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At least 19 recordsLinked to original sources
PubMed2006

[Involuntary patient admission and treatment against patient's will by emergency physicians].

INTRODUCTION: The treatment of acutely ill patients who presumably lack the insight or judgement to determine their need for medical treatment, is a difficult challenge for emergency physicians. We have carried out a study to assess the frequency and relevance of involuntary treatment and procedures in medical emergency services. METHODS: Retrospective chart analysis for a 1-year period was performed for all treatment protocols of a medical emergency service unit and for all court-ordered treatments of a guardianship court. Cases of involuntary treatment by emergency physicians were identified and analysed. RESULTS: In 10.4% of all emergency calls analysed a relevant and acute psychiatric condition was found. In 0.3% of the cases or 4.8% of the psychiatric cases, involuntary inpatient commitment was chosen by the emergency physician. DISCUSSION: Involuntary inpatient commitment by emergency physicians was only necessary in relatively few cases. Nevertheless, in order to be able to correctly consider treatment and management options, emergency physicians should be aware of the basic conditions for treatment without a patient's consent.

Adolescent↗
PubMed1995

[Patient admission to a child and adolescent psychiatric polyclinic. Referral, patient information, preparation, concepts, expectations and fears of children, adolescents and their parents].

This study investigates 77 families i.e. their children, aged 7-17, and their parents, who attended the out-patient clinic of the child psychiatric department for the first time. It was intended to examine and outline the subjective situation on entering the clinic. A structured verbal interview was conducted with the children before the start of the actual examination procedure, while a written questionnaire was submitted to the parents. Among the questioned items were modes of referral, references, sources of information, knowledge and preparedness, ideas, expectations and apprehensions about the institution and its treatments. The answer that were obtained reflected a lack of self-determination on the part of the children and the strength of influence exerted by the parents along with other relevant authorities. The children were often taken to the clinic without any active consent on their part. When asked about hopes of improvement they did not often confirm. Similarly fears about the impending examination were at first denied by most children but subsequently conceded, when concrete suggestions were made. Strikingly the better informed and prepared, children were able to admit to their fears more often. The results of the parental questionnaire illustrate an extensive lack of information about the institution that the families were actually attending. It may be concluded that the parents had also been little assertive when preparing their children for the examination. When asked about their expectations the parents primarily quoted "help" and "advice". Scepticism about the examination came only at the bottom of the list.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Admission-discharge policies for hysteroscopic surgery: a randomised comparison of day case with in-patient admission.

OBJECTIVE: To study the effectiveness and acceptability of day case hysteroscopic surgery. DESIGN: Prospective randomised controlled trial. SETTING: Aberdeen Royal Infirmary. SUBJECTS: One hundred and ninety four consecutive women who underwent hysteroscopic endometrial ablation. INTERVENTION: Seventy three women were allocated to day case surgery and 37 to inpatient admission; 84 women though otherwise fit for day case surgery were scheduled for in-patient admission as they lived more than 20 miles away. All women completed a questionnaire 24 h after their operations. Readmission rates were obtained from case notes. Satisfaction rates 12 months after the operation were recorded by means of a follow-up questionnaire. RESULTS: Post-operative pain was absent or slight in 48 (75%) of the women in the day case group 27 (84%) of women in the in-patient group, and 55 (82%) in the non-randomised in-patient group. Post-operative analgesia was necessary in 34 (52%) women in the day case group, 24 (75%) women in the in-patient group and 36 (53%) women in the non-randomised in-patient group. Hospital costs were significantly less in the day case group. Satisfaction with stay 92% in the day case group, and 100% in the other two groups. CONCLUSION: In this setting, day care is a safe acceptable and less expensive alternative to in-patient care for hysteroscopic endometrial ablation.

Adult↗
PubMed2005

Bridging the information gap between hospitals and home care services: experience with a patient admission and discharge form.

Hospital care and ambulatory care are institutionally and financially so deeply separated in Germany that discontinuity of individual treatment and, hence, losses in both the quality and efficiency of care are all too often the consequences of this widely deplored systemic defect. In order to improve the communication between home care services and hospitals during admission or discharge of patients in need of long-term nursing care, the research project 'aski' has developed an innovative instrument and procedure for the reciprocal transfer of information between these institutions. After successful testing, the Patient Accompanying Form was offered for public use. Two years later, a written and telephone survey was conducted among the somewhat disappointingly small number of its users. Based on their experience, issues surrounding the implementation of such instruments in the health care system are discussed as well as the chances of enhancing integrative care by promoting coordinated communication between the providers.

Aftercare↗
PubMed1997

Mental illness, physical abuse and burden of care on relatives: a study of acute psychiatric admission patients.

