Profile and costs involved in long-term compulsory hospitalization of psychiatric patients

Objective: Involuntary hospitalization for acute psychiatry cases can be acceptable when there is potential harm. However, there are few reasons for a patient committed on these grounds to stay in an institution for a long period. The objective of the present study was to identify the profile and costs of compulsory hospitalizations over 20 days in a public psychiatric hospital in the coastal region of the state of São Paulo. Methods: Retrospective data were collected from the medical records of 1,064 patients admitted between July 2013 and June 2016 from an intensive mental healthcare unit in Santos, state of São Paulo, Brazil. Results: Records were found of 527 patients who had been hospitalized for at least 21 days during the study period. Long-term hospitalization related to judicial mandates represented 5.9% of the total sample. These patients stayed in the hospital for an average period of 142 days, while patients hospitalized for any other reason stayed an average period of 35 days (p < 0.001). The cost of a long-term court-ordered hospitalization averaged US$ 21,311 per patient. Conclusion: Judicial mandate has been an important reason for the long-term hospitalization of chronic psychiatric patients in Santos, Brazil.

Transtornos somatoformes (manifestações histéricas) em mulheres atendidas em hospital psiquiátrico de São Luís, Maranhão / Somatoform disorders (hysterical manifestations) in women served in the psychiatric hospital of São Luís, Maranhão

Os sintomas somáticos sem explicação médica ou manifestações histéricas são freqüentes, estando associados a sofrimento mental em vários contextos. Atualmente são classificados na psiquiatria como transtornos somatoformes (TS). Estudos prévios apontam que as populações latino-americanas são propensas à somatização. No entanto, existem poucos estudos nacionais e locais sobre estes transtornos. Desse modo, este estudo objetivou verificar a ocorrência de TS em mulheres atendidas em um hospital psiquiátrico em São Luis Maranhão. Realizou-se um estudo seccional de base documental a partir dos dados coletados dos prontuários médicos das pacientes atendidas no período de Agosto de 2012 a Janeiro de 2013. Estimou-se a prevalência de TS com base em um total de 1.220 atendimentos, o que resultou em 62 casos de sintomatologia compatível com TS (5,08%), dos quais, apenas 5 receberam diagnóstico conclusivo de TS (8,06%). Os TS diagnosticados pelo CID 10 foram: quatro casos de transtorno dissociativo conversivo e um de neurovegetativo somatoforme. Os transtornos ocorreram mais frequentemente entre mulheres pardas com idade média de 34,3 anos. Os sinais e sintomas mais freqüentes foram insônia, dor de cabeça e inapetência. Os resultados apontam a necessidade de investigações mais minuciosas com os pacientes e auxílio de outros profissionais na composição de uma equipe multidisciplinar na investigação e fechamento do diagnóstico clínico. Levando-se em consideração as reformulações pelo qual o Código Internacional de Doenças versão 10 para as modificações na 11ª edição, estudos sobre os TS contribuirão de forma significativa para o processo de revisão dos sistemas diagnósticos de transtornos mentais e de comportamento.

Unexplained somatic medical symptoms or hysterical symptoms are common and frequently associated with mental distress in various contexts,representing, in general, a quarter to half of visits in primary and secondary care. They are currently classified in psychiatry as somatoform disorders (SD). Previous studies suggest that the Latin American populations are susceptible to somatization. However, there are few national and local studies on these disorders. Thus, this study aimed at verifying the occurrence of SD women attended in one psychiatric hospital in São Luís Maranhão. It was conducted a cross-sectional study of documentary basis of data collected from the medical records of patients treated during the period August 2012 to January 2013. It was estimated the prevalence of SD based on a total of 1,220 calls, which resulted in 62 cases of symptoms compatible with SD (5.08%), of which only 5 received conclusive diagnosis of SD (8.06%). The SD diagnosed by ICD 10 were: four cases of dissociative conversive disorder and a somatoform autonomic. Disorders occurred more frequently among brown women with a mean age of 34.3 years. The most common signs and symptoms were insomnia, headache and loss of appetite. The results indicate the need for more detailed investigations with patients and aid of other professionals in the composition of a multidisciplinary team in research and clinical diagnosis closure. Taking into account the reformulations by which the International Classification of Diseases version 10 for modifications in its 11th edition, the SD studies will contribute significantly to the process of revising the diagnostic systems for mental and behavioral disorders.