scholarly journals Three-year outcome of first-episode psychoses in an established community psychiatric service

2000 ◽  
Vol 176 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Swaran P. Singh ◽  
Tim Croudace ◽  
Shazad Amin ◽  
Rosemary Kwiecinski ◽  
Ian Medley ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Psychiatric Service ◽  
First Episode ◽  
Inception Cohort ◽  
Severe Mental Disorders ◽  
Affective Psychoses ◽  
Community Psychiatric ◽  
Icd 10 ◽  
Community Psychiatric Service

BackgroundChanges in service provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis.AimsTo assess the three-year outcome of an inception cohort of first-episode psychoses treated in a modern, community-oriented service; to compare outcomes with an earlier cohort treated in hospital-based care; and to examine the predictive validity of ICD–10 diagnostic criteria.MethodThree-year follow-up (1995–1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980–1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort.ResultsOn most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance-related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability.ConclusionsIn a modern community service, 30–60% of patients with first-episode psychoses experience a good three-year outcome. The ICD–10 criteria have good predictive validity.

The Effects that Patients Have on their Families in a Community Care and a Control Psychiatric Service—A Two Year Follow-up

1968 ◽  
Vol 114 (508) ◽  
pp. 265-278 ◽  
Author(s):  
Jacqueline Grad ◽  
Peter Sainsbury
Keyword(s):  
Mentally Ill ◽  
Community Care ◽  
Care Service ◽  
Psychiatric Service ◽  
Research Unit ◽  
Admission Rates ◽  
Community Psychiatric ◽  
Community Psychiatric Service ◽  
Made In

The effects that mentally ill people have on their families have been more commented upon than studied. The currently favoured practice of community care has increased the need for a systematic attempt to evaluate the families' problems, and an opportunity to do this occurred when a community psychiatric service was introduced in Chichester in 1958, while the neighbouring Salisbury district continued with a conventional hospital-based service. The Medical Research Council's Clinical Psychiatry Research Unit has been evaluating the new service to find out how it affects referral and admission rates; how it influences social and clinical outcome, and the effect it has on the community itself. As the patient's family is the sector of the community most closely concerned in any extension of the extra-mural care of patients, we began by assessing the effects on them. The present paper therefore describes the assessments we made of the burden the patients' families carried in the Chichester Community Care Service and compares their burden with that experienced by families in Salisbury, where admission to hospital was more commonly practised. The comparison is made in terms of the relief that was afforded the two groups of families over a period of two years.

The Clinical Evaluation of a New Community Psychiatric Service Based on General Practice Psychiatric Clinics

1992 ◽  
Vol 160 (4) ◽  
pp. 493-497 ◽  
Author(s):  
Brian Ferguson ◽  
Sylvia Cooper ◽  
Judith Brothwell ◽  
Aristos Markantonakis ◽  
Peter Tyrer
Keyword(s):  
General Practice ◽  
Psychiatric Service ◽  
Multidisciplinary Care ◽  
Chronically Ill ◽  
Community Psychiatric ◽  
City Population ◽  
New Community ◽  
Community Psychiatric Service ◽  
Chronically Ill Patients

A new community psychiatric service in Nottingham based on general practice clinics was compared with a conventional hospital-orientated model. Despite providing treatment for an inner-city population of significantly greater social disadvantage, the community service was associated with similar levels of symptom morbidity as assessed by the CPRS and the SFS. It also involved greater use of day-hospital facilities, more extensive multidisciplinary care, and a commitment to longer-term follow-up of chronically ill patients. Such a model is offered as a basis for future developments of urban community psychiatric services.

Episodes of Care for First-Ever Psychiatric Patients a Long-Term Case-Register Evaluation in a Mainly Urban Area

1995 ◽  
Vol 167 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Michele Tansella ◽  
Rocco Micciolo ◽  
Annibale Biggeri ◽  
Giulia Bisoffi ◽  
Matteo Balestrieri
Keyword(s):  
Cox Regression ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Mental Illnesses ◽  
Rank Test ◽  
First Episode ◽  
Case Register ◽  
Episode Of Care ◽  
Episodes Of Care ◽  
Community Psychiatric Service

BackgroundPsychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of ‘survival analysis’ have rarely been used for assessing such data.MethodA longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses.ResultsThe duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts.ConclusionsThe community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.

