General Hospital Psychiatric Unit Research Articles

1661 – Effects of a basic protocol to manage patients with personality disorders in the general hospital

Introduction Patients presenting Personality Disorders and specially Borderline Personality Disorder are often admitted to Psychiatry Units in General Hospitals. Their impulsivity, affective disregulation and difficulties in interpersonal relations complicate the therapeutic atmosphere and cause problematic interactions with staff and other patients. We have developed a basic protocol to manage behavioural problems of those patients in the general hospital. Objectives To study the effect of the protocol on the unit's work. Aims. To know the effect of the protocol on some specific variables related to the admission and specifically the use of mechanical restraint. Methods. Prospectively, we compare data on all patients admitted during 2010 (876 total, 87 PD) before establishing the protocol and all those admitted during 2011 (870 total, 112 PD) when the protocol was in use. Results The proportion of patients with PD who experienced at least one mechanical restraint intervention went down from 43.7% in 2010 to only 2.7% in 2011 (p= 0.000). In the total group, figures also decreased from 17.3% in 2010 to 3.4% in 2011 (p= 0.000). Conclusions The use of mechanical restraints with PD patients in General Hospital Psychiatric Units can be drastically reduced using a protocol guiding the staff to better manage behavioural problems of the patients.

Study of socio-demographic profile, phenomenology, course and outcome of bipolar disorder in Indian population

Context: Though many researchers have made an attempt to study the phenomenology, clinical syndromes, course of bipolar mood disorder. However there was no orderliness in the research pursuit of understanding this disorder in the Indian context. Aims: Assessment of socio-demographic profile, age of onset, phenomenology, course and outcome of patients with bipolar disorder in south Indian population. Settings and Design : This prospective-retrospective study was done in a general hospital psychiatric unit including both out-patient and in-patients. Materials and Methods : All patients were diagnosed with bipolar disorder during out- and in-patient setting was evaluated by using the semi-structured questionnaires and standard tools for socio-demographic profile, age of onset, phenomenology and course and outcome in-patients with bipolar disorder. Results: In 100 bipolar patients socio-demographic data suggest mean age of presentation was 34 years, with majority being males, married, belonging to Hindu religion and were from rural background. Mean age of onset of illness was 27 years total mean number of episodes were 5.26 ± 7.4 (mania: 3.72 ± 5.2, depression: 2.1 ± 1.3). Majority had 2-5 episode (n = 62) commonly followed by recurrent mania (n = 22). Mean duration of symptoms were 116.2 ± 145.2 days in depression and 109.3 ± 124.9 days in mania. Two-third reduction in symptomatology was seen in 80% of in-patients at the time of discharge. Conclusions : Recurrent mania was a commonly observed phenomenon and duration of suffering in both phases (depression and mania) was nearly 4 months. We need long-term follow-up of these group of patients for better course and outcome data from developing country.

Prescribing patterns of antidepressants, antipsychotics and mood stabilizers in bipolar patients misdiagnosed with major depressive disorder in China

Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to examine prescribing patterns of antidepressants, antipsychotics and mood stabilizers in BD patients misdiagnosed with MDD in China. A total of 1487 patients originally diagnosed with MDD were consecutively screened for diagnostic revision in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses. Data on psychotropic prescriptions were collected by a review of medical records. Three hundred and nine of the 1487 patients (20.8%) fulfilled DSM-IV criteria for BD; 118 (7.9%) for BD-I and 191 (12.8%) for BD-II on the MINI. Of the BD patients (n = 309), 227 (73.5%) received any use of antidepressants, 73 (23.6%) antipsychotics and 33 (10.7%) mood stabilizers. In multiple logistic regression analyses, compared with those with MDD, patients with BD-I were more likely to receive antidepressants (OR 1.7, 95% CI 1.1-2.8, p = 0.02), antipsychotics (OR 1.6, 95% CI 1.04-2.5, p = 0.04) and mood stabilizers (OR 3.9, 95% CI 2.1-7.2, p < 0.001), whereas patients with BD-II were more likely to receive mood stabilizers (OR 2.4, 95% CI 1.3-4.4, p = 0.003). There was no difference in the use of antidepressants (OR 1.1, 95% CI 0.8-1.5, p = 0.7) and antipsychotics (OR 1.3, 95% CI 0.9-1.9, p = 0.2) between BD-II and MDD. In addition, there was no difference between BD-I and BD-II in any use of antidepressants, antipsychotics and mood stabilizers. The prescription of antidepressants for BD patients misdiagnosed with MDD is very common, and only a very small proportion of patients received guideline-concordant treatment. Considering the potentially hazardous effects of inappropriate pharmacotherapy in this population, continuing education and training addressing the correct diagnosis of BD and rational use of psychotropic medications are needed in China.

