Tendencia de las hospitalizaciones en la Unidad de Corta Estadía de Psiquiatría del Hospital Clínico Herminda Martin durante 14 años / Trend of hospitalizations in the Short Stay of Psychiatry Unit of Herminda Martin Clinical Hospital for 14 years

INTRODUCCIÓN: La hospitalización psiquiátrica de corta estadía es un recurso necesario para tratar trastornos mentales con descompensación severa que no pueden resolverse ambulatoriamente. El conocimiento de sus resultados ayuda en la gestión clínica y administrativa. Este estudio tiene por objeto evaluar la evolución de indicadores hospitalarios, características sociodemográficas y clínicas de pacientes hospitalizados en unidad de corta estadía de psiquiatría. MATERIAL Y MÉTODO: Estudio longitudinal, retrospectivo, de tendencia, realizado sobre el universo constituido por 4.563 egresos de UCEP de Hospital de Chillán, Chile, durante 14 años, desde el 01/07/2005 al 30/06/2019. Se evaluaron variables hospitalarias, sociodemográficas y clínicas. RESULTADOS: en el período en estudio: Disminuyeron los egresos, se prolongó el promedio días estada, aumentó el índice ocupacional y disminuyó el índice de rotación. Un bajo número de pacientes, con predominio de adversidades socioeconómicas y psicosociales, se re-hospitalizó frecuentemente. A mayor número de internaciones mayor estadía. Se incrementaron las hospitalizaciones administrativas y judiciales; éstas últimas con mayor promedio de estada. Aumentó la hospitalización de varones, adolescentes, jóvenes y adultos mayores. Predominaron comunas y consultorios con mayor población, cercanía y acceso. Se mantuvo frecuencia de esquizofrenia y otros trastornos psicóticos y trastorno de personalidad, se duplicaron los trastornos afectivos, triplicaron los trastornos por sustancias, duplicó la patología dual, y el trastorno de personalidad fue frecuente en comorbilidad con trastorno por sustancias y trastornos afectivos. CONCLUSIONES: se requerirían estrategias con Sistema Judicial y Servicio de Salud, implementar unidad de adolescentes y unidad de adicción, y fortalecer atenciones multidisciplinarias para adultos mayores.

BACKGROUND: Short-stay psychiatric hospitalization is a necessary resource to treat mental disorders with severe decompensation that cannot be resolved outpatiently. Knowledge of your results helps in clinical and administrative management. This study aims to evaluate the evolution of hospital indicators, sociodemographic and clinics characteristics of inpatients in a short-stay unit of psychiatry. MATERIAL AND METHODS: Longitudinal, retrospective, trend study was conducted in a universe of 4,563 egress of short-stay psychiatric unit of Chile, for 14 years, from 01/07/2005 to 30/06/2019. Hospital indicators, sociodemographic and clinical variables were evaluated. RESULTS: during the period under study: The egress decreased, the average days were prolonged, the occupational index increased and the turnover rate decreased. A low number of patients, predominantly socioeconomic and psychosocial adversities, were frequently re-hospitalized. The greater the number of hospitalizations longest stay. Administrative and judicial hospitalizations were increased; the latter with the highest average stay. Hospitalization of males, adolescents, young people and older adults increased. Communes and primary care center with a greater population, proximity and access predominated. It remained frequency of schizophrenia and other psychotic disorders and personality disorders, doubled affective disorders, tripled substance disorders, doubled dual pathology, and personality disorder was common in comorbidity with substance disorder and affective disorders CONCLUSIONS: strategies would be required with the Judicial System and Health Service, implement adolescent unity and addiction unit, and strengthen multidisciplinary care for older adults.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance / Satisfação com o cuidado em uma unidade de internação psiquiátrica brasileira: diferenças nas percepções dos pacientes segundo tipo de plano de saúde

