Characteristics of a nationwide cohort of psychiatric patients--with special reference to the elderly and the chronically admitted

Prevalence of personality disorders in two geropsychiatric inpatient units

One hundred males from a Veterans Affairs geropsychiatric inpatient ward, and 100 females from a geropsychiatric inpatient ward of a private hospital completed the Structured Interview for Disorders of Personality-Revised (SIDP-R). Chart reviews provided information including age, years of education, marital status, race, as well as Axis I and Axis II psychiatric diagnoses. Data from a young adult sample, drawn from an initial SIDP-R validation study, were used for comparison. Results indicate a 56.5% rate of personality disorders (PD) for older patients. Significantly more elderly men than elderly women were diagnosed with PD by psychiatric evaluation, and elderly men were also more likely to be diagnosed with paranoid, avoidant, and multiple PD using the SIDP-R. Psychiatrists gave far fewer Axis II diagnoses than were yielded by the SIDP-R, particularly with females. There were no significant differences in total PD rates between aged and young subjects, but older adults with PD were diagnosed less frequently with multiple PD. Older adults were also less likely to be diagnosed with the "Dramatic" cluster PD, and more likely to be diagnosed with the "Odd" cluster PD. The level of depression was related to both clinical and SIDP-R diagnoses.

Trends in long-stay hospitalization in Denmark: a descriptive register study, 1972-1987

By means of 4 cross-sections at 5-year intervals from 1972 to 1987, information on long-stay inpatients and daypatients was extracted from the computerized, cumulative psychiatric case register in Denmark. Long-stay refers to continuous hospitalization of more than 1 year. The prevalence of long-stay patients declined from 101 per 100,000 general population in 1972 to 38 per 100 000 in 1987. As the prevalence of all diagnoses declined, regardless of age and sex, it is suggested that the major cause of the observed trends is altered political and administrative strategies, influenced by and influencing altered capabilities and methods of treatment. The trends are described in detail and their implications discussed.

Patterns and correlates of psychiatric hospitalization in a nationwide sample. II. Correlates of length of hospitalization and length of stay out of hospital

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984. A multivariate analysis was performed, where the dependent variables were: the cumulative length of all hospitalizations, the mean duration of hospitalization and the mean length of stay out of hospital. The independent variables were: age, sex, marital status, ethnic origin, diagnosis, and various indices of previous hospitalizations. For patients whose hospitalization in 1980 (index hospitalization) was the first in their life, older age and male gender predicted a low probability of readmission, and the diagnosis of schizophrenia a long cumulative stay. For patients whose index hospitalization was not the first in their life, the main variables predictive of long cumulative stay were: old age, being single, long duration and high frequency of previous hospitalizations. Patients tended to maintain the same relative length of inpatient stay and the same frequency of readmission from the beginning of their hospitalization history.

Patterns and correlates of psychiatric hospitalization in a nationwide sample. I. Patterns of hospitalization with special reference to the "new chronic" patients

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984 regarding their hospitalization patterns. Information about hospitalizations as well as demographic and diagnostic data were obtained from the Israel Central Psychiatric Case Register. Two main contrasting patterns of hospitalization emerged. One pattern consisted of a single short hospitalization during the entire follow-up period. This pattern was found among more than 50% of those patients for whom this hospitalization was the first in their life. The second pattern characterized the patients who accumulated long periods of inpatient stay, that is, at least one year during the follow-up period. These are the "new chronic" patients (about 30% of the total sample). About one third of these "new chronic" patients (8.2% of the total sample) accumulated their long stay through one continuous hospitalization, thus resembling the "old chronic" patients; two-thirds accumulated their long stay over several hospitalizations. Each patient has a fairly constant pattern of hospitalization, regarding the length of stay in hospital and out of hospital.

The case for psychiatric record linkage

Evaluation of regional psychiatric services is essential for effective and economical planning and requires a complete and accurate source of data about individuals in the system. Routinely collected statistics describe only events, and cannot link data about individuals over time. This is possible with record linkage systems (or case registers) which are systematic standardized data collections about individuals' contacts with specified facilities over time. Such data bases have a wide range of clinical, epidemiological and administrative functions. The confidentiality of such systems is of paramount importance and is maintained by several safeguards. There are numerous technical considerations in establishing and operating record linkage systems. A wide variety of studies have been produced from systems around the world. An ongoing collection of linked data is required for many types of research and particularly for service evaluation. In times of cost constraints and diminishing resources, it is essential to deliver psychiatric services in the most effective and cost efficient manner possible.