Acute Stress Reactions and Associated Factors in the Help-Seekers after the L’Aquila Earthquake

Background: The assessment of acute stress reactions and psychiatric symptomatology shortly after the occurrence of a traumatic catastrophic event, like an earthquake, is essential for implementing relief activities and for the identification of the long-term aftermath. The aim of our study was to assess the psychological distress and the occurrence of acute stress disorder (ASD) among individuals seeking help at the General Hospital Psychiatric Unit at San Salvatore Hospital following the earthquake at L’Aquila. Factors (sociodemographic, coping strategies, event-related and postevent variables) associated with the acute stress reactions were also assessed. Methods: For the first 4 weeks following the earthquake, 122 help-seekers were assessed with a checklist of traumatic-event-related variables. Measurement instruments included the Stanford Acute Stress Reaction Questionnaire (SASRQ) for the detection of ASD according to DSM-IV criteria, the 12-item General Health Questionnaire (GHQ-12) for assessing psychological distress, and the Brief Cope questionnaire for assessing coping strategies. Results: Despite the high level of psychological distress (GHQ-12 ≥20, cut-off value) found in 65.6% of the subjects, only 6 subjects (4.9%) could be considered affected by ‘full’ ASD, whereas 48 subjects (39.3%) could be considered affected by ‘partial’ ASD, which is defined as showing at least one symptom on each DSM-IV criterion as evidenced by scoring higher than 3 on each SASRQ scale. The strongest predictor of traumatic stress reactions among all the predictor variables included in our study was having been trapped/injured under rubble during the earthquake, and among earthquake stressors (explaining 20% of variance in our model), a weaker predictor was the loss of personal privacy because of home displacement. In our model, more variance (39%) was explained when individual psychopathological variables and coping styles were also included as predictors. Showing coping strategies as exhibiting ‘behavioural disengagement’ or ‘requesting emotional support from others’ were found to increase the likelihood of a positive estimate of being an ‘ASD case’, while the adoption of an ‘acceptance’ coping style seemed to reduce the likelihood of the positive estimate of being an ‘ASD case’. Conclusions: This study underlines the importance of identifying ASD subsyndromal cases and taking appropriate intervention/prevention measures that focus on giving psychological support to individuals trapped/injured under rubble, showing a low acceptance of reality. A relevant underestimated source of distress was the dislocation in large accommodation settings (such as large tent camps) in which individuals lack privacy.

