Partial psychiatric hospitalization and differences in clinical outcome

2016 ◽  
Vol 33 (S1) ◽  
pp. S195-S195
Author(s):  
J. Vázquez Bourgon ◽  
F. Hoyuela Zatón ◽  
E. Gómez-Ruiz ◽  
E. Cortazar Lopez ◽  
B. Agüeros Perez ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Personality Disorder ◽  
Clinical Outcome ◽  
Depressive Disorder ◽  
Psychiatric Hospitalization ◽  
Clinical Severity ◽  
Partial Hospitalization ◽  
Significant Difference ◽  
Competing Interest ◽  
Clinical Resource

IntroductionIntensive treatment in partial hospitalization unit may represent an efficient alternative to traditional inward hospitalization. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder.ObjectivesWe aimed to study possible differences in the effectiveness of treatment in a partial hospitalization regime for different psychiatric disorders.MethodsThree hundred and thirty-one patients were admitted to the Valdecilla acute psychiatric day hospital between January 2013 and January 2015. Clinical severity was assessed using BPRS-E and HoNOS scales at admission and discharge. Other relevant clinical and socio-demographic variables were recorded. For statistical comparisons, patients were clustered into 4 wide diagnostic groups (non-affective psychosis; bipolar disorder; depressive disorder; personality disorder).ResultsWe observed a significant difference in the status of discharge (χ2 = 12.227; P = 0.007). Thus, depressive patients were more frequently discharged because of clinical improvement, while patients with a main diagnose of personality disorder abandoned the treatment more frequently (23% vs. 4,0%)When analysing the clinical outcome at discharge, we found that patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F = 5.305; P = 0.001) than those diagnosed of psychosis or depressive disorder. Interestingly, we found no significant differences between diagnoses in hospital re-admission in the following 6 months after being discharged.ConclusionsOur results suggest that acute treatment in partial hospitalization regime may be more effective for bipolar and depressive disorder, and particularly less effective for those patients with a personality disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Augmentation strategies in the treatment of major depressive disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S407-S407
Author(s):  
S. Bise ◽  
B. Kurtovic ◽  
D. Begic ◽  
O. Cemalovic
Keyword(s):  
Major Depressive Disorder ◽  
Combination Therapy ◽  
Depressive Disorder ◽  
Mood Stabilizers ◽  
Augmentation Therapy ◽  
Major Depressive ◽  
Augmentation Strategies ◽  
Significant Difference ◽  
Augmentation Strategy ◽  
Competing Interest

Augmentation strategies for the treatment of Major depressive disorder (MDD) are needed when patients with MDD have a partial, or not responded to antidepressant monotherapy. The focus of augmentation therapy has been combining an antidepressant (AD) medication with another AD. Atypical antipsychotics (AAP) are becoming commonly used to augment antidepressants. Beyond AD and AAP, alternative augmentation strategies include mood stabilizers (MS).AimTo analyze the characteristics of therapy in patients with diagnosis of MDD and to investigate the frequency of augmentation therapy.MethodStudy included 28 patients hospitalized during one year with MDD diagnosis. Statistical analysis was performed with x2 and t-test.ResultAmong patients with MDD there were 18 (64.28%) women with an average age 57.5 and 10 (35.71%) men with an average age 53.5. Of the 28 patients with MDD, 25 (89.28%) were treated with a combination therapy, and monotherapy in the remaining 3 patients (10.71%). Of 25 patients with augmentation strategy treatment, 22 (88%) used two medications and the remaining 3 (12%) tree psychotropic medications (AAP, AD, MS). The most frequent combinations were a combination of AD and AAP (17 patients, 68%). Beyond that frequent combination were AD and MS (6 patients, 24%). Two patients used combination two AAP, and one patient with two AD and one patients used AAP and MS.ConclusionAugmentation strategy is often used in patients with MDD. There is no significant difference in the use combination therapy based on gender and age.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The importance of establishing a good differential diagnosis in bipolar disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S338-S338
Author(s):  
I. Peñuelas Calvo ◽  
J. Sevilla Llewellyn-Jones ◽  
C. Cervesi ◽  
A. Sareen ◽  
A. González Moreno
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Personality Disorder ◽  
Correct Diagnosis ◽  
Unipolar Depression ◽  
Health Condition ◽  
Diagnostic Process ◽  
Negative Consequences ◽  
Competing Interest ◽  
Disorder Type

