Anticonvulsant drug regimen and cost of acute treatment for status epilepticus in a Philippine tertiary hospital: A retrospective cohort study

Background@#Status epilepticus (SE) is a neurological emergency requiring prompt evaluation and management to prevent disease refractoriness associated with significant mortality and morbidity. Thus, estimating costs attributable to the treatment of SE is important because of the severity of this disease. In the Philippines, healthcare provisions are mostly out-of-pocket expenses; hence the cost of treatment is a critical determinant for disease management. Unfortunately, the availability of data regarding the cost of illness of SE in developing countries is limited.@*Objectives@#To determine the frequently used anticonvulsant drug regimen and direct inpatient costs of acute treatment for status epilepticus within five years in a private tertiary hospital in the Philippines.@*Methods@#Records from patients diagnosed with SE who were admitted under or referred to the Adult Neurology Service in a private tertiary hospital from January 2015 to December 2019 were retrospectively evaluated. The SE type was classified as non-refractory (NRSE), refractory (RSE), and super refractory (SRSE). Demographic data, clinical features, SE type, etiology, antiepileptic drugs (AEDs) and anesthetic drugs used, total cost of AEDs and anesthetic drugs, total cost of 5-day hospitalization, and total cost of entire length of stay were recorded.@*Results@#We retrieved the records of 61 patients admitted for SE. Of these patients, 23 were classified as nonrefractory, 20 as refractory, and 18 as super refractory. Diazepam was given to all SE patients as first-line treatment. Valproic acid and levetiracetam were used as second-line treatments. The most frequently given anesthetic drug was midazolam. The mean hospitalization cost per patient was ₱52,0982.3 for SE, ₱659,638.7 for RSE, and ₱134,1451 for SRSE. The mean cost of 5-day hospitalization was ₱193,572.3 for NRSE, ₱358,808.5 for RSE, and ₱652,781 for SRSE. The mean cost of medications was ₱18,546 for NRSE, ₱30,780 for RSE, and ₱128,263 for SRSE.@*Conclusion@#The direct cost of SE varied depending on subtype and response to treatment. Costs increased with disease refractoriness. Direct inpatient treatment costs for SRSE were twice as high as that of NRSE and RSE.

Hospitalización por Intento de Suicidio en Adolescentes: Mirada retrospectiva de la experiencia y los cambios asociados / Hospitalization for Attempted Suicide in Adolescents: Retrospective look at the experience and associated changes

Resumen: Antecedentes: El principal factor de riesgo para suicidio consumado es el Intento Suicida (IS) previo. La hospitalización psiquiátrica es un recurso terapéutico utilizado en adolescentes para proteger su integridad. Objetivo: Describir y comprender la experiencia de hospitalización psiquiátrica por intento de suicidio y los cambios asociados a ésta, desde la perspectiva de lo/as adolescentes implicados. Método: Estudio cualitativo descriptivo que entrevista a 10 adolescentes que fueron hospitalizados por IS en un centro psiquiátrico. Las entrevistas semiestructuradas fueron codificadas según los criterios de codificación abierta y axial de la Teoría Fundamentada. Resultados: Se presentan dos categorías descriptivas: a) Hospitalización: "lo peor que me ha pasado en la vida… pero tuvo cosas buenas", y b) "Una vez afuera, pienso que me sirvió para cambiar". Luego, se presenta un esquema relacional que articula ambos fenómenos, "de la conmoción a la contención reflexiva". Conclusiones: La experiencia de hospitalización psiquiátrica por IS constituye una experiencia de alto impacto existencial, que brinda posibilidades de movilizar cambios personales y familiares. Sólo post-hospitalización lo/as adolescentes visualizan y desarrollan estos cambios, adhiriendo a los tratamientos indicados y apoyo familiar. Sin embargo, la indicación y gestión de este recurso terapéutico debe ponderarse, para evitar riesgos asociados.