The Stigmatization of Mental Illnesses

This In Review is intended to provide a statement about the stigmatization of mental illnesses from 2 different but complementary perspectives: one from the vantage of public stereotypes, particularly those expressed by mental health and health providers'; and the other from the vantage of self-stigma, which occurs when an individual internalizes negative stereotypes and experiences a range of negative psychosocial and interpersonal consequences.2 Both papers identify key issues and offer strategies that can be used to reduce the stigma caused by a mental illness. The theoretical literature dealing with stigma and discrimination is vast and dates to the middle of the last century with the seminal work of Goffman,3 who examined stigma from the perspective of spoiled social identity and who recognized that mental illnesses were among the most deeply discredited of all stigmatized conditions. In Asylums, Goffman4 was highly critical of the mental hospitals of the day for their antitherapeutic and stigmatizing effects. Along with contemporaries, such as Scheff and Szasz,6 these writers reinforced the concept that the negative and debilitating consequences of mental illnesses were more a result of the way in which psychiatry was organized rather than the illnesses themselves. In modern times, despite having replaced asylums with general hospital psychiatric units and an array of community supports and services, people who have a mental illness still experience society's negative response to them as more devastating, disabling, and life-limiting than the illness itself.7 The paper by Dr Patrick W Corrigan and Dr Deepa Rao2 highlights the insidious process of self-stigmatization that may occur and describes novel approaches that have been used to reduce internalized stigma and to improve self-esteem and empowerment. While these smaller, focused efforts are not intended to improve public perceptions or behaviours, they do hold considerable promise for an individual's personal recovery. Dr Julio Arboleda-Florez and I' also include stigma selfmanagement as 1 of 6 approaches that may be used to disrupt the stigmatization process. From the original focus on stigma as a by-product of the social organization of psychiatry and psychiatric services, much of the subsequent theory has pertained to the social psychology of stigma, outlining the cognitive and attitudinal components necessary to create and maintain stigmatized world views. From this vast array of research, it is clear that one of the most fundamental characteristics of stereotypes is that, once established, they are highly resistant to change.8 This suggests that we will need powerful multi-level strategies that address stigma at individual, interpersonal, and social-structural levels. It also suggests that it will be important for antistigma activists to begin work early, before stereotypes have crystallized. In addition, to be successful, interventions must become a routine part of our institutionalized response to stigmatization. Short-lived bursts of activity are unlikely to create the level of sustained change that will be required to improve quality of life for people who have a mental illness and for their family members. Therefore, stigma reduction must be viewed as a transgenerational challenge. Quantitative researchers have spent considerable time documenting the scope and content of public stigma. For example, in their review of the literature between 1990 and 2004, Angermeyer and Dietrich9 identified 33 national studies and 29 local and regional studies, most of which were conducted in Europe. Among these, only 6 were attempts to evaluate population-based interventions, and 4 of these focused on depression - 1 of the disorders demonstrated in population surveys to be the least negatively viewed.10 No study examined whether changes in attitudes corresponded to changes in behaviour - arguably, the most important end point for antistigma programming. …

Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital

This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender, and age) completed a questionnaire and clinical interview. Data on discharge services were extracted from the electronic health record. Factors associated with access to services were examined using logistic regression models. Despite a similar duration of hospitalization to housed participants, homeless participants were significantly less likely to have outpatient follow-up with a family physician, intensive case management, assertive community treatment, income support or prescription drug coverage at the time of discharge from hospital. Although inpatient hospitalization presents an opportunity to reduce homeless people’s barriers to accessing health and social services, our results show inequities for homeless people persist at the time of discharge.

Demographic and Clinical Features and Prescribing Patterns of Psychotropic Medications in Patients with the Melancholic Subtype of Major Depressive Disorder in China

BackgroundLittle has been known about the demographic and clinical features of the melancholic subtype of major depressive disorder (MDD) in Chinese patients. This study examined the frequency of melancholia in Chinese MDD patients and explored its demographic and clinical correlates and prescribing patterns of psychotropic drugs.MethodsA consecutively collected sample of 1,178 patients with MDD were examined in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The cross-sectional data of patients’ demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. The diagnosis of the melancholic subtype was established using the Mini International Neuropsychiatric Interview (MINI). Medications ascertained included antidepressants, mood stabilizers, antipsychotics and benzodiazepines.ResultsSix hundred and twenty nine (53.4%) of the 1,178 patients fulfilled criteria for melancholia. In multiple logistic regression analyses, compared to non-melancholic counterparts, melancholic MDD patients were more likely to be male and receive benzodiazepines, had more frequent suicide ideations and attempts and seasonal depressive episodes, while they were less likely to be employed and receive antidepressants and had less family history of psychiatric disorders and lifetime depressive episodes.ConclusionsThe demographic and clinical features of melancholic MDD in Chinese patients were not entirely consistent with those found in Western populations. Compared to non-melancholic MDD patients, melancholic patients presented with different demographic and clinical features, which have implications for treatment decisions.