Abstract Introduction User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. Methods This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. Results We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. Conclusion Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Resumo Introdução A avaliação da satisfação do usuário nos serviços de saúde mental é um importante indicador da qualidade do tratamento. O objetivo deste estudo foi avaliar a satisfação com o tratamento em uma amostra de pacientes internados com transtornos mentais e as associações entre os níveis de satisfação e variáveis clínicas/sociodemográficas. Métodos Este estudo exploratório investigou 227 pacientes psiquiátricos internados que responderam a Escala de Satisfação do Paciente com os Serviços de Saúde Mental (SATIS-BR) e a Escala de Percepção da Mudança (EMP). Os escores SATIS-BR foram analisados segundo associações com dados clínicos e sociodemográficos. Correlações de Pearson foram usadas para correlacionar escores SATIS com outras variáveis. Resultados Encontramos alto grau de satisfação com o atendimento na unidade de internação psiquiátrica avaliada. Em geral, os pacientes atribuíram satisfação máxima para a maioria dos itens. Os maiores escores de satisfação foram associados a pacientes em tratamento pelo Sistema Único de Saúde (SUS) e com menor escolaridade. A SATIS mostrou uma correlação positiva moderada com EMP. A pior dimensão avaliada foi associada às instalações físicas e conforto da enfermaria. Conclusão Pacientes com cobertura pelo SUS podem estar mais satisfeitos do que pacientes com planos privados de saúde quando tratados na mesma unidade. A avaliação da satisfação com o tratamento pode ser usada para reorganizar serviços em unidades de internação psiquiátrica.

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.

Perfil sociodemográfico de tabagistas internados em enfermaria psiquiátrica de hospital geral / Sociodemographic profile of smokers admitted to the psychiatric ward of a general hospital / Perfil sociodemográfico de los tabaquistas hospitalizados en la enfermaría psiquiátrica de uno hospital general

A partir do interesse dos profissionais da saúde em controlar o tabagismo, chamou a atenção sua elevada frequência na população psiquiátrica. Neste estudo, objetivou-se identificar o perfil sociodemográfico de pacientes psiquiátricos, tabagistas, comparando-o com o de ex-tabagistas e não tabagistas. Pesquisa exploratória, realizada de agosto de 2010 a fevereiro de 2012, envolvendo pacientes psiquiátricos, internados em hospital geral, por meio de entrevista com questionário estruturado. Das 433 pessoas internadas, participaram 270, das quais 83,7% eram portadoras de transtornos mentais severos, 35,6% eram tabagistas, 14,1% extabagistas e 50,4% não tabagistas. Entre os tabagistas, predominou o sexo masculino, 30-49 anos de idade, ensino fundamental, área rural, separados/divorciados, sem ocupação, renda R$ 600, espíritas e sem prática religiosa. Esse perfil é semelhante ao encontrado em tabagistas de outros grupos da população. Houve diferença no perfil de pacientes psiquiátricos, segundo o tabagismo. Esse conhecimento pode ajudar o enfermeiro a planejar intervenções, segundo as necessidades e possibilidades dos sujeitos.

From the interest of health professionals in tobacco control, stood out its high frequency in psychiatric population. This paper aimed to identify the socio-demographic profile of psychiatric patients who are also smokers, comparing with former smokers and non smokers. Exploratory survey, conducted from August 2010 to February 2012, involving psychiatric patients hospitalized in a general hospital, through interviews using a structured questionnaire. Out of the 433 persons hospitalized, 270 took part of this study; 83.7% are carriers of severe mental disorders; 35.6% are smokers, 14.1% former smokers and 50.4% non smokers. Higher proportion of smokers was found among male, 30-49 years old, junior high schooling, rural area, separated/divorced, without occupation, income and religion practice. This profile is similar to smokers of other groups of population. There was difference in the profile of psychiatric patients according to smoking. This knowledge may help nurse to plan interventions, according the needs and possibilities of the subjects.

Desde el interés de los profesionales de la salud en controlar el tabaquismo, llamó la atención su frecuencia elevada en la populación psiquiátrica. Objetivó-se identificar el perfil sociodemográfico de los pacientes psiquiátricos, tabaquistas, comparándolos con los de ex tabaquistas y no tabaquistas. Encuesta exploratoria, realizada a partir de agosto 2010-febrero 2012, la participación de los pacientes psiquiátricos hospitalizados en un hospital general, a través de entrevistas mediante un cuestionario estructurado. De los 433 pacientes hospitalizadas, participaron 270; 83,7% eran portadoras de trastornos mentales severos; 35,6% eran tabaquistas, 14,1% ex tabaquistas y 50,4% no tabaquistas. La mayor proporción de tabaquistas ocurrió en personas del sexo masculino, 30-49 años, educación primaria, área rural, separado/divorciado, sin ocupación, renda R$ 600 reales, espiritistas y sin práctica religiosa. Este perfil es similar al encontrado en los tabaquistas de otros grupos de la población. Hubo diferencia en lo perfil de los pacientes psiquiátricos, según el tabaquismo. Ese conocimiento puede ayudar el enfermero a planear las intervenciones, según las necesidades y posibilidades de los sujetos.