Abstract: Background: Previous suicide attempt (SA) is the main risk factor for completed suicide. Psychiatric hospitalization is a therapeutic resource used in adolescents to protect their integrity. Aim: To describe and understand the experience of psychiatric hospitalization due to SA and the changes associated with it, from the perspective of adolescents involved. Method: Descriptive qualitative study that interviews 10 adolescents who were hospitalized for SA in a psychiatric center. Semi-structured interviews were coded according to Grounded Theory's open and axial coding criteria. Results: Two descriptive categories are presented: a) Hospitalization: "the worst thing that has happened to me in my life… but it had something positive", and b) "Once outside, I think it helped me to change". Then, a relational scheme that articulates both phenomena is presented, "from shock to reflective containment". Conclusions: The experience of psychiatric hospitalization for SA constitutes an experience with a high existential impact, which offers possibilities to mobilize personal and family changes. Only after hospitalization adolescents visualize and develop these changes, adhering to the indicated treatments and family support. However, the indication and management of this therapeutic resource must be considered, to avoid associated risks.

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Objective: To describe and evaluate the response and predictors of remission during inpatient treatment in a psychiatric unit in a general hospital based on symptomatology, functionality, and quality of life (QoL). Methods: Patients were admitted to a psychiatric unit in a tertiary general hospital in Brazil from June 2011 to December 2013 and included in the study if they met two of the severe mental illness (SMI) criteria: Global Assessment of Functioning (GAF) ≤ 50 and duration of service contact ≥ 2 years. Patients were assessed by the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) Severity Scale , GAF, the World Health Organization Quality of Life Instrument – Abbreviated version (WHOQOL-Bref), and specific diagnostic scales. Results: A total of 239 patients were included. BPRS mean scores were 25.54±11.37 at admission and 10.96±8.11 at discharge (p < 0.001). Patients with manic episodes (odds ratio: 4.03; 95% confidence interval: 1.14-14.30; p = 0.03) were more likely to achieve remission (CGI ≤ 2 at discharge) than those with depressive episodes. Mean length of stay was 28.95±19.86 days. All QoL domains improved significantly in the whole sample. Conclusion: SMI patients had marked improvements in symptomatic and functional measures during psychiatric hospitalization. Patients with manic episodes had higher chance of remission according to the CGI.

Hospitalização integral para tratamento dos transtornos alimentares: a experiência de um serviço especializado / Inpatient treatment for eating disorders: the experience of a specialized service

OBJETIVO: Descrever as características da hospitalização integral para o tratamento de transtornos alimentares em um serviço especializado de Ribeirão Preto, SP. MÉTODOS: Foram revisados todos os prontuários dos pacientes em seguimento pelo serviço, de 1982 até 2011, especialmente aqueles que tiveram indicação de internação integral. Foram coletados dados sociodemográficos e referentes ao diagnóstico. RESULTADOS: No período referido, 186 pacientes receberam atendimento pelo serviço e, desses, 44,6% (n = 83) foram internados para tratamento. Ao longo do tempo, houve redução na relação atendimento/internação, passando de 77,7% para 36,2% dos casos. A média de internações foi de 1,9 ± 3,9 vezes, e 73,5% (n = 61) dos pacientes foram hospitalizados apenas uma vez. A duração média da internação, independentemente do número de hospitalizações, foi de 70,6 ± 115,9 dias (variação de 3 a 804 dias). A predominância foi do sexo feminino, raça branca, solteira, sem filhos e com idade média de 23,3 ± 10,8 anos. O diagnóstico predominante foi de anorexia nervosa (85,5%), sobretudo em seu tipo restritivo (54,2%). As indicações mais frequentes para internação foram para realização de terapia nutricional (50,9%), seguida da investigação do quadro clínico (30,1%) e por causa de depressão e/ou ideação suicida (10,9%). CONCLUSÃO: A hospitalização integral é uma modalidade terapêutica necessária para o tratamento desses quadros, e sua frequência foi considerada significativa, porém diminuiu ao longo do tempo. Esse resultado pode ser explicado pela tendência de desospitalização a partir da reforma psiquiátrica, do diagnóstico e tratamento mais precoces e da experiência adquirida pelos profissionais do serviço ao longo dos anos.

