Acute Mental Disorders Research Articles

Stroke: Is it sometimes overlooked?

Introduction Acute stroke is defined as an abrupt focal or global disorder of cerebral function. Ischemic stroke is significantly more frequent than the hemorrhagic stroke (75-80% of all). Occlusion of a blood vessel by thrombus or embolus causes it and it is characterized by sudden onset and rapid development of neurological symptoms. Object The aim of this paper is to point out that in cases when patients present with acute mental disorder and no apparent neurological symptoms, stroke should be considered as a possible diagnosis. Materials and methodology The data from the medical report and from the discharge list have been used to present this case of a patient with ischemic stroke. Results This is a case report of a 66-year-old male patient who suddenly developed a kind of a conduct disorder and psychomotor agitation, followed by confusion and occasional aggression. The EMS team found the patient in the bathroom of his home, switching on and off the washing machine. His wife said that he woke up 3 hours ago and began to behave strangely (urinated all over the house). Known facts about his previous condition were the following: smoker, with no history of alcohol abuse, had high blood pressure, but didn't take any medications. Verbal communication existed, though confused and anxious, patient spoke fluently with occasional meaningless words. He could move and execute certain simple tasks, but he had no insight into his condition; he refused help, resisted examination as well as going to the hospital. For the benefit of the patient, a police patrol was invited to escort him to the health facility. A partial examination was conducted: BP = 240/120 mmHg and blood glucose = 7 mmol/l; more detailed examination was not possible due to patient's reluctance for cooperation. Considering that problems occurred suddenly, and the possibility of intoxication was rejected, the patient was transported to a neurologist with a diagnosis of a possible stroke, which was eventually confirmed after neuroradiology diagnostics. Discussion The diagnosis of acute ischemic stroke should be confirmed during the first 3 hours to a maximum of 4.5 hours from the first symptoms, if thrombolytic therapy is to be included. We would have made a serious mistake and would have wasted precious time, if we had assumed that a mental disorder is the right diagnosis. Conclusion When examining a patient with acute mental disorder it is necessary to consider the possibility of the underlying organic cause, and therefore rule out the potentially life threatening conditions such as hypoglycemia, cerebral stroke, subdural hematoma, meningoencephalitis, etc.

De mi for you. Proyecto artístico de colaboración internacional entre personas afectadas por trastorno mental grave

El trabajo artístico colaborativo internacional consistió en generar un canal de comunicación y de creación entre dos grupos de participantes afectados por trastorno mental grave y usuarios de servicios de atención a la salud mental ubicados en países diferentes: un grupo situado en Calatayud, Zaragoza (España) y otro en Londres (Inglaterra). El marco de trabajo estuvo basado en la libertad de creación y la flexibilidad partiendo de una sencilla sugerencia apoyada en la "Teoría de las cinco pieles" del artista austriaco F. Hundertwasser.

Acute mental disorders and short and long term morbidity in patients with third degree flame burn: A population-based outcome study of 96,451 patients from the Nationwide Inpatient Sample (NIS) database (2001–2011)