The Impact of the Process of Deinstitutionalization of Mental Health Services in Canada: An Increase in Accessing of Health Professionals for Mental Health Concerns

This research evaluates accessing of community-based mental health services in relation to the ongoing process of deinstitutionalization of mental health services in Canada. From 1998/1999 to 2002/2003, the process of deinstitutionalization decreased in intensity among the provinces that implemented deinstitutionalization earlier and increased in intensity among the provinces that implemented deinstitutionalization later. By 2002/2003, average days of care per 1,000 population in psychiatric units in general hospitals exceeded days of care in psychiatric hospitals (transinstitutionalization). Accessing of community-based mental health services by individuals with higher levels of psychological distress increased in all provinces from 1998/1999 to 2002/2003.

The importance of psychiatry in undergraduate medical education in India

Byline: Roy. Kallivayalil is impossible for the part to be well, if the whole is not well- Socrates What Socrates said several centuries ago has become even more relevant in this era of specialization and super-specialization in medicine. While several medical specialities have made spectacular advances in various areas within their domain, humanism has often got neglected and forgotten. We all recognize that mental health is essential to overall health and the well-being of individuals and societies. Mental health affects the individual's ability to function, to be productive, to establish and maintain positive relationships, and to experience a state of well-being. This is the reason we say, There is no health without mental About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase the risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. [sup][1] Mental disorders, a highly prevalent group of non-communicable diseases, affect the lives of 1 out of 5 persons each year. They represent 20-40% of the burden of disability. Factors related to mental illness can interfere with the treatment of other illnesses and frequently co-occur with CVS, diabetes, cancer, and other non-communicable diseases (Eliot and Sacher, 2011). [sup][2] Health systems across the world remain significantly fragmented, affecting access, quality, and costs of the care delivered. Strengthening health systems is a global health challenge for all countries: low, middle, and high income. According to the World Health Organization, the key components of a well-functioning health system, namely, leadership and governance, health information systems, health financing, human resources for health, essential medical products and technologies, and services delivery are sine qua non for health system's functioning and strengthening. [sup][3] The development of mental health care all over the world is best described as a developing process. The World Health Report (2001) [sup][4] described the changes over the last two centuries as follows: Over the past half century, the model for mental health care has changed from the institutionalization of individuals suffering from mental disorders to a community care approach backed by the availability of beds in general hospitals for acute cases. This change is based both on respect for the human rights of individuals with mental disorders and on the use of updated interventions and techniques. The care of people with mental and behavioural disorders has always reflected prevailing social values related to the social perception of mental illness. At the time of Indian Independence, the Bhore Committee, 1946, [sup][5] emphasized the need for training in the social aspects of medicine to boost India's meager mental health resources (19 hospitals with 10,181 beds and a few general hospital psychiatric units). It also recommended setting up of psychiatry departments in every general hospital to review and enhance the existing curriculum and training in Psychiatry for medical undergraduates. It is now realized that training of Psychiatry to undergraduate medical students is very vital. …

Mortality in schizophrenia and related psychoses: data from two cohorts, 1875–1924 and 1994–2010

ObjectiveTo investigate death rates in schizophrenia and related psychoses.DesignData from two epidemiologically complete cohorts of patients presenting for the first time to mental health services in North Wales for whom...

The incidence of admissions for schizophrenia and related psychoses in two cohorts: 1875–1924 and 1994–2010

ObjectiveTo investigate changes in incidence of admissions for schizophrenia and related non-affective psychoses in North Wales.DesignData from two epidemiologically complete cohorts of patients presenting for the first time to mental...

