BackgroundResearch on length of stay (LOS) of psychiatric inpatients is an under-investigated issue. In this naturalistic study factors which affect LOS of two groups of patients were investigated, focusing on the impact on LOS of medical comorbidity severe enough to require referral.MethodsActive medical comorbidity was quantified using referral as the criterion. The study sample consisted of 200 inpatients with the diagnosis of schizophrenia and 228 inpatients suffering from bipolar disorder (type I or II). Jonckheere and Mann–Whitney tests were used to estimate the influence of referrals on LOS, and regression analyses isolated variables associated with LOS separately for each group.ResultsHalf of the patients needed one or more referrals for a non-psychiatric problem. The most common medical condition of patients with bipolar disorder was arterial hypertension. Inpatients with schizophrenia suffered mostly from an endocrine/metabolic disease - 12% of referrals were for Hashimoto’s thyroiditis. A positive linear trend was found between LOS and number of referrals; the effect was greater for schizophrenia patients. The effect of referrals on LOS was verified by regression in both groups. Overall, referred patients showed greater improvement in GAF compared to controls.ConclusionsTo our knowledge this was the first study to investigate physical comorbidity in psychiatric inpatients using the criterion of referral to medical subspecialties. Comorbidity severe enough to warrant referral is a significant determinant of hospital stay. This insight may prove useful in health care planning. The results show lack of effective community care in the case of schizophrenia and negative symptoms may be the cause of this. Our findings call for more attention to be paid to the general medical needs of inpatients with severe mental health and concurrent severe medical comorbidity.

ObjectivesPlacebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice.DesignLiterature review and survey.MethodsWe systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature.ResultsThe final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patient–practitioner interaction (7 procedures and 18 clinical applications).ConclusionThe taxonomy provides a preliminary and novel tool with potential to guide translational research aiming to harness placebo effects for patient benefit in practice.

These data suggest that an increase in the minimum price of alcohol to 50 pence price per unit is only likely to disproportionately affect people on low incomes if their alcohol consumption is excessive.

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BackgroundNo studies have been conducted in Greece with the aim of investigating the influence of ethnicity on the prescribing and treatment outcome of voluntarily admitted inpatients. Most studies conducted in the UK and the US, both on inpatients and outpatients, focus on the dosage of antipsychotics for schizophrenic patients and many suffer from significant methodological limitations. Using a simple design, we aimed to assess negative ethnic bias in psychotropic medication prescribing by comparing discrepancies in use between native and non-native psychiatric inpatients. We also aimed to compare differences in treatment outcome between the two groups.MethodsIn this retrospective study, the prescribing of medication was compared between 90 Greek and 63 non-Greek inpatients which were consecutively admitted into the emergency department of a hospital covering Athens, the capital of Greece. Participants suferred from schizophrenia and other psychotic disorders. Overall, groups were compared with regard to 12 outcomes, six related to prescribing and six related to treatment outcome as assesed by standardised psychometric tools.ResultsNo difference between the two ethnic groups was found in terms of improvement in treatment as measured by GAF and BPRS-E. Polypharmacy, use of first generation antipsychotics, second generation antipsychotics and use of mood stabilizers were not found to be associated with ethnicity. However, non-Greeks were less likely to receive SSRIs-SNRIs and more likely to receive benzodiazepines.ConclusionsOur study found limited evidence for ethnic bias. The stronger indication for racial bias was found in benzodiazepine prescribing. We discuss alternative explanations and give arguments calling for future research that will focus on disorders other than schizophrenia and studying non-inpatient populations.

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IntroductionMedical comorbidity in patients with schizophrenia and bipolar disorder is associated with poor psychiatric treatment outcome and,for inpatients, with increased length of stay (LOS) -either by increasing psychiatric symptomatology or by being the focus of medical attention.ObjectivesTo assess the impact of medical comorbidity that receives medical attention (as opposed to lack of concurrent medical problems or to stable comorbidity) on clinical outcomes and LOS within two psychiatric populations.AimsTo estimate the prevalence of comorbid medical conditions in schizophrenia and bipolar disorder. To test for differences, primarily in LOS and psychiatric treatment outcome, between inpatients who received care for physical problems and those who did not need to.MethodsThis was a retrospective study of consecutive voluntary admissions of 106 patients suffering from schizophrenia and 110 patients suffering from bipolar disorder (type I or II). Our main independent variable was whether or not inpatients received treatment for a medical condition after referral from the attending psychiatrist. We used GAF and CIRS-SA assessments.ResultsMost reported problems for schizophrenia patients were cardiovascular/respiratory (notably hypertension) and for bipolar patients endocrine/metabolic. Patients who received medical treatment did not differ in LOS or psychiatric outcome from those who did not receive, in either diagnosis group. 84% of bipolar patients who reported a psychiatric comorbidity received treatment for a medical problem.ConclusionsMedical care for comorbid physical problems does not impact on LOS, diagnosis being a better predictor of the latter. In bipolar disorder significant medical burden appears to be drug-induced.