Características clínicas y sociodemográficas de los pacientes atendidos en psiquiatría de enlace en la unidad de psiquiatría infanto-juvenil, Hospital Clínico Félix Bulnes, Santiago de Chile / Sociodemographic and clinical features of patients attended through consultation-liason psychiatry in the Children and Adolescent Psychiatry Unit of Felix Bulnes Hospital, between 1997 and 2008

El presente trabajo tiene como objetivo describir las características sociodemográficas y clínicas de los pacientes atendidos mediante Interconsultas de Enlace por la Unidad de Psiquiatría Infanto-Juvenil del Hospital Clínico Félix Bulnes entre 1997-2008. La muestra se conformo por 938 pacientes, entre 6 meses y 19 años de edad. El tipo de estudio fue de carácter no experimental, exploratorio des-criptivo, de corte longitudinal retrospectivo. La edad media fue de 11,64 años, con predominio del sexo femenino. Los principales diagnósticos observados fueron: intento de autoeliminación, trastorno depresivo y trastorno ansioso. Las indicaciones más frecuentes fueron control en policlínico, seguimiento durante la hospitalización y derivación al Centro Comunitario de Salud Mental (COSAM). Los servicios de mayor demanda fueron Cirugía Infantil y Segunda Infancia. En ese periodo hubo un aumento sostenido de interconsultas por año. Se concluye que existe la necesidad objetiva de aumentar las actividades de educación médica psiquiátrica a otros servicios.

The purpose of this research is to describe the sociodemographic characteristics of 938 patients between 6 months and 19 years of age, attended through consultation-liaison psychiatry of the Children and Adolescent Psychiatry Unit of Felix Bulnes Clinical Hospital, between 1997 and 2008. This is a retrospective descriptive study. The mean age was 11.64 years, with female patients being more frequent than mal ones. The main diagnoses were suicidal attempts, depressive disorders, and anxiety disorders. The most frequent prescriptions were: follow-up as outpatients, follow-up during the hospitalization, reference to communitarian mental health care centers. Pediatric Surgery and Second Infancy were the clinical services with more demand. In this period we observed a sustained increase in the number of consultations every year. We conclude that there is a need of increasing the activities of psychiatric education towards other clinical services.

Caracterização das internações de dependentes químicos em Unidade de Internação Psiquiátrica do Hospital Geral / Characterization of admission of chemical-dependents in a Psychiatric Admission Unit of the General Hospital

A Unidade de Internação Psiquiátrica do Hospital Geral (UIPHG) é uma proposta articulada ao movimento da reforma psiquiátrica. O objetivo deste estudo foi avaliar os determinantes das internações de dependentes químicos na UIPHG Dr. Estevam, em Sobral (CE). Este estudo foi do tipo documental com abordagem quantitativa, envolvendo 203 clientes que foram internados na UIPHG no período de outubro de 2005 a abril de 2006. Os dados foram coletados por meio de um roteiro adaptado a partir do documento usado no momento da internação. Observou-se predomínio de pacientes do sexo masculino (95,1 por cento), com idade entre 30 e 40 anos (62,5 por cento) e solteiros (59,1 por cento). Em 76,3 por cento dos casos, o diagnóstico da internação foi síndrome de abstinência do álcool. Após alta hospitalar, 70 por cento desses clientes foram encaminhados ao CAPS-AD. Esses resultados demonstram quão imprescindíveis são os serviços de saúde mental que enfoquem a problemática do alcoolismo.