Factors Influencing Referrals to a Community Psychiatric Service

1969 ◽  
Vol 3 (3) ◽  
pp. 170-174
Author(s):  
I. Pilowsky ◽  
W. Childs
Keyword(s):  
Mental Health Problems ◽  
Psychiatric Service ◽  
Demographic Variables ◽  
Demographic Characteristics ◽  
Referral Rate ◽  
Referral Patterns ◽  
Class Composition ◽  
Factors Influencing ◽  
Community Psychiatric ◽  
Community Psychiatric Service

Referral patterns to a community psychiatric service have been correlated with demographic variables relating to the population (120,000) served. The total suburban referral rate correlated significantly with social class composition and general practitioner sensitivity. Diagnosis has been considered in relation to referral rates and the demographic characteristics of individual suburbs. These findings suggest that studies of this sort can play an important part in delineating the mental health problems to which a service is sensitive and in helping to discover areas in the region to which special attention might be paid.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Caltagirone 1987–1990

1992 ◽  
Vol 1 (1) ◽  
pp. 45-60 ◽  
Author(s):  
Gaetano Interlandi ◽  
Maria Grazia Sotera
Keyword(s):  
Psychiatric Service ◽  
Similar Rate ◽  
Outpatient Clinics ◽  
Case Register ◽  
Diagnostic Categories ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte, con la stessa metodologia impiegata in altre 4 aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-aerea, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Caltagirone. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (763/100000 residenti adulti) e un giorno (223/100000 residenti adulti) hanno valori inferiori ai RPC europei. I tassi di incidenza (281/100000 residenti adulti) indicano un afflusso di nuovi casi appartenenti a tutte le categorie diagnostiche. II RPC di Caltagirone monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale: residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 4,4 a 1. II tasso di lungoassistiti è di 122/100000 residenti adulti, con una tendenza ad un accumulo per quelli che vivono nel territorio, mentre vi è un calo di quelli che sono in Comunità. II costo del Dipartimento, che è andato riducendosi dal 1987 al 1990, è in buona parte da addebitare alle giornate di assistenza in Comunità.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Caltagirone are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the year prevalence (763'100000 adult inhabitants) and day prevalence (248'100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (248'100000 adult inhabitants) shows that new patients belong to all diagnostic categories. The PCR records data of the activities made in multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, care in outpatient clinics, domiciliary care, etc. The ratio between non-hospitalized and hospitalized users is 4.3 to 1. The rate of long-term patients is 122'100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the sheltered apartments is decreasing. The costs of the Service (which have decrease from 1987 to 1990) have to be attributed mainly to the costs of the treatment in sheltered apartments.

Eighteen Years of Community Psychiatric Service in the Island of Samsø

1977 ◽  
Vol 131 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Johannes Nielsen ◽  
Jørgen Achton Nielsen
Keyword(s):  
Psychiatric Hospital ◽  
General Practitioners ◽  
Rural Population ◽  
Psychiatric Service ◽  
Home Visits ◽  
Referral Rate ◽  
Community Psychiatric ◽  
The Mean ◽  
Community Psychiatric Service

SummaryAn analysis has been made of patients aged 15 + referred to the community psychiatric service in a Danish rural population during 18 years. The mean referral rate per year was 17·9 per 1,000.The majority of the patients (79 per cent) were referred to the clinic by the general practitioners, and it is stressed that a close and good co-operation between the psychiatrists and the local physicians is one of the most important factors in establishing a good community psychiatric service.Only 11 per cent of all referrals were admitted to a psychiatric hospital. The admission frequency for psychoses was only 19 per cent, and it was estimated that it would have been approximately 44 per cent higher, if the service had been of the usual hospital-oriented type. Forty-three per cent of the patients were visited by the psychiatrist in their home at least once and 42 per cent of all 6,000 consultations were home visits.When evaluating the treatment possibilities it was considered that approximately 50 per cent of all patients referred could be treated by the local physicians after examination by psychiatrists and discussion of the cases with them.

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