[Heavy users of inpatient services: a comparison of diagnostic subgroups]. / Heavy User stationärer psychiatrischer Behandlung: Vergleich nach Diagnosegruppen.

OBJECTIVE: Quantitative and qualitative assessment of heavy users (HU) of psychiatric inpatient treatment. METHODS: Screening over 9 months for patients with ≥ 3 admissions or ≥ 100 days of treatment during 1 year prior to index admission. RESULTS: During the recruiting period 1217 persons were treated of whom 132 (10.8 %) fulfilled HU criteria. Patients belonged most often to the diagnostic group F2 (43 %), followed by F1 (21 %) and F3 (17 %). HU were most common within the diagnostic group F6 (33 %), next to F2 (21 %), F1 (9 %) and F3 (6 %). HU had signs of more severe illness compared to the other patients: only 8 % held a job and 73 % ware on a disablement pension, patients with a diagnosis of F2 faring worst. HU were treated more frequently involuntarily (50.5 vs 30.7 %). An office-based physician referred only 5 % of the patients and almost half attended the clinic without any referral. HU participated only to a modest degree in community-based treatments and 37 % attended no doctor in the month prior to admission. During the year following the index admission more than 80 % of HU were admitted again and were hospitalized almost as many days as before the index admission. Patients with a diagnosis of F1 and F2 showed the greatest persistence of heavy use behavior. CONCLUSIONS: This sample of HU show a persistent pattern of use of psychiatric inpatient treatment. Strategies to improve the situation are discussed.

Deterioration of metabolic parameters during short-term psychiatric inpatient treatment: a prospective naturalistic study.

OBJECTIVE: To investigate the influence of a single episode of psychiatric inpatient treatment on metabolic parameters. METHODS: A total of 294 consecutive patients of an Upper Austrian psychiatric department were assessed at admission and discharge regarding bodyweight, body mass index (BMI), high density cholesterol (HDL), low density cholesterol (LDL), triglycerides (TG) and fasting glucose (FG), and the TG/HDL ratio. RESULTS: Patients showed an increase of BMI of 0.35 kg/m² (+ 1.3%) during a mean duration of inpatient stay of 25.8 days. LDL rose by 10.7 mg/dl (+ 8.1%), triglycerides by 23.0 mg/dl (+ 17%), HDL decreased by 4.4 mg/dl (-7.4%). Fasting glucose decreased by 3.6 mg/dl (-3.8%), yet the TG/HDL ratio, as a marker for insulin resistance, increased significantly from 2.86 to 3.58 (+ 25.2%) on average. Patients with psychotic disorders gained about three times more weight than patients with other diagnoses. Negative alterations of serum lipids were to be found in all diagnostic groups but were especially pronounced in patients with psychotic disorders who were treated with second-generation antipsychotics clozapine, olanzapine and quetiapine. CONCLUSIONS: Psychiatric inpatient treatment leads to clinically relevant deterioration of metabolic parameters within a short time, most pronouncedly in patients with psychotic disorders.

[Psychiatric manifestation of a dengue-encephalopathy]. / Psychiatrische Manifestation einer Dengue-Encephalopathie.

Psychiatric manifestation of dengue virus infections is seldom reported. Here a case is presented of a 21-year-old man who developed mainly neuropsychiatric symptoms which he caught one week after a feverish infection during his stay in India: troubles with concentration and memory, confusion, as well as depressive delusions and agoraphobia. Liquor diagnosis as well as CCT and MRI was mainly inconspicuous. The FDG-PET showed a diffuse lack of activity. IgM and IgG antibodies of dengue virus were positive. We interpreted these psychiatric symptoms as a result of a dengue virus infection.