The Psychiatric Admission Unit of the General Hospital (UIPHG) is integrated to the psychiatric reform movement. The aim of this study was to evaluate chemical-dependent's admission causes at the UIPHG Dr. Estevam in the city of Sobral, Ceará State. It was a documental study with a quantitative approach involving 203 patients who were admitted at the UIPGH Dr. Estevam from October 2005 to April 2006. Data were collected from a document filled during admission process in the hospital. 95.1 percent of the sample was represented by men, age range of 30-40 years (62.5 percent) and single (59.1 percent). The alcohol withdrawal syndrome was the main admission cause (76.3 percent). After leaving the hospital, 70 percent of the sample was conducted to aftercare at CAPS-AD. These results provide preliminary evidence for the need of mental health services emphasizing alcohol dependence problem.

Aspectos epidemiológicos de la población ambulatoria en el servicio de psiquiatría de un hospital general: [revisión] / Epidemiological aspects of ambulatory patient population consulting a general hospital's psychiatry service: [review]

En las últimas décadas, la aparición de las sucesivas versiones del DSM-IV y la CIE 10 han contribuído a una mayor coherencia diagnóstica en el ámbito de la psiquiatría, favoreciendo así la búsqueda de datos epidemiológicos alrededor de los trastornos mentales que afectan a nuestras poblaciones. En tanto numerosos trabajos se abocan a trastornos específicos, escasos trabajos reflejan la consulta ambulatoria que abarque todas las patologías de la salud mental. El objetivo de este estudio de carácter descriptivo y exploratorio es obtener datos epidemiológicos de la población consultante, los diagnósticos prevalentes y los factores estresantes asociados para orientar los posibles abordajes terapéuticos. La metodología utilizada fue el relevamiento de 1.928 historias clínicas de los pacientes evaluados por los médicos admisores, psiquiatras de larga trayectoria clínica y que comparten un marco teórico común.

Estudio descriptivo de 64 pacientes con estructura limítrofe de personalidad / Descriptive analysis of 64 bordeline personality structure patients

Objetivo: Describir un grupo de pacientes desde un punto de vista demográfico, psicopatológico y terapéutico que presentan Estructura Limítrofe de Personalidad. Esta organización de personalidad subyace en varios de los trastornos de personalidad más graves, que demandan altos costos en su atención. Se tomaron 488 fichas de la Unidad de Trastornos de Personalidad del Hospital del Salvador que corresponden a un seguimiento de los pacientes ingresados entre los años 2006 y 2008. De estas se seleccionaron las 256 que presentaron Estructura Limítrofe de Personalidad (diagnóstico clínico) y luego se consideraron las 64 que se encontraban activas. Resultados: Destaca un promedio de edad de 39,3 años. Mayor porcentaje de mujeres (94 por ciento). El 51 por ciento tiene trabajo o está estudiando al momento del ingreso a la Unidad. Estado civil de los pacientes: 19 por ciento casado(a), 11 por ciento convive, 31 por ciento separado(a), 39 por ciento soltero (a). Nivel educacional: 6 por ciento educación básica, 53 por ciento educación media y 14 por ciento nivel universitario. El 56 por ciento ha presentado al menos una hospitalización. Discusión: El reconocimiento clínico de estos pacientes, la precisión de los síntomas más prevalentes que ellos presentan nos permite generar estrategias terapéuticas multidisciplinarias en el corto plazo, y planificar a partir de criterios de selección en algunos pacientes de psicoterapias más prolongadas que permitan un cambio más permanente. Se discuten algunos criterios terapéuticos y desafíos futuros para su tratamiento.

Objective: To describe a group of Borderline Personality Structure patients from demographic, psychopatologic and therapeutic perspectives. This anomalous personality organization behind several more serious personality disorders demanding high cost of its assistance. We consider 488 clinic sheets of the Personality Disorder Unit, Del Salvador Hospital, Santiago, Chile, which corresponded to a follow-up of patients admitted between 2006 to 2008. From these we selected 256 ones who presented Borderline Personality Structure (clinical diagnosis) and then considered the 64 active cases. Results: The group had 39.3 years of average age, with higher women percentage (94 percent). The 51 percent had job or were studying at admission time. Marital status: 19 percent married, 11 percent coexists, 31 percent separated, 39 percent single. Educational level: 6 percent basic, 53 percent secondary and 14 percent university level. The 56 percent had submitted one hospitalization at least. Discussion: The better clinical recognition of these patients, as well as the accuracy of the most prevalent symptoms they presented, the more we could generated multidisciplinary therapeutic strategies in the short time, and to plan selection criteria for more protracted psychotherapy for some of them to allow a more permanent change. Finally we discuss some therapeutic criteria and future challenges for the treatment of these patients.