BackgroundAlthough burn patients with preexisting mood disorders have been shown to have diminished clinical recovery, acute mental disorders (AMD) are often unrecognized despite a link with post-traumatic stress disorder and social maladjustment later on. This study assessed the clinical profile of a large cohort of burn patients who developed AMD compared to those with chronic mental illness (CMI) and those without mental health problems to assess the impact of AMI on burn outcomes. MethodsAdmission data on 96,451 patients with third degree flame burns was abstracted from the Nationwide Inpatient Sample (NIS) Database from 2001 to 2011. AMD was defined as adjustment disorder (ICD-10 codes F43.2–F43.29) and acute stress disorder (F43.0), while CMI was defined as major depressive disorder (F33.0–F33.9) and bipolar disorder (F31.0–F31.9). Data was compared across three subgroups: AMD, CMI, and patients without any mood disorders. Categorical variables were compared using the Chi-square test, and continuous variables were compared using Student t-test and analysis of variance (ANOVA). Multivariate analysis using the “backward Wald” method was performed to calculate odds ratios (OR) and determine independent factors which increased the risk of developing AMD after burn. Results979 (1%) burn patients were diagnosed with AMD, compared to 5971 (6.2%) with CMI and 89,501 (92.8%) without mood disorders at the time of the burn. Patients with AMD were significantly younger, predominantly male and Caucasian. Patients with AMD had a higher frequency of multiple third-degree burn sites. AMD patients had a significantly longer length of hospitalization and shorter actuarial survival. More AMD patients lacked social or family support, suffered from alcoholism or illicit drug abuse, and had a history of psychological trauma or self-inflicted injuries compared to other groups. After burn, 4.9% of AMD patients developed burn wound infections, 5.0% had nutritional deficiencies, 1.7% had skin graft failure, 0.7% had acute psychosis, and 3.7% had suicidal ideation, p<0.05. Multivariate analysis identified age 10–39 (OR 4.6), alcoholism (OR 1.4), drug abuse (OR 1.9), psychoses (OR 1.4), and total body surface are (TBSA) 10–39% third degree burns (OR 1.8) as independently associated with developing AMD, p<0.005. ConclusionThe development of AMD in burn patients is associated with poor clinical outcomes including longer hospitalization, decreased survival, and increased complication rates. Premorbid psychopathology, substance abuse and age were associated with a higher incidence AMD after burn than was the severity of the burn wound itself. Routine screening for psychological symptoms of AMD should be performed in all burn patients to avoid increased rates of short and long-term morbidity and mortality.

The current status of delirium after elderly hip fracture

Delirium is a common complication after elderly hip fracture, and is associated with high rates of mortality and morbidity. There is no enough attention for delirium compared to deep vein thrombosis, pulmonary embolism, heart failure, etc. This paper reviews the definition, diagnosis, incidence, prognosis, treatment and other aspects of delirium in order to better under-stand delirium clinically. Delirium is an acute mental disorder of consciousness, attention, perception, thinking ability, memory, mental activity, and emotion. It is characterized by the disorder of sleep or wakefulness, and these changes are difficult to explain by dementia. The confusion assessment method(confusion assessment method, CAM)is generally accepted as the current diagnostic tools for delirium, and mainly depends on the patient's consciousness and cognitive function. The mechanisms of delirium are unclear, and it is influenced by many factors, such as agedness, cognitive impairment, pain, sleep rhythm disorders, and theories mainly include neurotransmitter theory, the central inflammatory response theory, the theory of stress response, sleep wake cycle, et al. The delirium is difficult to explain by using single, liner factor, but is elaborated by many various factors. However, the influences of delirium on outcome for hip fracture are unclear, and it is definite that these patients have poor functional recovery, poor independent living ability, longer time in bed, demand for more care. The prevention should be implemented as mainly measures for delirium. Elimination of risk factors, including correct hypoxia, reduce pain, avoid water electrolyte disorders, improve sleep rhythm, and avoid using of opioids should be tried. In addition, adequate analgesia and appropriate anesthesia should used, and some inappropriate drugs should be avoided. Multidisciplinary cooperation mode, including doctors from orthopedics, anesthesiology, and geriatric department should be conducted to reduce the incidence of delirium as far as possible. Once diagnosed, some measures should be applied, such as maintaining of airway patency, adequate nutritional support, correction of water and electrolyte disorders, anemia and low serum albumin, to ensure adequate physical and mental support, and to create a good environment for the ward, as well as to remove the possible etiological factors, such as anemia, low protein acidosis and electrolyte disturbance.