Diagnosis plays a key role in identification of a disease, learn about its course, management and predicting prognosis. In mental health, diseases are often complex and coalesce of different symptoms. Diagnosing a mental health condition requires careful evaluation of the symptoms and excluding other differential disorders that may share common symptoms. Diagnose hastily can lead to misdiagnosis. A premature diagnosis or misdiagnosis has clear negative consequences. This is one of the problems related to mental health and one needs to optimize the diagnostic process to achieve a balance between sensitivity and specificity. Currently, the diagnosis of bipolar disorder (BD) is one of the major mental health conditions that is often misdiagnosed.To differentiate BD from unipolar depression with recurrent episodes or with personality disorder (PD), especially type Cluster B – with features shared with mania/hypomania like mental instability or impulsivity, it is important to differentiate between a diagnosis and its comorbidity. BD is often misdiagnosed as personality disorder and vice versa specially when both are coexisting (almost 20% of patients with bipolar disorder type II are misdiagnosed as personality disorders). This is common especially with borderline PD, although in some cases the histrionic PD may also be misdiagnosed as mania.Due to the inconsistency in patient care involving different psychiatrists combined with difficulty in obtaining a precise patient history and family history leads to loss of key information which in turn leads to misdiagnosis of the condition. The time delay in making the correct diagnosis cause by such inconsistencies may worsen the prognosis of the disease in the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Projective Technique Testing Approach to the Understanding of Psychological Pain in Suicidal and Non-Suicidal Psychiatric Inpatients

2019 ◽  
Vol 17 (1) ◽  
pp. 284
Author(s):  
Isabella Berardelli ◽  
Salvatore Sarubbi ◽  
Alessandra Spagnoli ◽  
Chiara Fina ◽  
Elena Rogante ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Suicide Risk ◽  
Cross Sectional Study ◽  
Psychological Pain ◽  
Major Depressive ◽  
Clinical Factor ◽  
Cross Sectional ◽  
Significant Difference

Psychological pain is a core clinical factor for understanding suicide, independently from depression. The aim of this study is to assess the role of psychological pain on suicide risk and to evaluate the relationship between psychache and different psychiatric disorders. We conducted the present cross-sectional study on 291 inpatients with a diagnosis of major depressive disorder, bipolar disorder, and schizophrenia. We administered Shneidman’s Psychological Pain Assessment Scale (PPAS) for the assessment of mental pain and the Mini International Neuropsychiatric Interview (MINI) for the assessment of suicide risk. There was a significant association between current psychache and worst-ever psychache and suicide risk in inpatients affected by a depressive disorder, bipolar disorder and schizophrenia. Furthermore, we found a significant difference in current psychache between inpatients with major depressive disorder and inpatients with schizophrenia and in worst-ever psychache between inpatients with bipolar disorder and inpatients with schizophrenia, with lower scores in inpatients with schizophrenia. The assessment of psychache appears to be useful for predicting suicidal risk and should be used routinely for identifying and treating suicide risk in clinical practice.