Resultados de los tratamientos en la Unidad de Intervención en Crisis del Servicio de Psiquiatría del Hospital del Salvador, Región Metropolitana: 2006-2009 / Outcome of treatmet in the Crisis Unit of a Psychiatric Service in a General Hospital in the Metropolitan Region of Santiago de Chile: 2006-2009

Para evaluar los resultados de intervenciones en crisis en un servicio público, aplicamos el cuestionario Outcome Questionnaire 45.2 entre los años 2006 y 2009. Se analizan las características socio-demográficas e indicadores de respuesta terapéutica de un total de 335 casos evaluados, de los cuales tenemos medición pre-intervención (M1) de 221, 70 casos con dos mediciones (M2), y 23 contres (M3). La edad promedio de los 335 casos ingresados a la Unidad fue 41,4 años (DS 15,8), y el número promedio de atenciones 7,6 (DS 4,2). Se presentan los casos con Índice de Cambio Confiable en el OQ 45.2 y se clasifican de acuerdo al método de Jacobson y Truax. El puntaje global promedio al ingreso fue de 91 puntos (DS 24), que descendió a un promedio de 77,5 (DS 27,6) en M2, y a 60(DS 23,9) en M3. Se concluye que el principal problema en la evaluación naturalística de estas intervenciones, es el alto porcentaje de abandono. Por otra parte, los pacientes tratados en esta modalidad mejoran en promedio sus puntajes en esta escala, los mejores resultados se ven en los casos que persisten en terapia por lo menos ocho sesiones.

To evaluate the results of crisis interventions in a public psychiatric service in Santiago de Chile, we applied the Outcome Questionnaire (OQ 45.2) in a pre-intervention measurement (M1) to 221 patients of a total of 335 assisted between 2006 and 2009 with pre-intervention measurement (M1); 70 early treatment measurements (M2)and 23 advanced treatment measurements (M3). We present the socio-demographic characteristics of 335 and outcome indicators of 70 cases with two measurements and of 25 with three measurements. Mean age was 41,4years (DS 15,8), and mean number of sessions was 7,6 (DS 4,2). Cases are presented with Reliable Change Scores and are classified according to the method suggested by Jacobson and Truax. The mean score at intake was 91 points in the global scale (DS 24). This decreased to a mean of 77,5 (DS 27,6) in M2, and to 60 (DS 23,9) en M3. To evaluate a dose-response curve, we correlated the number of me sessions and change between M1 and M2 or M3, finding a Pearson correlation coefficient +0.38 for M1 M2 and the number of sessions, and one of -0.406 for M1 M3. The main problem in this naturalistic study was the high attrition rate. On the other hand, patients treated in a crisis intervention approach improve, with the better results in case that stay in therapy at least for eight sessions.

Prevalência dos transtornos mentais em pacientes atendidos no ambulatório da residência médica de psiquiatria da Universidade Estadual de Maringá / Prevalence of mental disorders in patients treated at the psychiatry residency clinic at the State University of Maringá

Objetivo: caracterizar o perfil dos pacientes no Ambulatório de Psiquiatria da Residência do Hospital Universitário Regional de Maringá, por idade, sexo, cor, religião, escolaridade, estado civil, profissão, avaliando a prevalência dos transtornos mentais. Métodos: pesquisa nos prontuários dos pacientes atendidos neste serviço, entre maio de 2002 e dezembro de 2005. Foram utilizados a Análise Multivariada (análise de Correspondência) e o aplicativo Statistica 7.8, para caracterizar o diagnóstico. Resultados: A depressão correspondeu a 29% dos diagnósticos, seguida pela categoria Transtorno Afetivo Bipolar com 16%. Constatou-se que a maioria dos pacientes é do sexo feminino (68,19%), com idade média de 40,28 anos e desvio-padrão de 15,24 anos. A cor branca predomina com 70,87%, assim como os casados que totalizam 52%. Conclusão: foi registrada alta taxa de utilização do serviço de saúde por pessoas com diagnóstico de transtorno depressivo, transtorno bipolar e transtornos ansiosos, correspondendo a 60% dos pacientes