OBJECTIVE: To describe the characteristics of inpatient treatment for eating disorders in a specialized service in Ribeirao Preto, SP. METHODS: We reviewed all the medical records of patients followed up for the service between 1982 and 2011, particularly those who received inpatient treatment. Sociodemographic data and related to diagnosis were collected. RESULTS: In the said period, 186 patients were treated by the service and 44.6% (n = 83) were hospitalized for treatment. A reduction was observed in hospitalization rates of 77,7% to 36,2% over time. The average hospitalization was 1.9 ± 3.9 times of which 73.5% (n = 61) patients were hospitalized only once. The mean duration of hospitalization, regardless of the number of hospitalizations was 70.6 ± 115.9 days (range 3-804 days). Most patients were female, Caucasian, unmarried, childless and with a mean age of 23.3 ± 10.8 years old. The predominant diagnosis was anorexia nervosa (85.5%), especially in its restrictive type (54.2%). The most common indications for hospitalization were for nutritional support therapy (50.9%), followed by the clinical research (30.1%) and due to depression or suicidal ideation (10.9%). CONCLUSION: Inpatient treatment was a therapeutic modality required for treatment of these patients and their frequency was significant, but decreased over time. This result can be explained by the trend of deinstitutionalization from the psychiatric reform, earlier diagnosis and treatment and the experience gained by service professionals over the years.

Effects of Kampo Therapy for Inpatient on Medical Economics / 日本東洋医学雑誌

We investigated prescriptions and drug costs at admission and discharge for 35 patients hospitalized in Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital from September 2006 to October 2008. They recovered after Kampo therapy from various non-acute diseases. The number of western drugs decreased from 3.7 at admission to 2.7 at discharge, thus their drug costs per day significantly decreased from302.1yen to 227.6 yen. The cost of Kampo medicines themselves, on the other hand, did not decrease significantly. Total drug costs, however, were significantly reduced from 437.8 yen at admission to 348.0 yen at discharge, so patients' overall costs were reduced by 20%. These results indicated that the proper use of Kampo medicine for various diseases would reduce drug costs and the impact of treatment expenses on medical economics, with improvement in disease outcomes.

The Family Therapy and Inpatients Treatment for the Adolescent Internet Addiction

The status and function of family plays the key role in the maintenance, aggravation and recovery of adolescent internet addiction. Especially, the secure attachment and open communication between parents and adolescents can prevent the situation from getting worse. Given the adequate supervision, support and relationship in the family, the adolescents can be immunized against internet addiction. Internet addicts have diverse underlying psychopathologies, such as attention deficit hyperactivity disorder, impulse control disorder, depressive-anxiety disorder, and socialization deficit. The management of the internet addicts needs a holistic approach including medication for the underlying psychopathology, family therapy, cognitive behavioral therapy, and educational therapy. In this review article, the authors describe the family education, family therapy and multidisciplinary-integrative inpatient treatment for the adolescent internet addicts.

Inpatient Treatment of Anorexia Nervosa: Clinical Practice Models / 신경정신의학

The treatment consensus of anorexia nervosa in the last century was to remove the patient from her family and home surroundings. A great range of treatment from prescribing hormonal extracts to prefrontal leucotomy has been tried. Although in former decades many quite different forms of treatment have been described and advocated for anorexia nervosa, there is today consensus concerning the overall management of the disorder. But there still remains a widespread clinical opinion that inpatient treatment is necessary for some as a means of reliably increasing weight. Over the last hundred years the management of anorexia nervosa has changed. Treatment has shifted from medical wards, through to psychiatric wards and now, following the trends in all of medicine, towards community care in Western society. In Korea, case reports of anorexia nervosa and related articles have been published since the late seventies. Recently several epidemiological studies and clinical reports suggested increasing rate of eating disorders including anorexia nervosa in Korea. However, systematic approaches for these patients have not been tried in Korea. The author introduces the treatment model for inpatients with anorexia nervosa of Johns Hopkin's Hospital, Maudsley Hospital, and St. John's Mercy Medical Center. The author also introduces treatment experience with anorexic inpatient at Seoul Paik Hospital.