Psychiatric outpatients dropout: Causes and institutional context
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Keywords:
Dropout (neural networks)
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Concordance
Psychiatric diagnosis
Diagnosis of schizophrenia
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Quarter (Canadian coin)
Psychiatric hospital
Inpatient care
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A total of 164 (47%) out of 350 new psychiatric patients in a general hospital in Japan were those referred to psychiatric consultation. In 47% of the cases, concurrent physical and psychiatric disorders were reported. In the referred patients, neurosis (38%) was the most common psychiatric disorder, followed by other nonorganic psychoses (9%), schizophrenic psychoses (8%), alcoholic psychoses (8%), transient organic psychotic conditions (7%), affective psychoses (6%) and others. The high frequency of psychiatric emergency cases (23%) including cases with suicide attempts (12%) indicated that psychiatrists play an important role in psychiatric emergency crisis intervention in the general hospital emergency service. In suicide attempts, depression was most prominent, but schizophrenic psychoses were also involved in a third of the cases.
Neurosis
General hospital
Depression
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Tardive dyskinesia
Outpatient clinic
Psychiatric hospital
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Psychiatric diagnosis
Depression
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In order to evaluate which single or combined factors can lead to best acceptance of continuing out-patient psychiatric care, a random sample of 73 patients diagnosed as schizophrenic were entered into a follow-up study on leaving a psychiatric hospital. In a given region with only one public mental health center it was found that early and comprehensive planning of hospital dismissal, cooperation of family and--where possible--no change of the responsible therapist led to a 84% rate of patients remaining in the regional psychiatric care system, with a rehospitalisation rate of 33% within a year. Literature on the subject is reviewed in perspective of the rather high acceptance of psychiatric aftercare and the rather low rate of rehospitalisation.
Psychiatric hospital
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Psychiatric assessment
Depression
Psychiatric interview
Mini-international neuropsychiatric interview
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Stigma
Shame
Psychiatric hospital
Social stigma
Social distance
General hospital
Mental hospital
Outpatient clinic
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Although problem drinkers are over-represented in psychiatric treatment populations throughout the United States, it is unclear whether this is primarily due to difficulties in differentially diagnosing alcohol and mental problems and to high rates of comorbidity, or to factors unique to help-seeking for alcohol problems. This article examines the role that alcohol problems play in treatment entry to inpatient and outpatient mental health agencies, considering the potential roles of a drinking problem both as a condition perceived by the sufferer to require a psychiatrist's help, and as a source of social disruption that activates others to encourage mental health treatment. Analysis focuses on comparing samples of newly admitted patients in a community mental health system and untreated individuals with high levels of psychiatric symptoms living in the same community. Experiencing the adverse social consequences of a drinking problem, holding the belief that drinking has caused one's psychological problems, and having prior experiences in mental health treatment for a drinking problem are factors found to be positively associated with psychiatric admissions, while heavier drinking and dependence symptoms are not. Further analysis of events precipitating psychiatric admission suggests that an important role for the mental health system vis à vis alcohol problems is to contain social disruptions attributable to problem drinking in the community. Alcohol-related psychiatric admissions are found to have more frequently involved public disruptions, to have elicited police or court referrals, and to have more often resulted in the client's going to a locked hospital ward, as opposed to a mental health outpatient clinic.
Psychiatric comorbidity
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OBJECTIVE: The authors prospectively examined inpatient psychiatric hospitalization and mortality rates of psychiatric patients seen in the emergency room of a large Department of Veterans Affairs medical center. METHOD: Charts of 504 patients receiving evening psychiatric consultation during a 13-month period were assessed 5 years after the consultation to determine rates of psychiatric hospitalization and mortality. RESULTS: Patients with multiple psychiatric diagnoses, including comorbid addiction disorders, had significantly higher rates of psychiatric hospitalization 5 years after an emergency room visit. Comorbid psychiatric disorders increased the rate of inpatient psychiatric hospitalization across diagnoses. Seventy-eight patients died during the study period. CONCLUSIONS: These findings reveal relationships between diagnostic profiles and future psychiatric hospitalization and mortality rates. This information could focus psychiatric and medical interventions for high-risk patients.
Psychiatric diagnosis
Veterans Affairs
Tertiary care
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