Psychiatric units in general hospitals: 1979.

Despite the network of community mental health centers, the general hospital has become the focal point for the delivery of mental health care in the U.S. The author presents an overview of the psychiatric unit in the general hospital, including its history, structure and function, and its relationship to the hospital itself and to the continuum of mental health services in the community. The units' goals are not clearly defined but appear to be crisis intervention, acute treatment, correction of decompensation, prevention of chronicity, and speedy return of the patient to the community; there is little attempt to serve chronic patients. Paradoxically, the psychiatric unit also does not serve the hospital it is part of, as it rarely accepts patients from medical-surgical wards. The author summarizes evaluation studies related to general-hospital psychiatric units and recommends, among other points, truly evaluating the effects of short-term treatment and eliminating the current competition for the shortest stay.     

Psychiatric episodes in general hospitals without psychiatric units

Forty percent of inpatient psychiatric episodes are treated in general hospitals without psychiatric units, but little is known about these patients and their treatment. A survey of medical records personnel at 452 hospitals without psychiatric units revealed that the hospitals' psychiatric patients typically lived at home, were admitted through the emergency room because of a substance abuse disorder, received active medical treatment, were discharged back home after about four days, and paid with private insurance. The hospitals that treated primarily substance abusers provided a significantly different mix of treatments than did those that treated primarily patients with traditional diagnoses. The data suggest that general hospitals without psychiatric units may provide appropriate treatment for psychiatric patients, especially those with a substance abuse disorder.     

Psychiatric consultations in short-term general hospitals

We investigated the use of psychiatric consultations in short-term general hospitals using a national sample of 327 hospitals and examining the hospital experience of approximately 263,000 patients discharged from these hospitals. We found that the demographic characteristics of patients receiving psychiatric consultations in the national sample were roughly similar to those reported for patients receiving consultations in earlier, single-hospital studies. Rates of consultation were considerably lower, however: 0.9%, compared with a median rate of 3.3% reported in the literature. We also found that patients receiving psychiatric consultations used more hospital resources than other patients.     

Psychiatric consultations in two Israeli general hospitals

Data were gathered on 479 inpatients of two Israeli general hospitals for whom psychiatric consultations were requested over a 1-year period. The data presented here include age and sex of referred patients, source of referral, reason for referral, psychiatric and physical diagnoses, and consultant's recommendation. Emergency ward consultations are included. Additional data were collected on patients transferred to psychiatric wards. Our findings are similar in general to those reported from other countries, although such comparisons are limited by the lack of uniformity in the classifications used by the various workers.     

Psychiatric services in general hospitals. Rational and irrational considerations

The structure of a psychiatric service in an urban general hospital is complex. Varied intrainstitutional and extrainstitutional relationships create stress, which can lead to rational and irrational reactions, often in combination. Psychologic mechanisms that exist in individuals also occur as shared defense mechanisms in an institutional setting, serving to reduce anxiety and stress but often at the expense of accurate reality perception. Good communication can play a vital role in reducing reality distortions but is itself often blocked or impaired by the same defense mechanisms that led to the distortions. An awareness of how these mechanisms operate in an institutional setting can aid the psychiatric administrator in correcting distortions and maintaining good channels of communication.     

Utility and sufficiency of psychiatric inpatient units in general hospitals: a cross-sectional study in Tokyo

In order to investigate the utility and sufficiency of psychiatric beds in general hospitals (GHP beds), a cross-sectional study was performed in general hospitals all over Tokyo. Reasons for admission were acute-phase treatment (43%), medical comorbidity (15%), electroconvulsive therapy (13%), differential diagnosis (12%), and others (17%). The number of patients who could not be admitted to GHP beds despite appropriate reasons for admission was estimated to be greater than that of inpatients without indispensable reasons for admission to GHP beds on the day of the survey. GHP beds played the expected roles, and were in short supply.     

Psychiatric disorders in two general hospitals: a survey of prevalence and treatment by nonpsychiatrist physicians.

This study reports an opinion survey of 211 nonpsychiatrist physicians in two general hospitals who estimated that 16.1% of their patients have psychiatric disorders and that they spent 13.8% of their time in treating the psychiatric components of their patients' illnesses. Physicians indicated that anxiety and psychosomatic and depressive illness were the most frequent psychiatric disorders and that one-third of them would personally treat such disorders without referral to psychiatric consultation. The findings also suggest that adequate undergraduate psychiatric education was associated with increased recognition of psychiatric disorders and more preference for their personal treatment. In addition, it provides a possible explanation for the discrepancy between the high prevalence of psychiatric disorders in general hospital patients and the low referral rate to psychiatric consultation.     

Psychiatric intensive care units: a literature review

BACKGROUND: Psychiatric Intensive Care Units (PICU) have been part of most inpatient psychiatric services for some time, although information about their functioning and outcome has not previously been collated. AIM: To conduct a systematic literature review to assess the current state of knowledge about such services. METHOD: A search of electronic databases was undertaken, followed by obtaining additional references from items obtained. RESULTS: Over 50 papers in English containing some empirical data were identified. Most studies were retrospective. Typical PICU patients are male, younger, single, unemployed, suffering from schizophrenia or mania, from a Black Caribbean or African background, legally detained, with a forensic history. The most common reason for admission is for aggression management, and most patients stay a week or less. Evidence of the efficacy of PICU care is very poor. CONCLUSIONS: Most research so far has been small scale, and more substantial work using better methodologies is clearly required.     

Psychiatric hospitals in motion

Papers in respect to the topic "On the possibility of influencing the course of psychiatric illness" which were presented at the 5th Steinhof Symposium, October 1979 in Vienna, are summarized with the aim to focus on and to support necessary efforts for an improvement of psychiatric care. Investigations in inpatient populations (Str?mgren, E.: Past and future changes in inpatient population; Gabriel, E.: Modifications in inpatient populations of big psychiatric hospitals) showed the importance of institutional differentiation and the similarity of problems in different countries, e.g. Denmark and Austria is mentioned. The papers of Ciompi (Prognosis in rehabilitation of chronic psychiatric patients) and Pfolz et al. (Factors preventing discharge of long-term inpatients from hospital) summarize concepts of inpatient care. In the papers of Sch?ny et. al. (Ward group therapy--its importance for the opening of psychiatric wards) and Lyon (Supervision of community--auxiliary lay workers) modern concepts of a pragmatic psychiatry are described. Trends in psychiatric inpatient care are becoming apparent which raise the hope that psychiatric hospitals will provide--through the aforementioned differentiation--more adequate care for the individual patient.     

Psychiatric consultations in a general hospital

A statistical analysis of psychiatric referrals for inpatients in a urban general hospital are presented: Data are compared to reports from the last twenty years. Significant differences for age, sex and diagnosis are noted. These are attributed to the specific vocation of the hospital as a chest and cardio center for eastern Quebec. The discussion deals with various aspects of the clinical material. References from out-patient clinics are not included.