Telepsychiatry “Coverage” to a Rural Inpatient Psychiatric Unit

Rural psychiatrists responsible for inpatient psychiatry units in general hospitals often have trouble getting coverage for training, vacations, and periods of illness. This article describes telepsychiatry "coverage" to a rural general hospital psychiatric unit for 1 week. All adult patients meeting criteria for inpatient mental health treatment in the emergency room were offered admission to the general hospital after obtaining informed consent regarding the use of inpatient telepsychiatry. The number of patients on the inpatient psychiatric unit ranged from three to nine, with an average daily census of seven. All psychiatric care was provided via video teleconferencing (VTC) at a bandwidth of 512 kilobits per second using Internet Protocol. Patients with psychosis reported more difficulty hearing the doctor than patients without psychosis and incorporated VTC into delusions in a congruent manner. Patients rated development of rapport and effectiveness of treatment higher than staff ratings. Two staff thought telepsychiatry was either not effective for acutely psychotic patients or more effective with higher functioning patients. Short-term coverage of rural inpatient psychiatric units for purposes of vacation, training, and illness is possible using telepsychiatry. Psychiatrist's efficiency and consistency are enhanced with instantaneous connections possible from hospital, office, or home. Significant increases in staff workload will occur without remote access to electronic medical records, electronic physician ordering, and an adequate physical layout of the inpatient psychiatric unit. Adequate educational preparation of unit staff regarding telepsychiatry and a staff process group during implementation is recommended.

Medicaid Cutbacks and State Psychiatric Hospitalization of Patients With Schizophrenia

Given financial difficulties precipitated by the flagging national economy, state policy makers are interested in the impact of Medicaid cutbacks on individuals with schizophrenia. Starting in 2003, the Oregon legislature eliminated all Medicaid coverage for large numbers of people, including many with schizophrenia. The objective of this project was to examine state psychiatric hospital utilization among persons with schizophrenia who maintained or lost Medicaid coverage. This longitudinal cohort study examined Oregon schizophrenia patients who had used Medicaid mental health services before the state's massive Medicaid reductions. Data were obtained from the state mental health, Medicaid, and vital statistics agencies. The outcome measures were involuntary psychiatric admissions to general hospitals and to state psychiatric hospitals, respectively. There were three cohorts, which comprised those who lost Medicaid coverage in calendar year 2003 (N=435), those who lost Medicaid coverage in 2004 (N=187), and those who maintained Medicaid coverage throughout study years 2002-2004 (N=3,427). Cohort members were on average 43 years old, and the sample was 42% female and 88% white. Analyses controlling for age, gender, race-ethnicity, Medicaid eligibility, and Medicare coverage showed that persons who maintained Medicaid coverage had little change in state psychiatric hospitalization, whereas utilization increased markedly over time for those who lost Medicaid coverage (p<.003). There were few differences in utilization of general hospital psychiatric units. Loss of Medicaid coverage generally preceded hospitalization. State policies designed to decrease Medicaid enrollment may have led to increased use of state psychiatric hospitals by former Medicaid enrollees with schizophrenia.

Medicaid Cutbacks and State Psychiatric Hospitalization of Patients With Schizophrenia

Objective: Given financial difficulties precipitated by the flagging national economy, state policy makers are interested in the impact of Medicaid cutbacks on individuals with schizophrenia. Starting in 2003, the Oregon legislature eliminated all Medicaid coverage for large numbers of people, including many with schizophrenia. The objective of this project was to examine state psychiatric hospital utilization among persons with schizophrenia who maintained or lost Medicaid coverage. Methods: This longitudinal cohort study examined Oregon schizophrenia patients who had used Medicaid mental health services before the state's massive Medicaid reductions. Data were obtained from the state mental health, Medicaid, and vital statistics agencies. The outcome measures were involuntary psychiatric admissions to general hospitals and to state psychiatric hospitals, respectively. There were three cohorts, which comprised those who lost Medicaid coverage in calendar year 2003 (N=435), those who lost Medicaid coverage in 2004 (N=187), and those who maintained Medicaid coverage throughout study years 2002–2004 (N=3,427). Results: Cohort members were on average 43 years old, and the sample was 42% female and 88% white. Analyses controlling for age, gender, race-ethnicity, Medicaid eligibility, and Medicare coverage showed that persons who maintained Medicaid coverage had little change in state psychiatric hospitalization, whereas utilization increased markedly over time for those who lost Medicaid coverage (p<.003). There were few differences in utilization of general hospital psychiatric units. Loss of Medicaid coverage generally preceded hospitalization. Conclusions: State policies designed to decrease Medicaid enrollment may have led to increased use of state psychiatric hospitals by former Medicaid enrollees with schizophrenia. (Psychiatric Services 62:871–877, 2011)

