathology. METHODS: During the October 2003 California firestorm that occurred at the wildland-urban interface, 357 persons who were seeking assistance from adjacent American Red Cross and government relief centers were recruited for this study. Within days of mandatory evacuation, participants completed baseline self-administered questionnaires assessing demographic characteristics, initial subjective reactions, and degree of fire exposure. At the three-month follow-up, symptoms of posttraumatic stress disorder (PTSD) and major depression were measured via a mailed survey. RESULTS: At follow-up 33% showed evidence of probable major depression; 24% exhibited probable PTSD. On a bivariate basis, seven initial reaction and fire exposure items were significantly associated with subsequent psychopathology. Best-subsets logistic regression analyses revealed that property damage and physical injury were the best multivariate predictors of psychopathology at follow-up. No additional items provided a significant incremental improvement in prediction. CONCLUSIONS: Individuals seeking immediate emergency assistance related to the wildland-urban interface fire were at elevated risk of psychopathology in the weeks after the fire. A short, easily administered, two-item screener, composed of items assessing fire exposure severity, appears to hold promise for aiding early identification of persons at risk of postfire psychopathology. These findings may also have implications for other mass disasters.     

Psychiatric emergency and somatic disorders

The authors made a survey in the setting of the Ste Anne hospital Emergency outpatient clinic to determine the incidence of somatic troubles in mental patients during a crisis situation. 1,000 patients were examined during a 24 day period. More than half of somatic problems had not been addressed to priori to Psychiatric consultation. More over, during those psycho-organic troubles, no precise information had been made available in half of the patient population. In 3% of cases, hospitalization could not continue in a psychiatric setting, which points to both the difficulty in assessing the medical capacity of psychiatric institutions ("secteurs") and acceptance of mental patients by the general medical hospital.     

Substance use disorders among personality disordered patients admitted for day hospital treatment. Implications for service developments

Personality disorders (PD) and substance use disorders (SUD) are highly comorbid conditions. However, their treatment services are often separated. The aims of this study was to investigate how extensive this separation was prior to a Norwegian health reform (2004) that promoted integration, and to discuss clinical challenges for an integrated treatment of PD and SUD. All patients with a diagnosis of PD (n=1783) admitted to 10 day hospital treatment programs (1993–2003) were examined. Diagnoses were assessed by Mini International Neuropsychiatric Interview and Structured Clinical Interview for DSM-IV interviews. Socio-demographic data, psychosocial functioning (Global Assessment of Functioning Scale), symptom distress (Symptom Check List-90-Revised), interpersonal problems (Circumplex of Interpersonal Problems) and treatment course were recorded. The majority of patients were females (72%) and the prevalence of SUD was low (14%). SUD occurred among all PD categories. Patients with borderline PD were over-represented and patients with cluster C disorders were under-represented in the SUD sample. The SUD sample contained more men and it was associated with more previous violence against self and others. The reported violence was partly explained by gender (males) and diagnoses (borderline and SUD). PD patients with SUD also displayed more aggression during treatment and dropped out more frequently. The findings demonstrate that the female dominated specialized psychiatric treatment services for PD to a large extent had excluded PD patients who also had SUD. The reasons are probably related to the surplus problems that characterized the SUD sample and gender issues. Implications for the development of the PD and SUD services with respect to an integrated treatment for these comorbid conditions are discussed.     

Psychiatric disorders in immigrant French Moslems]

The authors base their report on the case histories of 50 psychiatric in-patients, all Moslem French immigrants. The common characteristics are: 1. the absence of mental illness before immigration and throughout the first years in France; 2. a stay of at least one year in France. Five tables illustrate these case histories. Once again the question of immigration and in particular that concerning Algerian Moslems who chose French nationality in 1962 has been taken up. Certain problems concerning the failure of integration of immigrants have been highlighted. A bibliography comprising 24 books or articles completes this work.     

Psychiatric disorders among elderly patients attending a geriatric medical day hospital: Prevalence according to clinical diagnosis (DSM-III-R) and agecat

One hundred and fourteen elderly medically ill day patients were interviewed in order to assess the prevalance of DSM-III-R main psychiatric disorders. Dementia affected 14.0% of the subjects, major depression 20.3%, dysthymic disorder 4.4%, atypical depression 13.2%, other disorders 3.6%. Overall, 60.5% of the patients had a psychiatric disorder. The computerized case designation (AGECAT) showed an acceptable concordance with clinical diagnoses (kappa value for dementia 0.59, for depression 0.58). Some issues related to the high prevalence of major depression are discussed.     

Psychiatric disorders among wife batterers

Sixty-one male spouse batterers were identified from a population of relatives of treated alcoholics and compared to 319 married or formerly married men without a reported history of battering on lifetime psychiatric diagnoses and antecedent behaviors. Batterers had higher lifetime rates of alcoholism, antisocial personality disorder, and depression than nonbatterers, but not other psychiatric disorders. While batterers and nonbatterers could not be differentiated based on violent behaviors occurring before the age of 15, 95% of batterers reported other fighting as an adult. Batterers also were more likely to have been divorced two or more times and to report repeated infidelity. Implications for treatment of batterers and identifying groups at high risk for battering are discussed.     

Psychiatric disorders among Japanese children

OBJECTIVE: To generate current data on the prevalence of psychiatric disorders among Japanese children, using DSM-III-R criteria. METHOD: As part of an ongoing longitudinal study in a Japanese community sample, 114 mother-child dyads were interviewed when the children were approximately 8 years old. DSM-III-R disorders of the children were diagnosed through the administration of a structured diagnostic instrument, the parent and child versions of the Child Assessment Schedule, to both the children and their mothers. RESULTS: The prevalence rate for any diagnosis was 49.1%, which is similar to that of U.S. children and adolescents. CONCLUSION: The Child Assessment Schedule is an appropriate scale for assessing the psychopathology of Japanese children, which is as prevalent as in a U.S. sample.