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