Objective: to build a profile of patients treated in the Psychiatry Residency Clinic at the Regional University Hospital of Maringá as for age, gender, ethnicity, religion, education level, marital status and profession, and evaluate the prevalence of mental disorders among them. Methods: research of the medical records of patients treated at the location, between May 2002 and December 2005. In order to reach a diagnosis, the study made use of Multivariate Analysis (Correspondence Analysis) and the Statistica 7.8 software application. Results: Depression comprised 29% of diagnoses, followed by bipolar affective disorder with 16%. It was observed that the majority of patients were women (68.19%), with an average age of 40.28 ± 15.24 years. Caucasian patients were the majority (70.87%), and 52% of patients were married. Conclusion: It was observed that 60% of patients who looked for treatment were diagnosed with depression, bipolar or anxiety disorders

Características clínicas de niños y adolescentes menores de 18 años hospitalizados en una clínica psiquiátrica universitaria / Clinical characteristics of children and adolescent hospitalized in a University Psychiatric Clinic

Blackground: Five percent of children and adolescents consults in mental health services in one year. Approximately one every ten children has a mental health problem. Aim To assess clinical and demographic factors of children and adolescents hospitalized by psychiatric cause in a university psychiatric clinic. Patients and Methods: Review of medical records of 167 subjects aged 9 to 17 years, 97 women, admitted to a Psychiatric Service in the period 2001-2004. The International Classification of Primary Care (ICPC) manual of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) was used to classify admission complaints and symptoms and DSMIV to classify psychiatric disorders. Results: Mean hospital stay was 11+8 days. The main admission causes were suicidal attempts and psychomotor agitation/impulsive behavior in 54 percent and 26 percent of cases, respectively. The main psychiatric diagnoses were depressive disorder, suicide attempt and bipolar disorder. In 69 percent of patients, the personality diagnosis was deferred. Only 25 percent of families were considered functional. Conclusions: Affective disorders and suicidal behavior are the main psychiatric diagnoses at discharge in children and adolescents admitted to a psychiatric impatient service.

The use of electroconvulsive therapy and the length of stay of psychiatric inpatients at King Chulalongkorn Memorial Hospital, Thai Red Cross Society.

BACKGROUND: Electroconvulsive therapy (ECT) is the effective treatment in psychiatric patients. However, the controversies about the risk and benefit limit the use of this procedure. Some efficacies of ECT may be interesting to use in hospitalized patients such as rapid onset, risk reduction but it may increase the length of stay (LOS) in previous study. OBJECTIVES: To study the use of ECT in hospitalized psychiatric patients in the aspect of indication , diagnosis and the length of stay. MATERIAL AND METHOD: From August to September 2004, all 51 cases of psychiatric inpatient medical records were studied. The top five of diagnosis were schizophrenia (49%), bipolar disorder (23.5%), acute psychosis (7.8%), depressive disorder (5.9%) and dementia (5.9%). ECT was performed in 22 cases (43.1%). RESULTS: The average length of stay was 21.5 +/- 14.5 days. The mean LOS of the ECT group 25.9 +/- 15.8 days was not quite longer compared with 17.8 +/- 12.7 days of the Non ECT group comparison between the ECT group (64%) and the non ECT group (36%) of schizophrenia, the LOS of each group was 27.3 +/- 16.7 and 16.9 +/- 8.8 days which was also not significant. LOS of ECT of the bipolar group (20%) and the non ECT bipolar group (80%) was 10.5 +/- 4.9 and 23.0 +/- 18.3 days which was not statistically significant (p = 0.39). There were 3 major indications for ECT such as a severe violence case, suicidal case, refractory case with the mean LOS of 19.9 +/- 10.9, 17.5 +/- 12.8, 43.3 +/- 21.2 and 31.7 +/- 8.3 days subsequently. The patients who had the refractory indication had a longer length of stay than other indications. CONCLUSION: Overall average length of stay was not longer in the ECT group. The ECT group had a longer length of stay than the non ECT group in the refractory treatment case only. ECT can be used in a psychiatric ward with the efficacy of its indication without prolonged length of stay.

Violence in a general hospital psychiatry unit for men.

