A Comprehensive Emergency Psychiatric Service in a General Hospital

Rapid developments in general hospital outpatient psychiatry reflect increasing demands from the community for such setvices. Combining the outpatient caseload and Emergency Room psychiatric patients, nearly 2,500 patients per year were under care. To provide better care a new emergency intake service has been established, with a 72-hour limit of stay. This is a valuable therapeutic resource, and has made it possible to better study and treat selected acutely-ill patients. It is also a dynamic teaching setting. The establishment of this intensive-care unit has relieved pressure on the existing services. Suicidal patients, those with transient deliria and acutely disturbed patients have been accommodated. About 20 per cent of the casualty caseload has been admitted to the Short Stay Service, and nearly 50 per cent of such patients were able to return to their homes and community living within three days. These clinical experiences confirm the description of this unit as a ‘comprehensive emergency psychiatric service’ in a general hospital setting. The survival of the service is assured and encourages the establishment of similar units in other centres.

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La psychiatrie de consultation-liaison: une étude prospective en milieu hospitalier général

The Canadian Journal of Psychiatry ◽

10.1177/070674379303800303 ◽

1993 ◽

Vol 38 (3) ◽

pp. 168-174 ◽

Cited By ~ 6

Author(s):

Max Michalon

Keyword(s):

General Hospital ◽

Suicide Risk ◽

Illicit Drugs ◽

Psychiatric Service ◽

Hospital Setting ◽

Étude Prospective ◽

Benzodiazepine Use ◽

Suicidal Patients ◽

The Impact ◽

Overall Functioning

This study was conducted in Halifax, Nova Scotia, in a 740 bed university general hospital. For a period of two years, a prospective collection of data on 692 psychiatric consultations showed that 60% of all consultations came from internal medicine departments. Medical and psychiatric comorbidity was found in 50% of the patients; depression was diagnosed in 27.5% of the cases but schizophrenia in only 1.7%. Suicidal ideation was reported by 24% of the patients, 11.6% of them wishing to die imminently. More than 50% of suicidal patients were under 35 years of age; 42% of them were dependent on alcohol. Almost 30% of the patients seen in consultation admitted to being addicted to alcohol, 22% to benzodiazepines and 14% to illicit drugs. Among the ex-alcoholic patients, a significant dependence in benzodiazepine use was found. The patients with addictions to street drug had a greater suicide risk and were at the same time abusing alcohol. This paper will describe the overall functioning of a consultation-liaison psychiatric service and will analyze the impact of psycho-active substance abuse in a general hospital setting. The results will be compared with those in the literature.

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Socialization Scores in Psychiatric Patients and Their Implications for the Diagnosis of Personality Disorders

The Canadian Journal of Psychiatry ◽

10.1177/070674378603100211 ◽

1986 ◽

Vol 31 (2) ◽

pp. 138-141 ◽

Cited By ~ 6

Author(s):

Kevin Standage

Keyword(s):

Personality Disorder ◽

Parental Care ◽

Personality Disorders ◽

General Hospital ◽

Clinical Diagnosis ◽

Psychiatric Patients ◽

Psychiatric Service ◽

Strong Association

The distribution scores on the Socialization (So) scale of the California Psychologial Inventory was examined in a series of 83 admissions to a general hospital psychiatric service. The series was divided into groups of low and high scorers (Low So and High So). Low So scorers were younger than high scorers and had a raised mean Neuroticism score. A strong association was found between So scores and the quality of parental care which patients reported receiving from their fathers. Other parental attributes are reported. Patients with a clinical diagnosis of personality disorder were found in the Low So, but not the High So group.

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Psychiatric intensive care after two years

Psychiatric Bulletin ◽

10.1192/pb.13.8.421 ◽

1989 ◽

Vol 13 (8) ◽

pp. 421-422 ◽

Cited By ~ 1

Author(s):

J. M. O'Dwyer ◽

B. S. Mann

Keyword(s):

Mental Health ◽

Intensive Care Unit ◽

Intensive Care ◽

General Hospital ◽

Mentally Ill ◽

Psychiatric Patients ◽

District General Hospital ◽

Descriptive Study ◽

Psychiatric Unit ◽

Health Authorities

The following is a descriptive study of Willoughby Ward, a psychiatric intensive care unit, opened in Parkside Hospital, Macclesfield, in July 1986. It provides a moderately secure facility for the treatment of psychiatric patients within both Crewe and Macclesfield Health Authorities. The unit has 15 beds, of which two are funded and used by Crewe area, where, unlike Macclesfield, the psychiatric unit is located in the district general hospital. Managed as a locked ward, the patients are admitted under the provisions of the Mental Health Act 1983. As well as being mentally ill as defined in the Act, the patients were disturbed to a degree as to be unmanageable in open conditions.