Effectiveness and cost-effectiveness of home treatment compared with inpatient care for patients with acute mental disorders in a rural catchment area in Germany

Background and aimsHometreatment (HT) is considered as a safe and effective alternative to inpatient treatment (IT) for the treatment of patients with acute mental disorders. To date, there are only few studies on the effectiveness and no studies on the efficiency of HT vs IT in Germany. The aim of this study is to investigate the effectiveness and cost-effectiveness of HT in comparison with IT in a rural catchment area in Germany. MethodsIn a prospective observational trial, 60 patients with acute mental disorders treated by a HT team were compared with 58 patients who were eligible for HT but received IT. Treatment outcomes (change of psychotic symptoms [PANSS], depressive symptoms [HAMD] and overall clinical and functional impairment [HoNOS] from admission to discharge) were assessed. Treatment costs were assessed on the basis of reimbursement data. Effectiveness was estimated by means of mixed effects regression (MER) models. Cost-effectiveness was estimated by a net monetary benefit (NMB) regression model. Propensity score adjustment was applied for the control of selection bias in regression models. ResultsAs indicated by the results of the MER model, HT was more effective in comparison to IT with respect to HAMD reduction (b −4.11; p 0.004) and HoNOS total score decrease (b −4.43; p 0.021) but not as regards the PANSS total score (b −4.51; p 0.134). Unadjusted treatment costs did not differ between HT and IT, but after adjustment for propensity scores and for baseline values of the outcome measures HT was significantly less costly (b −7.151.10; p 0.028) than IT. NMB regression revealed a significant monetary benefit for a one unit change of the HAMD at a maximum willingness to pay (MWTP) of λ=0 € and λ=100 € and the HoNOS at λ=1000 €. ConclusionsHT is an effective and cost-effective alternative to IT for the treatment of people with acute mental disorders in the investigated catchment area. Results cannot be generalized for the whole of Germany. Further research is needed.

The effect of animal-assisted therapy on emotional and behavioral symptoms in children and adolescents hospitalized for acute mental disorders

IntroductionAnimal-Assisted Therapy (AAT) may be useful therapeutically to improve patient outcomes. The objective of this study was to examine the effects of AAT on behavioral and emotional symptoms reported by children and adolescent psychiatric patients hospitalized for acute mental disorders. MethodsA pre-post experimental design, randomized controlled trial (RCT) was carried out. 20 patients provided with an AAT intervention were compared with 20 patients receiving standard therapeutic treatment. A Youth Self-Report (YSR) was used to measure patients’ emotional and behavioral symptoms. Global functioning was assessed by the Children Global Assessment Scale (C-GAS). ResultsResults indicated a significant decrease in internalizing symptoms (p<.001) and an increase in total competence (p<.001), as well significant improvements in global functioning (p<.0001) in the AAT treatment group, but not in the control group. ConclusionsThe effects of AAT in reducing emotional and behavioral symptoms and increasing global competence and psychological functioning were substantiated in this study. We have also found that for internalization symptoms, AAT could be the more effective.

Disability and functional burden of disease because of mental in comparison to somatic disorders in general practice patients

BackgroundSeverity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society. MethodTo study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life. ResultsPatients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62). ConclusionMental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine.

The use of Animal-Assisted Therapy in adolescents with acute mental disorders: A randomized controlled study

ObjectivesThe aim of this study was to compare the effects of Animal-Assisted Therapy (AAT) with a standard treatment protocol in children and adolescents admitted to the psychiatry hospital for acute mental disorders. We used a methodology involving high quality standards for AAT research. DesignA pre-post experimental design with a randomized controlled trial (RCT) in 34 hospitalized patients (17 treatment, 17 control) was carried out. Main outcome measuresThe study focused on improvement in clinical status including, global functioning measured by the Children Global Assessment Scale (C GAS), format of care and ordinary school attendance measured by a rating scale. ResultsOur results indicate a statistically significant improvement in global functioning, reduction in format of care and increased ordinary school attendance in the treatment group, but not in the control group. ConclusionsOur results verify that AAT can have significant positive effects on therapeutic progress and the recovery process.

Tensions and Risks in the Blanket Use of Locked Door Policies in Acute Mental Health Inpatient Facilities: Balancing Human Rights, Clinical Utility and Public and Patient Protection

Although there has been a consistent trend away from institutionalised mental health care over the past decades, this has occurred at the same time as increased coercive care measures are employed in mental health inpatient facilities, as these facilities become weighted to more serious cases. Locked wards, which regulate the ability of both voluntary and involuntary patients to leave psychiatric units, are increasingly common in acute mental health inpatient settings. This article focuses on the controversy surrounding a recent initiative to extend locked door policies across all public acute inpatient facilities in Queensland, explores the legal, ethical and clinical issues around the implementation of locked door policies in acute mental health inpatient facilities, and examines the tensions in balancing individual rights and public and personal protections in the treatment of acute mental health disorders.

