This sample of HU show a persistent pattern of use of psychiatric inpatient treatment. Strategies to improve the situation are discussed.

During the years 2003 to 2006 compulsory admissions and physical restraints were recorded in a psychiatric department. During this period the rate of compulsory admissions per all psychiatric admissions rose from 29.4% in 2003 to 33% in 2006. The rate of patients with at least one episode of physical restraint rose from 2.6% to 5.6%. The rate of compulsory admissions per inhabitants of the catchment area rose from 320/100.000 inhabitants in 2003 to 411/100.000, the rate of admissions with at least one episode of physical restraint from 28.6/100.000 inhabitants to 69.3/100.000. The mean duration of compulsory treatment over the whole period was 8.6 days, the median was 3 days. The mean duration of physical restraints was 132 minutes, the median duration 45 minutes.

We report about a woman of 60 years who received psychiatric inpatient treatment for an affective disorder with psychotic symptoms on several occasions. As time elapsed symptoms of dementia became more and more obvious. Despite a comprehensive workup with neuroimaging methods (SPECT, PET) the correct diagnosis of Huntington's Chorea was not attained until the characteristic movements appeared. Up till then pathologic movements had hardly occurred and there were no known cases of Huntington's Chorea in the family. This case is remarkable as the patient was not only treated with different antidepressants and antipsychotics but with a course of ECT too. Beyond this it shows the enormous stress this illness imposes on patients and their caregivers.

Psychiatric inpatient treatment leads to clinically relevant deterioration of metabolic parameters within a short time, most pronouncedly in patients with psychotic disorders.