Staff Perceptions and Organizational Factors as Predictors of Seclusion and Restraint on Psychiatric Wards

Several factors have been shown to be involved in decisions to use seclusion and restraint in psychiatric inpatient settings. This study examined whether staff perceptions of factors related to the care team and violence on the ward predicted use of seclusion and restraint in psychiatric wards. A total of 309 staff members (nurses, rehabilitation instructors, and nurse's aides) providing care to patients with serious mental disorders were recruited from eight university psychiatric hospitals and general-hospital psychiatric units in the province of Quebec. Factors assessed included sociodemographic characteristics, psychological distress, staff perceptions of aggression and of interaction between members of the psychiatric team (team climate), and organizational factors. Bivariate analyses showed that certain aspects of the team climate, staff perceptions of aggression, and organizational factors were associated with greater use of seclusion and restraint. The final multivariate model indicated that the following factors independently predicted greater use: type of hospital ward (emergency department and intensive care unit), staff perception of a higher level of expression of anger and aggression among team members, perception of the frequency of incidents of physical aggression against the self among patients, and perception of insufficient safety measures in the workplace. These findings represent the first stage of a research program aimed at reducing use of seclusion and restraint in psychiatric settings. They underscore the importance of evaluating a variety of factors, including perceptions of safety and violence, when examining reasons for use of these controversial interventions.

Antipsychotics Prescribing Patterns of Patients with Schizophrenia Admitted to Korean General Hospital Psychiatric Unit: 2001 to 2008

ObjectiveAlthough the standard of treatment for schizophrenia is antipsychotic monotherapy, overall psychotropic polypharmacy including antipsychotic polypharmacy is increasingly practiced by clinicians. However, there are very few studies that assess the prescription patterns of psychotropic drugs for patients with schizophrenia in Korea. The objective of this study is to describe changes in prescription patterns with respect to antipsychotic polypharmacy and overall psychotropic polypharmacy.MethodsIn this retrospective study, we reviewed all psychotropic drugs prescribed at the time of discharge for patients diagnosed as having schizophrenia (DSM-IV criteria) who entered a psychiatric unit of a Korean general hospital from 2001 to 2008. These included a total of 467 patients.ResultsOf the 467 patients in this study, 205 (43.9%) were discharged with antipsychotic monotherapy and the rest, 262 (56.1%), were discharged with a polypharmacy regimen. A total of 9% of the studied patients received more than two antipsychotic drugs. The most frequent combination of antipsychotics was clozapine and aripiprazole, followed by clozapine and amisulpride, and risperidone and olanzapine. The ratio of patients discharged with a polypharmacy regimen including antipsychotic polypharmacy increased from 2001 to 2008. In relation to the mean dose of all antipsychotic drugs at the time of discharge, mean length of hospital stay and mean initial global assessment of functioning scores on admission statistically significant differences were not detected between both monotherapy and polypharmacy groups.ConclusionThe main finding of this study is that polypharmacy with antipsychotics and other psychotropic medicines increased in our psychiatric unit from 2001 to 2008. The rates of antipsychotic polypharmacy in our study were less than those described in our literature review.

P01-85 - Comorbidity of substance use and psychiatric disorders among inpatients of a General Hospital Psychiatric Unit

IntroductionIn substance – related disorders comorbidity refers to any preexisting or following psychological or psychiatric condition that influence the course and prognosis of a patient.ObjectivesTo determine the extent of comorbid substance use and psychiatric disorders among hospitalized in a General Hospital Psychiatric Unit patients and reveal the implications of treatment in such a unit.MethodAll patients hospitalized during a year, were included in the study. Demographics, final diagnosis, substance of use and means of admission (voluntary or involuntary) were recorded.Results7.4% of the total of 339 inpatients met the diagnostic criteria of comorbid substance use disorders. Eleven of them were diagnosed with alcohol use disorder comorbidity, 7 with illicit drug use comorbidity and 7 with both legal and illicit drug use comorbidity. Among inpatients with comorbid use disorders male patients had a significantly higher percentage versus females (x2 p &lt; 0.05). Mean age of inpatients with comorbidity was significantly less than the mean age of the sample (t-test p &lt; 0.05). Duration of hospitalization for inpatients with comorbidity was 15.16 ± 12.4 days versus 21.2 ± 18.4 days for the rest of patients (t-test p &lt; 0.05). Concerning the way of admission, 72% of inpatients with comorbid use disorders were involuntary admitted (x2 p &lt; 0.05).ConclusionConcerning age, sex and means of admission patients with a psychiatric disorder and substance use disorder comorbidity seem to vary from the rest of inpatients. These parameters are probably associated with serious difficulties in therapeutic compliance and with increased hazard.