Dissemination of DBT for borderline personality disorder in Egypt, facts and challenges

2017 ◽  
Vol 41 (S1) ◽  
pp. S334-S335
Author(s):  
A. Abdelkarim ◽  
D. Nagui Rizk ◽  
A. Ivanoff
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospitalization ◽  
Training Model ◽  
Borderline Personality ◽  
Global Functioning ◽  
Intensive Training ◽  
Evidence Based Treatments ◽  
Competing Interest ◽  
Scientific Meetings

BackgroundDBT proved to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning in Borderline personality disorder. As a step towards increasing utilization of evidence based treatments in the Egyptian healthcare system, the team at Alexandria university started a comprehensive DBT program.AimTo describe the implementation and dissemination experience of DBT in Egypt.MethodsThe implementation of DBT is examined quantitatively. Numbers were calculated retrospectively from the records at the implementation start in December 2013 and after 3 years in September 2016.ResultsNumber of therapists increased from one team of 2 therapists and one observer to 16 therapists organized in 3 teams plus 4 observers. The initial team, 7 psychiatrists and 2 clinical psychologists, could host and attend the first DBT Intensive Training in the middle east in 2014. DBT intensive training is the official training model developed by Dr. Linehan. We started with 8 clients one group for adults in Alexandria at 2013, increasing to 150 clients in 12 groups for adults, adolescent and SUD patients in 2016 with an average increase of 18.75 folds. The team participated and presented about DBT in 23 local and regional scientific meetings and hosted two workshops in collaboration with BehavioralTech, the official training institute.ConclusionsAlthough the DBT implementation in Egypt represented a great challenge, results are showing a promising increase in the number of trained therapists and participating clients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prevalence of involuntary hospitalization in patients with depressive disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S419-S420
Author(s):  
Á. Palma Conesa ◽  
F.N. Dinamarca Cáceres ◽  
M. Grifell Guardia ◽  
L. Galingo Guarin ◽  
L. González Contreras ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Emergency Service ◽  
Depressive Disorders ◽  
Symptom Control ◽  
Cross Sectional Study ◽  
Involuntary Hospitalization ◽  
Cross Sectional ◽  
Significant Difference ◽  
Competing Interest ◽  
Harm Prevention

IntroductionDepression is a disabling disorder with a high socio-economic impact. It might require hospitalization for symptom control and/or harm prevention. Other depressive disorders might as well require hospitalization in benefit of the patient. Hospitalization may be involuntary. Hospitalization willfulness in depressive patients has not been systematically studied in recent years.ObjectiveThe aim of this study is to explore the necessity of involuntary hospitalization in patients presenting depressive symptoms at the emergency service that were later diagnosed with a depressive disorder.Materials and methodsFrom all patients visited in the psychiatric emergency service from 2012 to April 2015 those that were hospitalized in the acute mental health unit and diagnosed with a depressive disorder were studied. All those monopolar depression diagnoses were considered, excluding those within the bipolar spectrum. Diagnosis followed CIE-9 criteria. A descriptive cross-sectional study of the samples was then conducted. Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, Ill.).ResultsFrom all 385 depressive disorders, 169 were involuntary admissions (43.9%), 196 were voluntary (50.9%) and 20 were scheduled (5.2%), difference was statistically significant (P < 0.05). Mean age, was 59.52 years for involuntary admissions, 61.7 for voluntary and 63.6 years for scheduled, with a statistically significant difference (P < 0.05). Gender differences were not significant.ConclusionsMost depressive disorders were hospitalized voluntarily. However, a relevant percentage of patients required involuntary hospitalization. Younger patients presented a higher ratio of involuntary hospitalization. Reasons for involuntary hospitalization needs should be further studied.Disclosure of interestThe authors have not supplied their declaration of competing interest. Liliana Galindo is a Rio Hortega fellowship (ISC-III; CM14/00111).

Comparison of insight in bipolar disorder with and without co-morbid substance use disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S466-S466
Author(s):  
S. Ben Mustapha ◽  
W. Homri ◽  
L. Jouini ◽  
R. Labbane
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Type I ◽  
Need For Treatment ◽  
Co Morbidity ◽  
Significant Difference ◽  
Competing Interest ◽  
Bipolar Patients