INTRODUCTION: General hospitals are increasingly providing psychiatric services in Sri Lanka. They face special challenges and patient violence is one of them. OBJECTIVE: To find out the extent of violence and factors that are associated with such violence in general hospital psychiatry units. SETTING: General Hospital, Peradeniya, male psychiatry ward. METHODS: All violent incidents were prospectively recorded in the male psychiatry unit for one year. The daily patient total, diagnoses and patient activity levels were also tabulated. RESULTS: 118 incidents of serious violence were recorded over one year. 42% of this violence was directed at the nurses. Alcohol withdrawal was the commonest cause of violence (45.7%), and schizophrenia and mania accounted for 43.0%. The other most important factor associated with violence was overcrowding of the wards. CONCLUSIONS: Patient violence is a common problem in general hospital psychiatry wards. Alcohol withdrawal is an important cause of patient violence in this setting. Steps to reduce overcrowding and treatment of alcohol dependence in special alcohol units are likely to reduce such violence.

Estudio epidemiológico de la población asistida en el Departamento de Psiquiatría del Hospital de Clínicas. Período 1999-2000 / Epidemiological study of the population assited at the Psychiatric Department of the Hospital de Clinicas. 1999-2000

La Clínica Psiquiátrica de la Facultad de Medicina asiste a los pacientes del Hospital de Clínicas en sus sectores de policlínica, emergencia y servicios de internación médico-quirúrgicos. El retraso en el sistema de registro y la ausencia de datos procesados y estandarizados sobre las características y enfermedades que afectan a la población asistida por la Clínica, ha dificultado, hasta ahora, todo intento confiable de investigación epidemiológica. Es con el propósito de comenzar a paliar estas importantes carencias que se ha realizado la presente investigación epidemiológica. Los principales objetivos fueron el aporte de información organizada y estandarizada en un banco de datos que continúe abierto y en permanente expansión, y el procesamiento y análisis estadístico de dicha información con el fin de caracterizar la población estudiada. Los datos se recabaron mediante fichas protocolizadns según criterios internacionales. Dicha información fue procesada y analizada con técnicas estadísticas, evaluándose un total de 864 pacientes. Las enfermedades psiquiátricas predominantes fueron: trastornos depresivos mayores en 26,3 por ciento de los pacientes y los trastornos adaptativo y de ansiedad con una frecuencia de aproximadamente l5 por ciento cada uno. Se establecieron conclusiones sobre la importancia de mantener la metodología utilizada por esta investigación cuyos resultados tienen un valor indudable en la toma de decisiones referentes a la planificación de estrategias de asistencia y prevención, y para la formación de recursos humanos y docentes

Interconsulta psiquiátrica para servicios gineco-obstétricos / Psychiatric interconsultation for gyneco-obstetric services

Objetivo: comunicar la experiencia de la Unidad de Enlace del Servicio de Psiquiatría del Hospital Félix Bulnes, en interconsulta solicitadas para pacientes hospitalizadas en Servicios gineco-obstétricos. Material y método: se revisan los registros de las interconsultas realizadas por la Unidad de Enlace, a pacientes hospitalizadas en servicios gineco-obstétricos del área occidente, desde 1994 a 1999. Resultados: 202 pacientes fueron evaluadas en el período. Los motivos de referencia más frecuentes fueron: síntomas ansioso-depresivos 30 por ciento. Uso de alcohol o drogas 22 por ciento. Alteraciones conductuales 14 por ciento. Un amplio espectro psicopatológico fue diagnosticado, los trastornos neuróticos fueron los más frecuentes (43 por ciento). No se evidenció patología psiquiátrica en 13 por ciento. Conclusiones: nuestra experiencia indica que la implementación de consulta psiquiátrica de enlace tiene una alta frecuencia de referencia desde gineco-obstetricia. El clínico consulta respecto a evaluación del estado mental y manejo de pacientes gineco-obstétricas con desórdenes mentales y conductuales. El principal diagnóstico fue trastorno adaptativo a aspectos psicosociales o enfermedad médica

Motivos de interconsulta psiquiátrica en pacientes con delirium / Psychiatric consultation motives in patients with delirium

