Patterns of Care of Depressive Illness: A Case Register Study Using a Hierarchical Diagnostic Classification

AbstractObjectiveA few empirically based studies' data on delusional disorder (DD) exist. We aim to describe sociodemographic and clinical correlates of DD and to identify clinical profiles associated to DD and its subtypes.MethodsThis is a case-register study based on all those subjects attending community mental health services within a geographically well-defined area. Four hundred and sixty-seven patients had been diagnosed as DD cases at psychiatric services serving a catchment area of some 607,494 inhabitants living in South Barcelona (Spain) during a three-year period (2001–2003). A thorough systematic review of computerised medical records was used to establish DSM-IV diagnosis, rendering a valid sample of 370 patients who fulfilled DSM-IV criteria for DD. Independent variables gathered include sociodemographic data, family and personal psychiatric history, and comorbid diagnoses on all DSM-IV axes (including GAF). We used descriptive and univariate statistical methods to explore sample frequencies and correlates across DD types.ResultsThe mean age of the patients was 55 years and the sample had a mean GAF score of 51 suggesting a poor functionality; 56.5% of the patients were female. The most frequent DD types were persecutory (48%), jealous (11%), mixed (11%) and somatic (5%), whilst 23% qualified for the NOS type. Most frequent symptoms identified were self-reference (40%), irritability (30%), depressive mood (20%) and aggressiveness (15%). Hallucinations were present in 16% of the patients (6% tactile; 4% olfactory). Nearly 9% had a family history of schizophrenia (higher among those with the jealous subtype) and 42% had a comorbid axis II diagnosis (mostly paranoid personality disorder). Depression was significantly more frequent among the persecutory and jealous types. Finally, global functioning was significantly better among jealous and mixed types and worse amongst erotomanic and grandiose cases (p = 0.008).ConclusionsIn the absence of other similar empirical data, this modest study provides unique empirical evidence of some clinical and risk correlates of DD and its subtypes.

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Release and Return Rates for Patients in State Mental Hospitals of Maryland. Psychiatric Case Register Study

Public Health Reports (1896-1970) ◽

10.2307/4592924 ◽

1966 ◽

Vol 81 (12) ◽

pp. 1095 ◽

Cited By ~ 15

Author(s):

Kurt Gorwitz ◽

Anita K. Bahn ◽

Gerald Klee ◽

Murray Solomon

Keyword(s):

Register Study ◽

Case Register ◽

Return Rates ◽

Psychiatric Case Register ◽

Mental Hospitals ◽

Psychiatric Case ◽

State Mental

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Mortality Among Patients with Psychiatric Illness a Ten-Year Case Register Study in an Area with a Community-based System of Care

The British Journal of Psychiatry ◽

10.1192/bjp.166.6.783 ◽

1995 ◽

Vol 166 (6) ◽

pp. 783-788 ◽

Cited By ~ 49

Author(s):

Francesco Amaddeo ◽

Giulia Bisoffi ◽

Paola Bonizzato ◽

Rocco Micciolo ◽

Michele Tansella

Keyword(s):

Poisson Regression ◽

Psychiatric Patients ◽

Age Groups ◽

System Of Care ◽

Register Study ◽

First Year ◽

Community Based ◽

Pattern Of Care ◽

Case Register ◽

Specialist Services

BackgroundMost studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples.MethodThis was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982–1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated.ResultsThe overall SMR was 1.63 (95% CI = 1.5–1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% CI = 1.9–2.6), among patients who were admitted to hospital (SMR = 2.23; 95% CI = 1.9–2.6), among younger age groups (SMR = 8.82; 95% CI = 4.9–14.6) and in the first year after registration (SMR = 2.32; 95% CI = 1.8–2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% CI = 3.0–4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role.ConclusionsThe overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration.

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