As mental health care policies increasingly emphasize treatment and care in community settings, there has been concern over the burden that families of mentally ill people might suffer as a result. We conducted a study of the prevalence of abuse faced by relatives of patients admitted during a 6-month period to the acute psychiatric unit of a busy general hospital, who had previously been living with a relative. Patients and their relatives were assessed using semi-structured interview schedules. The experience of burden and the specific experiences of abuse since the onset of their relative's illness were recorded. In total, 32 (32%) of the 101 relatives had been struck on at least one or two occasions. Verbal abuse, threats and temper outbursts were reported by over 50% of the relatives. Principal correlates of abuse were diagnosis, concurrent drug misuse and a poor pre-morbid relationship between carer and patient.

Adolescent↗
PubMed1995

Medication treatment in first-admission patients with psychotic affective disorders: preliminary findings on research-facility diagnostic agreement and rehospitalization.

The discharge medications of 101 Suffolk County subjects with facility and/or research diagnoses of affective disorder were ascertained. Rehospitalization was recorded for a 6-month follow-up period. Twenty-three of 31 patients (74.2%) with a facility diagnosis of depressive disorder were prescribed antidepressants, and 21 of 36 patients with a facility diagnosis of bipolar disorder (58.3%) were prescribed lithium. When research and facility diagnoses concurred, 84.2% of depressed patients were prescribed antidepressants, and 66.7% of bipolars were given lithium. The percentages were lower when the two diagnoses were discrepant. The results for diagnostic congruence were independent of demographic variables, length of stay, and premorbid functioning. Patients prescribed diagnosis-specific medications had a lower rate of rehospitalization (7.3%) than those not prescribed such medications (22.2%). The findings suggest that such medications are prescribed in the more unambiguous cases of affective disorders and are important (with or without antipsychotic treatment) in preventing rehospitalization.

Adolescent↗
PubMed1994

Six-month stability of psychiatric diagnoses in first-admission patients with psychosis.

OBJECTIVE: The short-term diagnostic stability of schizophrenic and other psychotic disorders was examined in first-admission patients, with attention to the principal reasons for diagnostic change. METHOD: Hospitalized first-admission patients (N = 278) participating in an epidemiologic study were interviewed at baseline and after 6 months with the Structured Clinical Interview for DSM-III-R. A best estimate diagnosis was made at both time points with the use of all available sources of information. Reasons for changes in diagnosis were determined by two psychiatrists. RESULTS: Affective psychosis and schizophrenic disorders were relatively stable broad diagnostic categories over the 6-month period, with 86.5%-88.9% of the patients remaining in the same category, although findings for specific diagnoses within these categories ranged from 61.5% to 85.7%. The groups with unknown and nonspecific diagnoses showed less stability; the diagnoses of more than one-third of these patients remained unknown or nonspecific at the 6-month evaluation. If the 6-month diagnoses are used as the research standard, somewhat lower percentages of patients received the same diagnoses at baseline. Forty-three percent of the changes in diagnosis were attributed to the clinical course of illness; the rest were attributed to the diagnostic process itself. CONCLUSIONS: A longitudinal diagnostic assessment based on multiple sources of information is crucial for categorizing first-admission psychotic patients, particularly those who do not initially fit into a DSM-III-R category. The short-term stability of a diagnosis is a function of multiple factors, including the changing clinical picture, additional sources of information, and new interpretations of original data.

Adolescent↗
PubMed2002

Gaps in use of antipsychotics after discharge by first-admission patients with schizophrenia, 1989 to 1996.

The authors examined gaps in the use of antipsychotic medications during the one-year period after discharge in an epidemiological sample of 189 first-admission patients with schizophrenia between July 1989 and January 1996. Sixty-three percent of the patients had one or more such gaps, and 51 percent had gaps of 30 days or longer, with an average total time off medication of about seven months. Most gaps occurred soon after discharge, and 73 percent were initiated by the patient. These data, which were obtained before the widespread use of atypical antipsychotic agents, provide a benchmark against which to examine the impact of the newer medications on adherence and continuity of treatment in the critical early stages of schizophrenia.

Adult↗
PubMed1991

Familial thyroid disease and delayed language development in first admission patients with schizophrenia.

One hundred consecutive first admission patients with a DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder were compared with 100 randomly selected community controls. Childhood histories of physical, medical, and perinatal trauma, as well as physical and cognitive development, were examined by structured interviews with all available mothers of patients and controls. The prevalence of specific psychiatric disorders and several medical illnesses among first degree and more distant relatives was determined by family history questionnaires. The patient group did not have an excess of childhood head injuries, serious infections, or perinatal/birth complications compared with controls. With social class level taken into account, it was found that the acquisition of reading skills occurred significantly later in patients than controls. Family histories of schizophrenia and thyroid disorders were significantly more frequent among patients than controls. These data fail to indicate any childhood physical or medical environmental trauma that could lead to an increased risk for schizophrenia, although patients were substance abusers to a greater extent than controls. This study also confirms the already known contribution of familial factors and suggests an association of the inheritance of thyroid disorders with schizophrenia. Delayed development of reading skills suggests that precursers of illness may appear early in life before psychosis is evident.

