Diagnose, indicate, and treat severe mental illness (DITSMI) as appropriate care: A three-year follow-up study in long-term residential psychiatric patients on the effects of re-diagnosis on medication prescription, patient functioning, and hospital bed utilization.

BACKGROUND: While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. We therefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill long-term residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization. METHODS: DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol. RESULTS: Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization. CONCLUSIONS: Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients.

[Hypertrophy of the inferior labial frenum]. / Het hypertrofisch frenulum van de onderlip.

Hypertrophy of the inferior labial frenum, which is present in approximately 8% of the population, can give rise to prosthodontic or periodontal problems. In contrast to hypertrophy of the superior labial frenum, there is no relation to orthodontic problems. The indications for extirpation of a hypertrophic inferior labial frenum are discussed.

The vertical avulsion flap.

Unilateral vertical tangential maxillofacial trauma may result in a combination of a certain number of charcteristic lesions. Although composed of wounds and fractures in the upper, middle and lower third of the face, this form of injury can be considered to be a separate distinct entity. Two patients are described, illustrating this type of injury. Both also sustained trauma of the ipsilateral shoulder.