P03-42 - Catatonia and its clinical course: Descriptive analysis of 12 consecutive cases in a general hospital psychiatric inpatient unit

IntroductionScientific research regarding Catatonia is limited to individual clinical cases. Few well-design studies investigating its clinical course or therapeutic options have been carried out. We aimed to describe a sample of consecutive Catatonic patients admitted to the Basurto's Hospital Adult Psychiatric Inpatient Unit to obtain more data about its clinical presentation.Material and methodsSubjects diagnosed of Catatonia anytime during admission were included (n = 12). Subject's admission dates ranged between December 2008 to September 2010. Catatonia was diagnosed following DSM-IV-TR criteria. Data was retrospectively obtained reviewing subject's clinical notes.ResultsThe sample was predominantly composed of women (66.7%). Media of age was 55.3 years. All subjects reported previous mental illness. More prevalent diagnosis were Schizophrenia (33.2%), Bipolar Disorder (33.2%), Non Specified Psychotic Disorder (16.6%), Schizoaffective Disorder (8.3%) and Recurrent Depressive Disorder (8.3%). Nine subjects (75%) reported previous admission to a psychiatric unit. No subjects had previously suffered from Catatonia and only 2 had previously received electroconvulsive therapy (ECT). More frequent catatonia subtype was retarded (66.7%) with no subjects presenting with malignant catatonia. CGI at admission showed a media of 6.64.Regarding treatment, 83.3% did not recover with benzodiazepines and needed ECT anytime during admission. Media admission length was 36.17 days.ConclusionsCatatonia was more frequently observed in female, middle-aged women with no previous history of catatonia or ECT treatment but a history of previous psychotic or affective illness and hospital admissions. Symptom severity was very high and thus required aggressive treatment and longer hospital stays in order to achieve recovery.

State of Consultation-Liaison Psychiatry in India: Current status and vision for future.

Over the years Consultation-Liaison (C-L) psychiatry has contributed significantly to the growth of the psychiatry and has brought psychiatry very close to the advances in the medicine. It has also led to changes in the medical education and in the providing comprehensive management to the physically ill. In India, although the General Hospital Psychiatric units were established in 1930s, C-L Psychiatry has never been the main focus of training and research. Hence there is an urgent need to improve C-L Psychiatry services and training to provide best and optimal care to the patients and provide best education to the trainees.

Do patients improve after short psychiatric admission? A cohort study in Italy

Background: Information on outcomes of acute inpatient care in routine psychiatric practice is scant. In particular, it is uncertain to what extent short hospitalization can produce clinically meaningful changes. Aim: Our aim was to estimate the symptomatic outcome in a representative sample of patients admitted for short treatment to general hospital psychiatric units in Italy. Methods: Patients were assessed at admission and discharge using 24-item Brief Psychiatric Rating Scale (BPRS). Reliable change index was calculated to estimate the proportion of change attributable to measurement error and a cut-off score of 38 was adopted to identify the patients who showed clinically significant change. Results: Average length of stay was 5.7 days. Mean BPRS score dropped from 53.2 on admission to 41.5 at discharge, showing statistically significant improvement with an effect size of 0.80. However, reliable change was achieved by 24.7% of patients and clinically meaningful change by 13.6%. Conclusions: Reliance on statistical significance and effect size overestimates treatment effects, whereas reliable and clinically significant change index provides a conservative way to assess outcome. Few patients showed relevant improvement after a brief admission.