Clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder in a psychiatric emergency service.

INTRODUCTION: To analyze factors associated with clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder (AD) seeking care at a psychiatric emergency unit. METHOD: A total of 5003 consecutive visits were reviewed over a three-year period at a psychiatric emergency service in a tertiary university hospital. Data collected included sociodemographic and clinical information as well as the Global Assessment of Functioning (GAF) and the Severity Psychiatric Illness (SPI) scale scores. RESULTS: Of all the visits, 992 (19.8%) were diagnosed of AD. Of these, 19.6% required clinical observation and 72.2% were referred to a psychiatrist at discharge. Regression analysis showed that referral to psychiatry was associated with being male, native, psychiatric background, greater severity, lower global functioning, and behavioral disorders. Clinical observation (in a box) was associated with being female, greater severity, and psychotic or behavioral symptoms. Prescription of benzodiazepines was associated with anxiety, no history of addiction, and lower global functioning. Antidepressants were associated with being a native, anxiety with no history of addiction, and lower functioning. Antipsychotics were associated with being native, psychiatric background (not addiction), anxiety, and lower functioning. CONCLUSION: Behavior, psychiatric background and illness severity were determinants of referral to a specialist. Besides these, psychotic symptoms and non-specific clinical symptoms were determinants of observation. Drug prescription in AD is less frequent if the main complaint is not anxiety and depends more on the level of functioning than on that of severity.

Observación, farmacoterapia y derivación al alta de los pacientes con trastorno de ansiedad en urgencias de psiquiatría / Clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder in a psychiatric emergency service

Introducción. Analizar los determinantes asociados a indicar observación, prescribir psicofármacos y derivar al especialista en los pacientes con trastorno de ansiedad (TA) visitados en urgencias de psiquiatría. Método. Se analizaron 5003 visitas consecutivas realizadas en un hospital general universitario durante tres años. Se incluyó información sociodemográfica, clínica y puntuación en las escalas de Evaluación de la Actividad Global (EEAG) y de Gravedad de la Enfermedad Psiquiátrica (GEP). Resultados. Del total de visitas, 992 (19,8%) fueron diagnosticadas de TA. De estas visitas, 19,6% utilizaron box y 72,2% fueron derivadas al especialista. El análisis de regresión mostró que la derivación a psiquiatría se asociaba con ser hombre, autóctono, tener antecedentes, mayor gravedad, menor actividad global y alteraciones conductuales. La observación (uso del box) se relacionó con ser mujer, mayor gravedad y síntomas psicóticos o de conducta. La prescripción de benzodiacepinas se asoció a ansiedad sin problemas de toxicomanías y a una menor actividad global. Los antidepresivos se relacionaron con ser autóctono, ansiedad sin toxicomanías y con menor actividad. Los antipsicóticos con ser autóctono, tener antecedentes sin toxicomanías, ansiedad y menor actividad. Conclusión. La conducta, los antecedentes y la gravedad resultaron determinantes de derivación al especialista. Además de estos, los síntomas psicóticos y la inespecificidad clínica lo fueron para indicar observación. La prescripción farmacológica en los TA es menos frecuente si el motivo de consulta no es por ansiedad y depende más del nivel de actividad que de la gravedad

Introduction. To analyze factors associated with clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder (AD) seeking care at a psychiatric emergency unit. Method. A total of 5003 consecutive visits were reviewed over a three-year period at a psychiatric emergency service in a tertiary university hospital. Data collected included sociodemographic and clinical information as well as the Global Assessment of Functioning (GAF) and the Severity Psychiatric Illness (SPI) scale scores. Results. Of all the visits, 992 (19.8%) were diagnosed of AD. Of these, 19.6% required clinical observation and 72.2% were referred to a psychiatrist at discharge. Regression analysis showed that referral to psychiatry was associated with being male, native, psychiatric background, greater severity, lower global functioning, and behavioral disorders. Clinical observation (in a box) was associated with being female, greater severity, and psychotic or behavioral symptoms. Prescription of benzodiazepines was associated with anxiety, no history of addiction, and lower global functioning. Antidepressants were associated with being a native, anxiety with no history of addiction, and lower functioning. Antipsychotics were associated with being native, psychiatric background (not addiction), anxiety, and lower functioning. Conclusion. Behavior, psychiatric background and illness severity were determinants of referral to a specialist. Besides these, psychotic symptoms and non-specific clinical symptoms were determinants of observation. Drug prescription in AD is less frequent if the main complaint is not anxiety and depends more on the level of functioning than on that of severity

Utilization of psychiatric emergency services by homeless persons in Spain.

OBJECTIVE: Studies examining the relationship between homeless persons and the use of psychiatric emergency services (PES) in a country with universal access to health care are lacking. This study aimed to determine the prevalence of homelessness in adults visiting a PES in Spain, identify the differences between homeless and non-homeless patients in the use of PES and analyze the factors associated with homelessness and the decision to hospitalize. METHOD: The study included a total of 11 578 consecutive admissions to a PES in a tertiary hospital in Barcelona, Spain, over a 4-year period. Data collected included socio-demographic and clinical information, and score on the Severity of Psychiatric Illness (SPI) scale. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness and the decision to hospitalize. RESULTS: Five hundred sixty (4.8%) admissions were considered homeless. Homeless patients had more psychotic and drug abuse disorders, greater severity of symptoms, more risk of being a danger to others and more frequent hospitalization needs than non-homeless patients. Factors related to homelessness were male gender, substance abuse and immigrant status from North Africa, Sub-Sahara Africa and Western countries. The decision to hospitalize homeless patients was associated with psychosis diagnosis, suicide risk, danger to others, symptom severity, medical problems and noncompliance with treatment. CONCLUSIONS: In an attempt to decrease the use of emergency resources and prevent the risk of homelessness, mental health planners in a universal healthcare system should improve outpatient access for populations with risk factors such as substance abuse and immigration.

Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service.

OBJECTIVE: This study aimed to determine factors associated with hospitalization and decisions to prescribe psychotropic medication for patients with borderline personality disorder seeking care at psychiatric emergency units. METHODS: A total of 11,578 consecutive visits were reviewed over a four-year period at a psychiatric emergency service in a tertiary hospital in Spain. Some patients were repeat visitors. Data collected included sociodemographic, clinical, social, and therapeutic information and the Severity of Psychiatric Illness (SPI) score. RESULTS: Borderline personality disorder was the diagnosis in 1,032 of the visits (9%) to the emergency department, which corresponded to 540 individuals. Of these visits, 11% required hospitalization. Multivariate statistical logistic regression analysis showed that the decision to hospitalize was associated with risk of suicide, danger to others, severity of symptoms, difficulty with self-care, and noncompliance with treatment. The decision to prescribe benzodiazepines was related to male sex, anxiety as the reason for seeking care, little difficulty with self-care, few medical or drug problems, and housing instability. Factors related to the prescription of antipsychotics were male sex, risk of endangering others, and psychosis as the reason for the visit. Factors associated with the prescription of antidepressants were depression as the reason for seeking help and little premorbid dysfunction. CONCLUSIONS: Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.