Suicide and gender ratios in Tasmania (Australia) using the Operationalized Predicaments of Suicide tool, and negative experiences

To examine coroner's reports of completed suicide in Tasmania with the intention of characterizing the influence of gender and other factors. One hundred coroner's reports from Tasmania 2010-2012 were examined and basic demographic details (age, gender), suicide method, medical, psychiatric, psychosocial and drug factors were collected. Data were organized using the Operationalized Predicament of Suicide tool and known risk factors, and analysed using SPSS software. We found an overall male:female ratio of 3:1. When acute mental disorder was identified, the male:female ratio was 1:1. When a history of mental disorder is considered, the ratio becomes 1.44:1. When social/environmental factors triggered the event this changed greatly to 5.57:1. Males suicide more frequently than females; but this difference disappears when only those with mental disorder at the time of death are considered, and almost disappears when a history of mental disorder are considered. Higher suicide rates of males are driven by social/environmental stressors. These results have implications for understanding the key drivers of suicide, and developing appropriate preventative strategies.

The multiplier role of psychiatrists in low income settings

Mental health care is receiving increased attention in low-income countries with the availability of a wide range of effective evidence-based treatments for acute and chronic mental disorders amidst scarce resources. Availability of these treatments and competent human resources enables the use of a variety of interventions at several levels of care for persons with mental illness and makes it feasible to ensure observance of quality in the treatment approaches that go beyond institutionalisation. However, unlike developed countries which are endowed with many and relatively well-paid mental health specialists, low-income countries face a dire shortage of highly trained mental health professionals in addition to several other challenges. In light of this, there is need to re-assess the role of the few available psychiatrists, with a shift to new core tasks such as designing mental health care programmes that can be delivered by non-specialists, building their health system's capacity for delivering care, including supporting front-line health workers through support supervision, raising awareness on mental health and patients' rights in addition to promoting essential research. This requires a fundamental paradigm shift from the current training for mental health specialists to a public health oriented approach and providing incentives for community engagement.

Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Despite the growing amount of data, much information is needed on patients' mental capacity to consent to psychiatric treatment for acute mental disorders. The present study was undertaken to compare differences in capacity to consent to psychiatric treatment in patients treated voluntarily and involuntarily and to investigate the role of psychiatric symptoms, competency, and cognitive functioning in determining voluntariness of hospital admission. Involuntary patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the 24-item Brief Psychiatric Rating Scale (BPRS), the Mini Mental State Examination (MMSE) and the Raven's Colored Progressive Matrices, and their data were compared with those for age- and sex-matched voluntary patients. Involuntary patients performed worse in all MacCAT-T subscales. Capacity to consent to treatment varied widely within each group. Overall, involuntary patients have worse consent-related mental capacity than those treated voluntarily, despite capacity to consent to treatment showing a significant variability in both groups.

Epileptic peri-ictal psychosis, a reversible cause of psychosis

IntroductionEpileptic psychoses are categorised as peri-ictal and interictal according to their relationship with the occurrence of seizures. There is a close temporal relationship between peri-ictal psychosis and seizures, and psychosis may present before (preictal), during (ictal) or after seizures (postictal). Epileptic psychoses usually have acute initial and final phases, with a short symptom duration and complete remission with a risk of recurrence. There is no temporal relationship between interictal or chronic psychosis and epileptic seizures. Another type of epileptic psychosis is related to the response to epilepsy treatment: epileptic psychosis caused by the phenomenon of forced normalisation (alternative psychosis), which includes epileptic psychosis secondary to epilepsy surgery. Although combination treatment with antiepileptic and neuroleptic drugs is now widely used to manage this condition, there are no standard treatment guidelines for epileptic psychosis. Clinical casesWe present 5 cases of peri-ictal epileptic psychosis in which we observed an excellent response to treatment with levetiracetam. Good control was achieved over both seizures and psychotic episodes. Levetiracetam was used in association with neuroleptic drugs with no adverse effects, and our patients did not require high doses of the latter. ConclusionsCategorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient's quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary.