AimsCompare the level of insight in bipolar disorder (BD) with and without substance use disorders (SUD).MethodsCase-control study during a period of six months from July 2015 to December 2015. One hundred euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. Two groups were individualized by the presence or not of SUD co-morbidity. We evaluated and compared insight with Birchwood IS scale (with its three sub-scales),ResultsThe mean age was 40.6 years (±16.4). The sex ratio was 2. Sixty-six percent of patients were diagnosed with bipolar disorder type 1 and type 2 bipolar disorder remains.There is no statistically significant difference between bipolar with and without SUD in terms of quality of insight.As for the subscales, bipolar patients with comorbid SUD had lower scores of awareness of any symptoms, whereas there was no significant difference regarding the awareness of illness and the need for treatment between the two populations.ConclusionsCo-morbid SUD can affect the quality of insight in individuals with BD. Patients with this co-morbidity should be targeted for intensive psycho-educational measures and psychotherapeutic interventions focused on the improvement of insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Formal thought disorder in schizophrenia and bipolar disorder: A systematic review and meta-analysis

2017 ◽  
Vol 41 (S1) ◽  
pp. S185-S185
Author(s):  
K. Alptekin ◽  
B. Yalincetin ◽  
E. Bora ◽  
A. Berna
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Thought Disorder ◽  
Formal Thought Disorder ◽  
Shared Feature ◽  
Significant Difference ◽  
Competing Interest

Historically, formal thought disorder has been considered as one of the distinctive symptoms of schizophrenia. However, research in last few decades suggested that there is a considerable clinical and neurobiological overlap between schizophrenia and bipolar disorder (BP). We conducted a meta-analysis of studies comparing positive (PTD) and negative formal thought disorder (NTD) in schizophrenia and BP. We included 19 studies comparing 715 schizophrenia and 474 BP patients. In the acute inpatient samples, there was no significant difference in the severity of PTD (d = –0.07, CI = –0.22–0.09) between schizophrenia and BP. In stable patients, schizophrenia was associated with increased PTD compared to BP (d = 1.02, CI = 0.35–1.70). NTD was significantly more severe (d = 0.80, CI = 0.52–0.1.08) in schizophrenia compared to BP. Our findings suggest that PTD is a shared feature of both schizophrenia and BP but persistent PTD or NTD can distinguish subgroups of schizophrenia from BP and schizophrenia patients with better clinical outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mortality and rehospitalization rates among patients with severe mental illness (SMI) at different levels of hospital spending

2020 ◽  
Author(s):  
Shih-Chi Lin ◽  
Kuan-Yi Tsai ◽  
Hung-Yu Wang ◽  
Shih-Pei Shen ◽  
Frank Chou
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Severe Mental Illness ◽  
Treatment Outcomes ◽  
Psychiatric Hospitalization ◽  
Major Depressive ◽  
National Health Research Institute ◽  
Patient Level

Abstract Background Evidence has shown that the relationships between hospital spending and treatment outcomes for physical conditions have been inconclusive. So to investigate the association between hospital spending and both risk-adjusted mortality and rehospitalization rates among patients with severe mental illness (SMI). Method This was a retrospective cohort study that used the Taiwan National Health Research Institute Database (NHRID) from 1999 to 2010. Hospital end-of-life (EOL) spending was used to quantify hospital spending and was determined by the total medical costs of the last year of life of patients with at least one previous psychiatric hospitalization. Patients with schizophrenia (n=13,229), bipolar disorder (n=4,476) and major depressive disorder (n=5,177) were followed for mortality and rehospitalization to psychiatric wards from 2009 to 2010 after they had been discharged from the study hospitals. Results Patients with schizophrenia had lower rehospitalization and mortality rates when treated at higher-spending hospitals than when treated at the lowest-spending hospitals. However, these associations became weak, even nonsignificant, when adjusted for patient-level variables. There were no significant findings for patients with bipolar disorder and major depressive disorder when patient-level variables were adjusted for. Patient-level variables showed more determinant roles than hospital-level variables in the relationships between hospital spending and treatment outcomes. Conclusion Hospitals that spend more at the EOL had lower mortality and rehospitalization rates for patients with schizophrenia but higher rates for bipolar disorder and major depressive disorder. Most of these associations could be explained by patients’ characteristics more than hospitals’ characteristics.

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