Adult↗
PubMed2006

Mortality among first-admission patients with psychosis.

OBJECTIVE: This study compared 5- and 10-year survival and absolute and relative mortality rates among first-admission patients with 1 of 4 psychotic disorders: schizophrenia/schizoaffective disorder, bipolar disorder, major depression, and other nonorganic psychoses. METHOD: The authors conducted a prospective 10-year follow-up of subjects first admitted with a diagnosis of nonorganic psychosis to any of 12 hospitals in Suffolk County, New York, during the period 1989 to 1995. Information on their death status since study entry was ascertained from the Social Security Death Index and the National Death Index. Survival analyses were conducted using the Kaplan-Meier product-limit estimator. RESULTS: There were no significant differences in survival rates among the 4 diagnostic groups at 5-year (range, 96.3%-97.8%) or 10-year (range, 90.2%-97.8%) follow-up. Absolute mortality over the study period ranged from 2.8% of bipolars to 6.7% of those with major depression. About 60% of deaths among schizophrenic/schizoaffective subjects were due to unnatural causes, whereas for the other 3 groups, deaths were more evenly split between natural and unnatural causes. Suicides comprised most deaths from unnatural causes, most of which occurred during the 2- to 5-year follow-up period. Deaths due to natural causes tended to be related to lifestyle factors. CONCLUSIONS: First-admission patients with psychosis experience similar patterns of mortality risk over the first 10 years after index admission regardless of underlying diagnosis. Causes of death (both natural and unnatural) were potentially preventable with more intensive medical and psychiatric follow-up and intervention. Many deaths from unnatural causes occurred during or shortly after discharge from an inpatient or residential treatment setting, highlighting this period as one needing close scrutiny by treating clinicians.

Affective Disorders, Psychotic↗
PubMed1977

Community-hospital pharmacist detection of drug-related problems upon patient admission to small hospitals.

A method was developed to increase community-hospital pharmacist consultation on patient drug use in order to detect drug-related problems upon patient admission to the hospital. A medication history was takenon criteria-selected patients admitted to two hospitals in distant, but similar, geographically small and isolated areas. Tho total number of patients selected was 392. Information about prior drug use was obtained from participating community pharmacists and their patient prescription records and medication profiles. It was found by pharmacist-acquired drug histories that one of five criteria-selected patients had a preexisting drug-related problem that the admitting physician acknowledged probably contributed to the admission and necessitated professional and patient communication. These problems included: adverse response to prescribed therapy, misuse of medication or noncompliance, effect of diet on therapy, patient treatment by more than one prescriber, and therapeutic ineffectiveness or inappropriateness of prescribed therapy. Drug histories were not obtainable in 25.6% of the patients.

Aged↗
PubMed2003

Primary options for acute care: general practitioners using their skills to manage "avoidable admission" patients in the community.

AIM: To enroll 600 primary care "avoidable admission" patients in a programme that utilised general practitioners to manage those patients in the community. METHODS: The Primary Options for Acute Care (POAC) programme ran from 26 February to 31 December 2001. Using networks already established, primary care teams were invited to manage patients using any resources they required, up to a cost of approximately $266 per patient. If needed, a Service Coordinator was available to arrange investigations, care, or treatment. RESULTS: From 26 February to 31 December 2001, 707 patients were enrolled in POAC by 100 GPs. 104 patients (15%) were eventually admitted to hospital. An average of $200.73 per patient per episode was spent (not including administrative costs). A wide variety of patients and diseases were managed. Patients and general practitioners reported high levels of satisfaction with the programme. CONCLUSION: POAC demonstrated the ability and willingness of primary care providers to successfully manage patients who traditionally would be sent to hospital, within a defined budget

Adult↗
PubMedDate not supplied

Diagnostic and demographic classification of psychiatric patients admission in Bendel state of Nigeria. A review of the University of Benin Teaching Hospital (UBTH) psychiatric inpatients' record of 1980.

The records of psychiatric inpatients treated in 1980 at the University of Benin Teaching Hospital psychiatric admission unit were reviewed. Diagnostic and demographic characteristics of these patients were extracted, analyzed and reported on. The trend in psychiatric patients admission in this part of the world is discussed.

Adolescent↗