2187 – Migration and acute mental disorders in italy. a comparison study in a psychiatric intensive care unit

First-generation immigrants from developed countries appear to be particularly at risk of being diagnosed with a mental disorder after migration. Nevertheless, in Europe immigrated people appear less likely than their native counterparts to access community mental health care. Inequity in treatment may lead to enhanced severity of the disease and consequent emergency referrals. The aim of this study was to explore demographic and clinical characteristics in immigrants patients compared to Italianborn patients admitted in a Psychiatric Intensive Care Unit (PICU) for an acute mental disorder. One hundred first-generation immigrant patients were consecutively recruited and compared to 100 age-, genderand diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Medical history and demographic information were collected with a study-specific form and were abstracted from medical records. The majority of patients were admitted to the PICU for an acute psychotic or manic episode. There were no differences in socio-demographic characteristics, in clinical severity scores and global functioning scores between immigrant and Italian-born patients. Despite no differences in age or diagnosis, immigrant patients were significantly more likely to be at the first psychiatric contact (32% vs 15%; p=0.007). Our results suggest a role of migration in the development of acute psychotic or manic episodes. Moreover, limited access for immigrants to community mental health services may lead to longer duration of untreated illness, increased disease severity and consequent emergency referrals.

Psicosis epiléptica periictal, una causa de psicosis reversible

IntroductionEpileptic psychoses are categorised as peri-ictal and interictal according to their relationship with the occurrence of seizures. There is a close temporal relationship between peri-ictal psychosis and seizures, and psychosis may present before (preictal), during (ictal) or after seizures (postictal). Epileptic psychoses usually have acute initial and final phases, with a short symptom duration and complete remission with a risk of recurrence. There is no temporal relationship between interictal or chronic psychosis and epileptic seizures. Another type of epileptic psychosis is related to the response to epilepsy treatment: epileptic psychosis caused by the phenomenon of forced normalisation (alternative psychosis), which includes epileptic psychosis secondary to epilepsy surgery. Although combination treatment with antiepileptic and neuroleptic drugs is now widely used to manage this condition, there are no standard treatment guidelines for epileptic psychosis. Clinical casesWe present 5 cases of peri-ictal epileptic psychosis in which we observed an excellent response to treatment with levetiracetam. Good control was achieved over both seizures and psychotic episodes. Levetiracetam was used in association with neuroleptic drugs with no adverse effects, and our patients did not require high doses of the latter. ConclusionsCategorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient's quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary.

Acute mental health/psychiatric nurses' experiences of clinical supervision in promoting their wellbeing in their workplace: a systematic review.

Review question What are the experiences of acute mental health /psychiatric nurses of clinical supervision in promoting their well-being in their place of work? Objectives The objective of this review is to synthesise the best available qualitative evidence on the positive aspects of clinical supervision experiences of acute mental health /psychiatric nurses, such as a sense of individual well-being Inclusion criteria Types of participants This review will consider studies that include nurses working in acute mental health in-patient care settings, who have first hand experience of clinical supervision regardless of age, gender, ethnicity, length of time since registration as a mental health nurse, work experience, or country of origin. For this systematic review we will use the following definitions: •The term mental health or (psychiatric) nurse is used interchangeably to reflect international preferences and refers to nurses who have completed a recognised approved training in mental health nursing by the relevant professional body, and awarded a licence to practice, and to use the legal title of ‘nurse’. •The term acute mental health (psychiatric) in-patient care settings or environments refers to wards or units providing hospitalisation and care for patients with acute mental disorders. •The term clinical supervision refers to a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and the safety of care in complex clinical situations. It is central to the process of learning and to the expansion of the scope of practice and should be seen as a means of encouraging self-assessment and analytical and reflective skills, and nurses’ well-being in the work place. Phenomena of interest The experiences of acute mental health/psychiatric nurses of clinical supervision in promoting their well-being in the work place.The types of data that include experiential accounts of acute mental health /psychiatric nurses of the contribution of CS to their well-being, for example reduced stress, less feelings of burn out and exhaustion, job satisfaction, and enhanced coping skills.

