Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution

Abstract

Objective: Characterize and compare acute psychiatric admissions to the psychiatric wards of a general hospital (22 beds), a psychiatric hospital (80) and of an emergency psychiatry unit (6). Method: Survey of the ratios and shares of the demographic, diagnostic and hospitalization variables involved in all acute admissions registered in a catchment area in Brazil between 1998 and 2004. Results: From the 11,208 admissions, 47.8% of the patients were admitted to a psychiatric hospital and 14.1% to a general hospital. The emergency psychiatry unit accounted for 38.1% of all admissions during the period, with a higher variability in occupancy rate and bed turnover during the years. Around 80% of the hospital stays lasted less than 20 days and in almost half of these cases, patients were discharged in 2 days. Although the total number of admissions remained stable during the years, in 2004, a 30% increase was seen compared to 2003. In 2004, bed turnover and occupancy rate at the emergency psychiatry unit increased. Conclusion:The increase in the number of psychiatric admissions in 2004 could be attributed to a lack of new community-based services available in the area beginning in 1998. Changes in the health care network did affect the emergency psychiatric service and the limitations of the community-based network could influence the rate of psychiatric admissions. Descriptors

Psychiatric emergencies: psychomotor agitation management and suicide risk assessment

“…Nós avaliamos todas as internações psiquiátricas ocorridas na região de Ribeirão Preto, num período de sete anos (1998 a 2004) e observamos que 38% das admissões psiquiátricas se resolveram em um período curto, em torno de 24 horas, na própria sala de emergência, mesmo com um número reduzido de leitos, em comparação com o hospital psiquiátrico tradicional e com as enfermarias em hospital geral. 5 Obviamente, isso só é possível se a rede de serviços extra-hospitalares for eficiente no sentido de absorver rapidamente os pacientes egressos do serviço de emergência e oferecer cuidados intensivos e individualizados para pacientes agudos. Mais recentemente, nós demonstramos que internações de curta duração (um a dois dias) não se associam com risco de readmissões precoces, 6 o que reforça a utilidade de internações breves no manejo de quadros psiquiátricos agudos.…”

First-Episode Psychosis: Emergency Assistance

“…Caracterizam-se como "porta de entrada" da rede de atendimento em saúde mental, participando inclusive da regulação (redução) das internações psiquiátricas, por meio de observações curtas em suas retaguardas [14][15][16] . A apresentação clínica sintomatológica inicial nos casos de PEP pode ser bastante heterogênea, difi cultando o diagnósti-co preciso com base em manuais (10ª edição da Classifi cação Internacional das Doenças -CID-10, e 5ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais -DSM-V).…”

Manejo de paciente agitado ou agressivo

“…Problems related to the use of psychoactive substances, including intoxication and withdrawal episodes, which are commonly associated with agitated and/or violent behavior, are among the main causes presenting in emergency services and requiring psychiatric care. 1,5 Similarly, agitated, potentially aggressive, and openly violent behaviors are not particular to any specific mental disorder and also imply the necessity for a broad investigation to perform the differential diagnosis. Patients with severe psychiatric disorders, particularly schizophrenia and manic episodes, use general and psychiatric emergency services more often than the general population.…”