Scielo RSS <![CDATA[The European Journal of Psychiatry]]> vol. 19 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Involuntary psychiatric admissions</b>: <b>A retrospective study of 460 cases</b>]]> Introduction: We collected the data relating to involuntary hospital treatment (IHT) in the University Psychiatric Ward at Novara Hospital between 1991 and 2002, and compared them with those relating to Piedmont and the whole of Italy. Methods: The data were collected from the ward medical records. Results: IHT was much more frequent among young male schizophrenics living with their families of origin. Most of the subjects were not working at the time of admission. There was a statistically significant correlation between male gender and the risk of being admitted for a period of less than 12 days. The risk of being admitted for more than 12 days significantly correlated with the province of birth and residence, as well as with a diagnosis of schizophrenic psychosis. Conclusions: Schizophrenia is the diagnosis that is most frequently associated with IHT. <![CDATA[<b>The Development of an Instrument to Measure Stigmatization</b>: <b>factor analysis and origin of stigmatization</b>]]> Assessment of stigmatization and understanding of its roots are gaining more importance as its effect on the prognosis of mental health is recognized. A search with Medline showed that there are instruments assessing stigmatization, most containing misconceptions, and regrettably none with adequate reliability and validity. To develop a reliable and valid instrument for research into stigmatization, and to define the structure of stigmatization by factor analysis of the results, about two thousand items from patients' own explanatory models, user groups' ideas, relatives' and social workers' accounts were scrutinized by the author and an independent observer. The items were simplified and rephrased so that they each contained a single idea expressed in clear language. Items were excluded on the grounds of redundancy, culture-boundness or representing factual knowledge rather than attitude. The draft of the instrument was field-tested, and rigorous assessments proved its reliability and validity. Factor analysis derived three factors indicating social, psychological and evolutionary foundations of stigmatization. The result is the Standardized Stigmatization Questionnaire, version 1 (SSQ1) which is now being used in several research centres in Europe. The Unitary Theory of Stigmatization resulting from this study has contributed to a new understanding of the meaning of stigmatization. <![CDATA[<b>Negative behaviours as the reason for referral to a liaison old age psychiatrist</b>]]> The analysis of 130 consecutive referrals to a liaison old age psychiatrist in two different London hospitals revealed that nearly half of these requests mentioned negative behaviours as the reason for referral. The common factor between these behaviours was that they made the delivery of the treatment or discharge plan very difficult. This type of referral was more common for patients who had stayed in hospital for longer at the time of the request. <![CDATA[<b>Professional secrecy as a stressor among norwegian physicians</b>]]> The aim of the present study is to assess how the necessary practice of professional secrecy may be a stressor for doctors, and to what extent MM (mortality and morbidity)-meetings and having a doctor as a spouse or partner, may serve as outlets for emotional charge. A postal survey was sent to a stratified sample of 780 doctors working in and outside hospitals in a health region in Norway (1.1 million inhabitants). With a response rate of 46 percent (358 / 780), 22 percent of the respondents were identified as being high on stress and low on coping. 26 percent of the doctors participated regularly in MM-meetings. The risk of being stressed increased with increasing score on the scale for perceived lack of possibilities to discuss emotionally charged issues at work and at home. The doctors who participated in MM-meetings had a significantly reduced stress risk. Having a doctor as partner did not affect the stress level significantly. The results indicate that MM-meetings are effective in stress reduction among Norwegian doctors and should be a self-evident part of ordinary clinical activities. <![CDATA[<b>Delirium</b>: <b>A predictor of mortality in the elderly</b>]]> The frequency of delirium in elderly inpatients is high, resulting in poor hospital outcomes. The objective of this study is to assess whether delirium is an independent predictor for mortality over a three-month period. Methods: Prospective, observational study in a cohort of 171 inpatients aged over 65 years. Presence of delirium and/or dementia, severity of delirium and incapacity due to illness were assessed at baseline using DSM-IV diagnostic criteria, the Confusion Assessment Method (CAM), the MMSE, the Delirium Rating Scale (DRS) and the Karnofsky Performance Status (KPS). Mortality rates were evaluated over a three-month follow-up period after enrollment. Kaplan-Meier survival curves were constructed and the adjusted effect of a set of covariates was evaluated with the Cox multiple regression analysis. Results: By 3 months after enrollment, 34.4% of the patients with delirium died, compared with 16.5% of those without delirium. The survival analysis shows a statistically significant difference between the two groups (log-rank=11.92; d.f.=1; P=0.0006). After adjustment for covariates, delirium was found to be independently associated with higher mortality. Conclusions: Delirium was found to be an independent marker for mortality in older medical patients over a three-month follow-up. <![CDATA[<b>Depressive co-morbidity in medical in-patients at the time of hospital discharge and outcome in a Primary Care follow-up</b>: <b>I. Rational and design of the project</b>]]> Objectives: In a context of a "continuity of care" model in Psychosomatic and Liaison Psychiatry, this study is intended to test, in patients to be discharged from Medicine wards, hypotheses related to a high prevalence of depression and, in particular, its negative outcome at six-months follow-up in Primary Care (PC), specially among the elderly. Methods:Sample. Consecutive patients aged 18 years or more, hospitalized in Medicine wards were randomly selected for screening at the time of admission. On the bases of a previous study and the expected sampling errors, sample size was estimated in 700 patients (approximately 60% in geriatric age) for the initial screening, to recruit 75 or more cases of depression and enough number of control, non-cases without psychiatric morbidity.. Instruments. Standardized, Spanish versions of screening/case-finding instruments COMPRI/INTERMED, Mini-Mental, CAGE and drug screening, Hospital Anxiety and Depression Scale (HADS), Standardized Polyvalent Psychiatric Interview (SPPI). Diagnostic criteria ICD-10 research, medical patients version and DSM-IV-TR (psychiatric); and ICD-9-M; ICHPPC, WONCA (medical). Cumulative Illness Rating Scale (CIRS) (severity of physical condition); SF36 and EuroQol (quality of life); Client Service Receipt Interview (CSRI) (costs). Procedure. Part I, hospital study: Two-phase screening (lay interviewers: COMPRI/INTERMED at admission; Mini-Mental, CAGE, HADS at the time of discharge; and standardized clinicians: SPPI). CIRS was used to control severity of physical conditions. Part II, follow-up study in PC (six months): Standardized clinicians, blind to the previous phases (HADS and SPPI to both cases and controls). Outcome study: EuroQuol, SF36, CSRI and data on morbidity and mortality, were collected. Conclusions. To our knowledge, this is the first study using modern epidemiological methods in medical patients to be discharged with co-morbid depression and followed in PC with a "continuity of care" strategy. The final analysis of data should support the design of an evidence-based, intervention study on co-morbid depression.