Determinants of dropout in a community-based mental health crisis centre.

BACKGROUND: Dropping out during the course of medical follow up is defined as an early therapy withdrawal without the agreement of the therapist. In a psychiatric crisis unit in Geneva, we empirically observed that almost 50% of the patients were not showing up to their first appointments, which were scheduled for 3 to 7 days post discharge. METHODS: The aim of this naturalistic descriptive cohort study is to identify the demographic, patient and care-related predictive factors of dropout in a community-based psychiatric crisis centre. We included 245 consecutive outpatients followed-up for 4 to 6 weeks of intensive outpatient psychiatric treatment. Logistic regression models were built to examine the association between dropout and demographic, care and patient-related variables. RESULTS: Among the 245 outpatients, dropout occurred in 37.5% of cases, and it most frequently occurred (81.8%) in the first 2 days of follow-up. Among care-related variables, referral by hospital units or private psychiatrists led to significantly lower levels of dropout compared to patients referred by the psychiatric emergency unit (respectively: OR = .32; p = .04; 95% CI [.10, .93]; OR = .36; p = .04; 95% CI [.13, .96]; OR = .22; p = .002; 95% CI [.08, .58]). Among patient-related variables, younger age increased the risk of dropout (OR = .96; 95%; p = .002; 95% CI [.94, .99]). Anxiety and personality but not mood disorders were also related to higher rates of dropout (respectively: OR = 2.40; p = .02; 95% CI [1.14, 4.99]; and OR = 1.98; p = .02; 95% CI [1.09, 3.59]). Unipolar depression (72.2%; OR = 1.47; p = .48; 95% CI [.34, 1.21]) was the most frequent primary diagnosis in this sample. CONCLUSIONS: This study makes clear the need for increased efforts to improve care adherence in young patients with anxious or personality disorders seen in emergency rooms because they are prone to early discontinuation of treatments. Future studies in this field are warranted to gain a better understanding into the complex reasons that surround discontinuation of care in outpatient settings.

[Antidepressant treatment and risk of suicidal attempts. A case series report]. / Antidépresseurs et suicidaité état des lieux. A propos d'une série de cas.

Scientific evidence that fluoxetine is one of the effective treatment of depression exists. Since 2000, a debate has been launched concerning the possibility of antidepressant drugs, especially, selective serotonin reuptake inhibitor to induce suicidality in some depressive patients. Suicidal attempts of 3 of the outpatients taken into care in a crisis center in Geneva, following the introduction of fluoxetine in the usual dose of 20 mg per day, led us to investigate and to carry out a non-exhaustive comprehensive literature review of available randomized trials, meta-analyses and epidemiological studies. This work enabled us to highlight some points of interest, including medical attitudes and therapeutic guidelines that sometimes seem to be contradictory, especially regarding the use of antidepressants in children and adolescents.

[Hoarding disorder, symptom or separate disorder? Case report]. / Syllogomanie, symptômes ou syndrome? A propos d'un cas clinique.

Hoarding or compulsive hoarding, a severe form of collectionism, is currently described in various psychiatric disorders, including the famous Diogenes syndrome. The lack of remission despite a correct treatment in a patient that we have followed in the brief therapy center in Geneva, has led us to carry out an extensive Medline review, which revealed several interesting points. It seems that excessive hoarding, with a prevalence of 2,3 to 4,6%, has received increasing interest and there is an actual debate of distinguishing hoarding from other disorders. Thus, this field requires further attention to better understand its phenomenology. This case report describes an excessive hoarding disorder confirming the complexity of this trouble and the possibility to consider it as an independent diagnosis.