Factors related to admission of psychiatric patients to medical wards from the general hospital emergency department: a 3-year study of urgent psychiatric consultations.

OBJECTIVE: Emergency Rooms (ER) of Emergency Departments (ED) in General Hospitals (GH) have a role in providing for psychiatric evaluation. The aims of the present study were to examine the decision-making process of consultation psychiatry at the GH-ER and to analyze the differences between psychiatric patients admitted to a medical ward with those admitted to the psychiatry unit and those who are discharged from the ER. METHOD: Over a period of 3 years, psychiatric consultations requested by ER of ED physicians to the GH Psychiatric service were recorded by using a form to describe epidemiological and clinical data on the consultation process. RESULTS: Of 1,962 psychiatric consultations, most regarded subjects who had had previous psychiatric contacts (76.2%) and at least one psychiatric admission (53.6%), and were currently cared for by the Mental Health Services (51.1%). Neurotic/stress-related syndromes (27.98%), schizophrenia (27.67%), and personality disorders (21.81%) were the most frequent ICD-10 diagnoses. The psychiatrist's disposal was to discharge the patient in 49.9% cases, to admit him/her to medical wards of the GH (MGH; 26.9%) or to the acute inpatient psychiatric ward (AIP; 23.1%). MGH group statistically differed from AIP group for being female (p < 0.01), older (p < 0.01), more likely having an ICD-10 diagnosis of neurosis/stress-related syndromes (p < 0.01) or organic mental disorder (p < 0.01), and less likely having a diagnosis of schizophrenia (p < 0.01), being in charge of the Mental Health Services (p < 0.01), and having had previous psychiatric admissions (p < 0.01). These results were confirmed by logistic regression analysis. CONCLUSIONS: The study shows that the medical wards of the General Hospital are a significant entry-point for providing psychiatric care of patients with ICD-10 neurotic and stress-related syndromes, even if without specific medical problems.

Violence in psychiatric units: a 7-year Italian study of persistently assaultive patients.

BACKGROUND: The problem of violence and aggressive behaviour among patients with psychiatric disorders need careful assessment to improve the quality of psychiatric care. The aim of this paper is to describe the characteristics of repeated episodes of violence among patients admitted to an Italian psychiatric ward. METHODS: All violent behaviours, which occurred in a 15-bed psychiatric inpatient unit over a 7-year period, were assessed by using the Staff Observation Aggression scale (SOAS). RESULTS: Of a total of 3.507 admissions, 409 aggressive episodes were recorded by 160 patients (rate per admission 11.6%). A total of 65 patients exhibited two or more episodes and 95 patients showed a single episode. Repeatedly violent patients had a higher length of stay in the unit, a higher number of previous admissions and a higher number of previous violent episodes. No difference was found in terms of psychiatric diagnosis, socio-demographic variables, type of admission (voluntary versus involuntary), ward overcrowding and characteristics of violent episodes (means, aims and consequence). CONCLUSIONS: In spite of the low prevalence of violent incidents among Italian psychiatric inpatients, careful monitoring of clinical variables associated with repeated violent episodes may help physicians recognise and prevent violence episodes among acute psychiatric inpatients.