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Psychiatric Referrals from Medical and Surgical Wards

Journal of Mental Science ◽

10.1192/bjp.108.453.183 ◽

1962 ◽

Vol 108 (453) ◽

pp. 183-190 ◽

Cited By ~ 44

Author(s):

J. J. Fleminger ◽

B. L. Mallett

Keyword(s):

General Hospital ◽

Psychiatric Patients ◽

Psychiatric Service ◽

Psychiatric Morbidity ◽

Laboratory Facilities ◽

Routine Work ◽

Medical Wards ◽

Set Up ◽

One Year ◽

Clinical Conditions

The practice of psychiatry in general hospitals is increasing and some of the problems it raises have been widely discussed. Many administrative questions have received close attention (Bennett et al., 1956; Smith, 1961) and the advantage to psychiatric patients of having readily available medical, surgical and laboratory facilities has been clearly seen (Gillies, 1959). It has been shown, too, that patients with mental illness can be admitted to beds in medical wards and be treated there successfully (Brook and Stafford-Clark, 1961). On the other hand, much less attention has been given to the psychiatric requirements of the general hospital itself, and there is very little information about the use that physicians, surgeons and specialists are likely to make of a psychiatric service for their own in-patients. Studies of psychiatric morbidity among general ward patients (Mittelmann et al., 1945; Zwerling et al., 1955) are of great interest, but they tend to shed an artificial light on the problems of practical needs and probable demands. Shepherd, Davies and Culpan (1960) have provided the most useful report so far, on the incidence of psychiatric referrals by physicians and surgeons and the clinical conditions encountered. This was the result of a one-year work-study specially set up for the purpose of investigating these questions at a general hospital in London. However, there appears to have been no account of findings based on the routine work of a hospital where a psychiatric unit has been well established.

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Differential-Diagnostical and Management Difficulties in 3.354 Psychosomatic/Psychiatric Patients Referred to a Psychosomatic Department in a General Hospital Setting

Psychosomatic Medicine ◽

10.1007/978-1-4684-5454-3_23 ◽

1987 ◽

pp. 137-139

Author(s):

P. Gathmann ◽

A. Friedmann

Keyword(s):

General Hospital ◽

Psychiatric Patients ◽

Hospital Setting

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A Psychiatric Intensive Care Unit in a General Hospital Setting

The Canadian Journal of Psychiatry ◽

10.1177/070674378603100908 ◽

1986 ◽

Vol 31 (9) ◽

pp. 834-837 ◽

Cited By ~ 20

Author(s):

L. Warneke

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

General Hospital ◽

Psychiatric Inpatient ◽

Hospital Setting ◽

Inpatient Service ◽

Unit Model ◽

Growing Pains ◽

Secure Environment ◽

Medical Intensive Care

A twelve month period of the functioning of a psychiatric intensive care unit in a general hospital is reviewed. The unit has actually been functioning for about three and a half years. Although there were growing pains initially, the unit has become an integral part of the psychiatric inpatient service. It serves to provide intensive care to acutely inpatients and provides a safe, secure environment. It also reduces the number of disturbed patients on the two general units. Very disturbed patients are expertly managed by the staff and a surprisingly low percentage of patients have to be transferred to the local mental hospital under certification. The experience demonstrates that a psychiatric intensive care unit based on a general medical intensive care unit model can function well with benefit both to patients and staff.

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261 Cost effectiveness of heart failure nurse in a district general hospital setting

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(04)90186-5 ◽

2004 ◽

Vol 3 (1) ◽

pp. 63

Author(s):

P JENKINS

Keyword(s):

Heart Failure ◽

Cost Effectiveness ◽

General Hospital ◽

Hospital Setting ◽

District General Hospital

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Outreach Psychiatric Emergency Service

Crisis ◽

10.1027/0227-5910/a000651 ◽

2020 ◽

Vol 41 (5) ◽

pp. 375-382

Author(s):

Remco F. P. de Winter ◽

Mirjam C. Hazewinkel ◽

Roland van de Sande ◽

Derek P. de Beurs ◽

Marieke H. de Groot

Keyword(s):

General Practitioner ◽

General Hospital ◽

Suicidal Behavior ◽

Emergency Service ◽

Attempted Suicide ◽

Emergency Services ◽

Psychiatric Emergency ◽

Psychiatric Emergency Services ◽

Psychiatric Emergency Service ◽

Suicidal Patients

Abstract. Background: Outreach psychiatric emergency services play an important role in all stages of a suicidal crisis; however, empirical assessment data are scarce. This study describes characteristics of patients assessed by these services and involved in suicidal crises. Method: During a 5-year period, detailed information from psychiatric emergency service assessments was recorded; 14,705 assessments were included. Characteristics of patients with/without suicidal behavior and with/without suicide attempts were compared. Outcomes were adjusted for clustering of features within individual patients. Results: Suicidal behavior was assessed in 32.2% of patients, of whom 9.2% attempted suicide. Suicidal behavior was most commonly associated with depression or adjustment disorder and these patients were referred to the service by a general practitioner or a general hospital, whereas those who attempted suicide were less likely to be referred by a general practitioner. Those who attempted suicide were more likely to be female and have had a referral by a general hospital. Self-poisoning by medication was the most common method of attempting suicide. Limitations: Bias could be due to missed or incomplete assessments. Primary diagnoses were based on clinical observation at the time of the assessment or on the primary diagnosis previously recorded. In addition, suicidal behavior or attempted suicide might have been underestimated. Conclusions: Suicidal behavior is commonplace in assessments by psychiatric emergency services. Suicidal patients with/without a suicide attempt differed with respect to demographic features, primary diagnoses, and referring entities, but not with respect to treatment policy. About 40% of the suicidal patients with/without an attempt were admitted following assessment.

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