Mental Health, Cardiovascular Disease and Declining Economies in British Columbia Mining Communities

The purpose of this study was to investigate the relationship between community-level exposure to changes in economic conditions and the incidence and prevalence of mental disorders and cardiovascular disease in 29 resource-based communities (with a focus on mining communities) in British Columbia (BC) during a period of time marked by an economic downturn (1991–2002) The investigation relied on Labour Force Survey (LFS) and Statistics Canada Census data, and health records from the British Columbia Ministry of Health (MoH). Age and sex adjusted prevalence and incidence rates were calculated for each community from 1991 to 2002 and the development of an economic change indicator defined using Census data and industry/government documents allowed for yearly assessment of community-level exposure to economic conditions. The relationship between exposure to economic change and rates of acute and chronic cardiovascular disease and mental disorders across the 29 study communities was investigated using a generalized linear model (stratified by type of community, and adjusted for the effect of the community). Findings indicate an impact on the prevalence rates for acute cardiovascular disease (CVD) during periods of economic decline (rate increased by 13.1 cases per 1,000 population, p &lt; 0.0001 as compared with stable periods) and bust conditions (rate increased by 30.1 cases per 1,000 population, p &lt; 0.0001 as compared with stable conditions) and mental disorders (rate increased by 13.2 cases per 1,000 population, p = 0.0001) in mining communities during declining economic conditions as compared to steady periods of mining employment. This is not observed in other resource-based communities. The paper concludes by highlighting implications for the mining industry to consider as they begin to recognize and commit to mining community health.

Inpatient Care in the 21st Century: Who Needs It?—In Reply

Back to table of contents Previous article Next article LettersFull AccessInpatient Care in the 21st Century: Who Needs It?—In ReplyIra D. Glick, M.D., Steven S. Sharfstein, M.D., and Harold I. Schwartz, M.D.Ira D. GlickSearch for more papers by this author, M.D., Steven S. SharfsteinSearch for more papers by this author, M.D., and Harold I. SchwartzSearch for more papers by this author, M.D.Published Online:1 May 2011https://doi.org/10.1176/ps.62.5.pss6205_0563aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail We appreciate Dr. Heath's feedback on our proposed model of inpatient care. In his book, he has championed “home treatment” as an alternative to hospitalization (1). Such proposals have been frequent over the past four decades, but they have gained little traction because anecdotally most clinicians in most countries have found them not to work for their patients over time or they turn out to be impractical or not financially viable.To settle this issue, we look forward to a controlled study that compares our model of acute inpatient care with the three outpatient alternatives mentioned by Dr. Heath. The primary outcome measure should assess changes in the trajectory of the patient's life course over six to 12 months after discharge. The study should, of course, include measures of patient satisfaction and cost-effectiveness. We're all for “international research,” but we're not clear on which predictors can identify the 40% of patients for whom clinicians can “dispense with inpatient care” and the 60% who need inpatient care not only to prevent their illness from worsening but also to help them toward recovery.We disagree with Dr. Heath's last paragraph. The issue is not where you treat patients who clinicians believe need inpatient care or how quickly you discharge them—or not admit them at all. Rather the objective is to provide controlled data on what is the most cost-effective treatment model in which mental health system to improve postdischarge outcomes for patients and their families, regardless of country.References1 Heath DS : Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization. New York, Routledge, 2005 Crossref, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 5 May 2011Pages 563-564 Metrics PDF download History Published online 1 May 2011 Published in print 1 May 2011

Inpatient Care in the 21st Century: Who Needs It?

Inpatient Care in the 21st Century: Who Needs It?

Inpatient Care in the 21st Century: Who Needs It?

Inpatient Care in the 21st Century: Who Needs It?