Factors related to positive and negative outcomes in psychiatric inpatients in a general hospital psychiatric unit: a proposal for an outcomes index

Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS), Global Assessment of Functioning (variation and at discharge) and Clinical Global Impression (severity and improvement) were used to build a ten-point improvement index (I-Index). Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes) were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

A Comparative Study of Phenomenology, Psychiatric Co-Morbidities and Global Functioning of People with ADHD from Childhood to Adulthood.

Introduction: Although previously thought to remit largely in adolescence, a growing literature supports the persistence of the disorder and/or associated impairment into adulthood. Studies in India are lacking on ADMD. Aims and Objectives: To compare the phenomenology of ADHD in childhood, adolescence and adulthood, to compare the psychiatric co-morbidities with ADHD in childhood, adolescence and adulthood, to compare the global functioning of subjects with ADHD in childhood, adolescence and adulthood. Methods: A statistical comparison was made between studies done in dept. of psychiatry, CSMMU UP, Lucknow on childhood, adolescent and adult ADHD for its various aspects. Conclusions: Hyperactivity-impulsivity decreases as subjects with ADHD grow up and inattention symptoms become more impairing, ADHD is highly co-morbid across all age groups but the nature of co-morbidities change, functioning of subjects with ADHD improve as they grow older.