Avaliaçäo de um hospital dia psicogeriátrico: valor da duraçäo média das hospitalizaçöes / Geriatric psychiatric day hospital: the length of stay as criteria of evaluation

Este trabalho tem como objetivo principal apresentar análise da duraçäo média das hospitalizaçöes foi feita para um período indo do 01/01/94 a 31/12/96. Inicialmente säo analizadas as duraçöes médias das hospitalizaçöes avaliadas pelo número de semanas de hospitalizaçäo e pelo número de diárias, ambas estudadas para cada para cada um dos sementres do período do estudo. Estes dois parâmetros foram ponderados em funçäo da proveniência , da destinaçäo, do diagnóstico e da intensidade da diminuiçäo da independência avaliada pela soma do resultado das escalas ADL e IADL (12) aplicadas no momento da admissäo. As duraçöes médias das hospitalizaçöes assim ponderadas säo analisadas para estes valores globais durante os 36 meses do estudo. Os autores concluíram que houve uma diminuiçäo näo significativa das duraçöes médias das hospitalizaçöes durante os 6 semestres que durou o estudo. Mas concluíram igualmente a uma influência das diversas proveniências, das diversas destinaçöes e dos diversos diagnósticos bem como uma ausência de influência dos 3 níveis de reduçäo da independência dos pacientes. Estes resultados säo discutidos em relaçäo ao contexto da cidade de Lausanne e de sua rede sanitária para as pessoas idosas sofrendo de transtornos mentais

Avaliacao de um hospital dia psicogeriatrico: valor da duracao media das hospitalizacoes

Este trabalho tem como objetivo principal apresentar uma analise preliminar da duracao media das hospitalizacoes do Hospital de Dia Psicogeriatrico de Lausanne, tentando identificar os fatores podendo modifica-la. A analise da duracao media das hospitalizacoes foi feita para um periodo indo do 01/01/94 ao 31/12/96. Inicialmente sao analisadas as duracoes medias das hospitalizacoes avaliadas pelo numero de semanas de hospitalizacoes e pelo numero de diarias, ambas estudadas para cada um dos semestres do periodo do estudo. Estes dois parametros foram ponderados em funcao da proveniencia, da destinacao, do diagnostico e da intensidade da diminuicao da independencia avaliada pela soma do resultado das escalas ADL e IADL(12) aplicadas no momento da admissao. As duracoes medias das hospitalizacoes assim ponderadas sao analisadas para estes valores globais durante os 36 meses do estudo. Os autores concluiram que houve uma diminuicao nao significativa das duracoes medias da hospitalizacoes durante os 6 semestres que durou o estudo. Mas concluiram igualmente a uma influencia das diversas proveniencias, das diversas destinacoes e dos diversos diagnosticos bem como uma ausencia de influencia dos 3 niveis de reducao da independencia dos pacientes. Estes resultados sao discutidos em relacao ao contexto da cidade de Lausanne e de sua rede sanitaria para as pessoas idosas sofrendo de transtornos mentais.

A double-blind double-dummy study of citalopram comparing infusion versus oral administration.

BACKGROUND: This study compares antidepressant efficacy and tolerability of citalopram given either orally or as a slow drop infusion. METHODS: Citalopram (40 mg/day) was administered double-blindly as tablets or slow-drop infusion during the first 10 days and then open, orally, up to treatment Day 42. RESULTS: In 60 moderately to severely depressed patients, the Hamilton depression total score (17-items) at baseline was 23.9 and 23.6 in the active infusion (n = 30) and active tablet (n = 30) group, respectively. These scores dropped in both groups to 15.6 and 16.9 on Day 10, and to 10.3 and 10.2 on Day 42. Response rates (delta Hamilton > or = 50%) amounted to 33.3% and 17.9% on Day 10, and 66.2% and 63.3% on Day 42, without a relevant group difference in citalopram plasma concentration. CONCLUSION: Slow-drop infusion with citalopram shows a similar risk/benefit relationship to oral citalopram. The design of this study allowed us to evaluate pharmacological but not psychological factors which may contribute to response to slow-drop infusion.

[Our knowledge is patchwork. Survey on the adherence to international guidelines concerning acute and long-term therapy in recurrent depressions and diseases in the schizophrenic field]. / Unser Wissen ist Stückwerk. Eine Umfrage über die Einhaltung internationaler Richtlinien bezüglich akuter und Dauertherapie bei rezidivierenden Depressionen und bei Erkrankungen aus dem schizophrenen Formenkreis.

In order to assess the observance of international guidelines, 88 psychiatrists and 88 general practitioners (GPs) were asked about their pharmacotherapeutic concepts for depressive and schizophrenic patients with a questionnaire. 47% of the psychiatrists and 72% of the GPs returned their answers. 29% of the psychiatrists and 24% of the GPs treat their depressive patients after an acute episode for six months (in accordance with WHO consensus). 32% of the psychiatrists and 47% of the GPs would suggest prophylactic treatment after two or more depressive episodes as proposed by the WHO. After one or more episodes within the last five years 2.7% of the psychiatrists and 12% of the GPs would start prophylactic treatment as suggested by the WHO. 16% of the psychiatrists and 17% of the GPs would treat a schizophrenic patient after a first episode for 12 to 24 months as proposed by the International Consensus Conference. After two or more psychotic episodes, 16% of the psychiatrists and 31% of the GPs would treat their patients in accordance with international guidelines. The consensus of the WHO for the treatment of depression and the international guidelines for relapse prevention in schizophrenics are hardly known by the examining psychiatrists and GPs and rarely used as treatment guidelines.

TSH, HGH, HPr, and cortisol response to TRH in depressed patients.

An intravenous (0.2 mg) and an oral (40 mg) TRH-test was performed on 21 depressed patients (4 psychogenous, 17 endogenous); TSH, HGH, HRr, Cortisol, T3, T4 and RT4 were measured. The test was redone after 3 weeks of antidepressive treatment. Using an oral stimulation, it looks like there would be a possibility to differentiate into different groups according to the severity of illness. It also seems that the oral stimulation is a possibility to get information on the beginning effectiveness of antidepressive treatment. The responsiveness to the oral stimulus returns earlier than the response to the i.v. stimulation. Roughly, one can also differentiate between endogenous and psychogenous depression with an oral TRH test.