Antecedentes: el delirium e un trastorno mental muy común y potencialmente fatal; por ello es necesario saber cómo detectarlo y, por ende, establecer procesos de diagnóstico más eficases y oportunos. Objetivo: evaluar las manifestaciones clínicas que generen la solicitud de interconsultas psiquiátricas a pacientes con diagnóstico definitivo de delirium. Material y métodos: se revisaron 1,474 referencias al Departamento de Psiquiatría del Hospital de Especialidades, del Centro Médico Nacional Siglo XXI, hechas entre 1995 y 1997. Todos los diagnósticos se realizaron de acuerdo con los criterios del DSM.IV. Resultados: doscientos dieciocho pacientes tuvieron delirium (14.7 por ciento); y las principales alteraciones de éstos fueron cognitivas (36.6 por ciento), de la conducta (21 por ciento y del afecto (20 por ciento). Conclusiones. es muy común que se confunda el delirium con la depresión. Entre los mismos servicios médicos y quirúrgicos hay diferencias en la apreciación de estas alteraciones, ya que los primeros descubren más trastornos del afecto, mientras que los segundos encuentran más cambios de la conciencia. Por otra parte, en cuanto al género de los pacientes, se identificaron más alteraciones efectivas en la mujer y cognitivas en el hombre

Red asistencial extrapsiquiátrica: tratamiento de pacientes psicóticos de evolución prolongada / Extrapsychiatric assistance net: treatment of psychotic patients of prolonged evolution

El trabajo da cuenta de la experiencia adquirida por la unidad de psicofármacos del Servicio de Psiquiatría de Valdivia al implantar en el curso de una década (1986-1996) una red asistencial extrapsiquiátrica para la mantención del tratamiento de sostén con neurolépticos de depósito de pacientes psicóticos de larga evolución. La consideración de las características geográfico-climatológicas y viales de la provincia de Valdivia, centros de atención del nivel primario de salud, subcentrales de neurolépticos de depósito, atención ambulatoria constituyen los fundamentos de la puesta en práctica y desarrollo de un modelo de atención descentralizado

Programa de psiquiatría de enlace e interconsulta psiquiátrica en un hospital general / Psychiatric liaison program and psychiatric consultation in a general hospital

Se analizaron las 447 interconsultas a Psiquiatría realizadas entre enero de 1992 y junio de 1993 se compararon estos resultados con los publicados en 1984 por uno de los autores. En los servicios de Endocrinología, Dermatología y Fisiatría se implementaron programas de Psiquiatría de Enlace, de acuerdo a la definición de Lipowsky. Se compara la tasa de derivación de éstos con el resto de los servicios. Se registran los diagnósticos más frecuentes formulados por los psiquiatras. En los servicios donde se implementaron programas de Psiquiatría de Enlace, se encuentran diferencias significativas en relación con la tasa de derivación a psiquiatría, 31,1 porciento en éstos, versus 1,5 porciento la tasa global de derivación (p<0,001). Los servicios de Medicina Interna derivaron significativamente más que los servicios quirúrgicos (6,2 porciento vs 1,2 porciento). Los trastornos depresivos fueron el diagnóstico psiquiátrico más frecuente (20,9 porciente del total de interconsultas)

Psychiatric morbidity in preschool children--a clinic based study.

Psychiatric morbidity patterns in preschool children attending a general hospital psychiatric clinic were studied. No psychiatric problem was detected in 48% of the sample, epilepsy being the diagnosis in more than half of these children. Common psychiatric problems were mental retardation (27%), breath-holding spells (11%) and hyperkinetic syndrome (7%). Emotional and behavioral problems, and habit disorders, which are quite common in this age group, were poorly represented in the clinic sample. It appears that mental retardation and epilepsy are the only two main disorders usually perceived by Indian parents as psychiatric problems in preschool age group.

Pattern of psychiatric morbidity in children attending a general psychiatric unit.

Patterns of psychiatric morbidity were studied retrospectively in children who attended the psychiatric outpatient clinic of a general hospital over a period of two years (January 1991-December 1992). Three hundred and eighty six children attended the clinic during this period. Twenty three percent of the children were diagnosed as mental retardation, whereas epilepsy was the diagnosis in 21% cases. A formal psychiatric diagnosis could be made only in less than half of the cases. The findings are discussed in terms of public awareness about child psychiatric disorders.