Open general medical wards versus specialist psychiatric units for acute psychoses

Abstract

Background As international healthcare policy has moved away from treating people with severe mental illness in large inpatient psychiatric institutions, beds for people with acute psychiatric disorders are being established in specialised psychiatric units in general hospitals. In developing countries, however, limited resources mean that it is not always possible to provide discrete psychiatric units, either in general hospitals or in the community. An alternative model of admission, used in the Caribbean, is to treat the person with acute psychosis in a general hospital ward. Objectives To compare the outcomes for people with acute psychosis who have been admitted to open medical wards with those admitted to conventional psychiatric units. Search methods We searched The Cochrane Schizophrenia Group’s study-based register (April 2007). This register is compiled from searches of BIOSIS, CINAHL, The Cochrane Library, EMBASE, LILACS, MEDLINE, PsycINFO, PSYNDEX, Sociofile, and many conference proceedings. Selection criteria We would have included all relevant randomised or quasi-randomised trials, allocating anyone thought to be suffering from an acute psychotic episode to either acute management on general medical wards, or acute management in a specialist psychiatric unit. The primary outcomes of interest were length of stay in hospital and relapse. Data collection and analysis We extracted data independently. For dichotomous data we would have calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based using a fixed effects model. Main results We didnt identify any relevant randomised trials. Authors’ conclusions The Caribbean practice of treating people with severe mental illness on general medical wards has been influenced by socio-economic factors rather than evidence from randomised trials. This practice affords an opportunity for a well designed, well conducted and reported randomised trial, now impossible in many other settings.

A case of schizophrenia refuting mind-body dualism

“…Another consideration is the initiation of psychotropics indicated on observation of those who are found not fit and/or not responsible due to mental illness. 1 , 7 A systematic review by Elyamani et al (2020) highlighted the poor mental health literacy of non-psychiatrists in the ‘Arab Gulf countries’. 8 In one of the studies included in the review, 54.3% had limited recognition of psychosis.…”

A case of schizophrenia refuting mind-body dualism

“…Another consideration is the initiation of psychotropics indicated on observation of those who are found not fit and/or not responsible due to mental illness. 1 , 7 A systematic review by Elyamani et al (2020) highlighted the poor mental health literacy of non-psychiatrists in the ‘Arab Gulf countries’. 8 In one of the studies included in the review, 54.3% had limited recognition of psychosis.…”

Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health

“…(Moses, 2013) Short-stay treatment in conventional primary and secondary care health facilities A unique feature of Jamaican postcolonial mental health public policy since 1965 has been the successful management of acute psychosis in open medical wards of general hospitals, where patients with acute psychotic illnesses have been treated alongside patients with other acute medical illness such as diabetes and myocardial infarction (Hickling, McCallum, Nooks, & Rodgers-Johnson, 2000). This approach has since been adopted in Rio Negro, Argentina (Collins, 2008), and has been recognized by the Cochrane Review as a uniquely innovative approach to the care of persons with acute psychiatric illnesses (Hickling, Abel, Garner, & Rathbone, 2007). By 2015, nearly 49% of the annual admissions of acute psychiatric patients were to these facilities, and 74% of all psychiatric admissions were to community hospital facilities (Munroe-Ellis, 2016).…”

A case study of the organisation of research knowledge by systematic reviews within the mental health care field

“…We only included the reviews that were of good methodological quality, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] which we assessed using the AMSTAR checklist 25 (17/57). As three of these 17 identified reviews did not include any studies, 9,13,15 we extracted data from 14 systematic reviews. The reviews were published during the period 1999 to 2011, with the literature searches carried out one year prior to the publication date.…”

A case of schizophrenia refuting mind-body dualism

“…Another consideration is the initiation of psychotropics indicated on observation of those who are found not fit and/or not responsible due to mental illness. 1 , 7 A systematic review by Elyamani et al (2020) highlighted the poor mental health literacy of non-psychiatrists in the ‘Arab Gulf countries’. 8 In one of the studies included in the review, 54.3% had limited recognition of psychosis.…”

Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health

“…(Moses, 2013) Short-stay treatment in conventional primary and secondary care health facilities A unique feature of Jamaican postcolonial mental health public policy since 1965 has been the successful management of acute psychosis in open medical wards of general hospitals, where patients with acute psychotic illnesses have been treated alongside patients with other acute medical illness such as diabetes and myocardial infarction (Hickling, McCallum, Nooks, & Rodgers-Johnson, 2000). This approach has since been adopted in Rio Negro, Argentina (Collins, 2008), and has been recognized by the Cochrane Review as a uniquely innovative approach to the care of persons with acute psychiatric illnesses (Hickling, Abel, Garner, & Rathbone, 2007). By 2015, nearly 49% of the annual admissions of acute psychiatric patients were to these facilities, and 74% of all psychiatric admissions were to community hospital facilities (Munroe-Ellis, 2016).…”

A case study of the organisation of research knowledge by systematic reviews within the mental health care field

“…We only included the reviews that were of good methodological quality, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] which we assessed using the AMSTAR checklist 25 (17/57). As three of these 17 identified reviews did not include any studies, 9,13,15 we extracted data from 14 systematic reviews. The reviews were published during the period 1999 to 2011, with the literature searches carried out one year prior to the publication date.…”

A case of schizophrenia refuting mind-body dualism

“…Another consideration is the initiation of psychotropics indicated on observation of those who are found not fit and/or not responsible due to mental illness. 1 , 7 A systematic review by Elyamani et al (2020) highlighted the poor mental health literacy of non-psychiatrists in the ‘Arab Gulf countries’. 8 In one of the studies included in the review, 54.3% had limited recognition of psychosis.…”

Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health

“…(Moses, 2013) Short-stay treatment in conventional primary and secondary care health facilities A unique feature of Jamaican postcolonial mental health public policy since 1965 has been the successful management of acute psychosis in open medical wards of general hospitals, where patients with acute psychotic illnesses have been treated alongside patients with other acute medical illness such as diabetes and myocardial infarction (Hickling, McCallum, Nooks, & Rodgers-Johnson, 2000). This approach has since been adopted in Rio Negro, Argentina (Collins, 2008), and has been recognized by the Cochrane Review as a uniquely innovative approach to the care of persons with acute psychiatric illnesses (Hickling, Abel, Garner, & Rathbone, 2007). By 2015, nearly 49% of the annual admissions of acute psychiatric patients were to these facilities, and 74% of all psychiatric admissions were to community hospital facilities (Munroe-Ellis, 2016).…”

A case study of the organisation of research knowledge by systematic reviews within the mental health care field

“…We only included the reviews that were of good methodological quality, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] which we assessed using the AMSTAR checklist 25 (17/57). As three of these 17 identified reviews did not include any studies, 9,13,15 we extracted data from 14 systematic reviews. The reviews were published during the period 1999 to 2011, with the literature searches carried out one year prior to the publication date.…”