A SURVEY OF PSYCHIATRIC UNITS IN GENERAL HOSPITALS IN CANADA.
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The Canadian Psychiatric Association recently recommended that all general hospitals over 200 beds should have psychiatric in-patient units. Questionnaires were sent to the administrators of the 52 existing general hospital psychiatric units in Canada. Most administrators expressed approval of these units, although some noted the existence of problems. Statistics are given on the staffing of the units. Although the number of beds was small, these facilities accounted for a very large number of admissions. Most had active teaching programs. The advantages of implementing the C.P.A. recommendation are many. General hospital psychiatric units should be encouraged to undertake comprehensive psychiatry, that is, to accept all types of psychiatric patients, and to retain responsibility for long-term care. (+info)
THE FUNCTIONING OF A PRIVATE PSYCHIATRIC CLINIC.
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SOME OF THE CLINICAL ADVANTAGES OF A PRIVATE PSYCHIATRIC CLINIC ORGANIZED FOR GROUP PRACTICE ARE: Readily available consultations with colleagues; cross-referral with better communication; more evenly filled hours; larger pools of patients for establishing and maintaining group therapy; better off-duty coverage; ready availability of the three disciplines, psychiatry, psychology and social work; satisfaction to the private psychiatrist of being able to arrange competent and prompt treatment for patients unable to meet usual fees; and cooperative research.Financial advantages include economies of time and money, a profit sharing plan, and availability of group life insurance, health benefits and social security. (+info)
THE DEVELOPMENT AND ORGANIZATION OF A CHILDREN'S PSYCHIATRIC HOSPITAL.
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Thistletown Hospital is a children's psychiatric hospital which was established by the Department of Health of the Province of Ontario. Special legislation permitting control of the admissions procedures was enacted. The administrative organization consists of a series of committees made up of the heads of hospital departments. An advisory board of distinguished psychiatrists and psychologists advises the Minister of Health directly on major policy changes or innovations envisaged for the hospital. Clinical organization is related to four functions: (1) service (treatment and assessment), (2) research, (3) training of staff, and (4) community education.The basic units of the hospital are related to the treatment or research design necessary in special diagnostic categories. A children's psychiatric hospital should not be restricted to in-patient facilities but should consist of a totally community-oriented service. (+info)
THERAPY OF CHLORPROMAZINE MELANOSIS: A PRELIMINARY REPORT.
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Melanosis observed in association with prolonged chlorpromazine therapy has become a serious problem in mental institutions. Skin pigmentation has produced an appearance which is cosmetically undesirable. Ocular deposits have caused visual impairment. Diffuse visceral involvement has been accompanied by functional disturbances of the involved organs.Withholding chlorpromazine did not diminish the pigment deposits already present in eight patients with chlorpromazine-induced melanosis. Therefore therapy for existing cases and means of preventing this side effect were investigated. A method of blocking melanin synthesis by depressing tyrosinase activity was devised. A copperchelating agent, D-penicillamine, was administered for a period of four weeks (300 mg. three times daily for six days each week, with mineral supplement substituted on the seventh day). Four of six days patients thus treated improved markedly as evidenced by diminution of skin pigmentation. Urinary copper excretion was substantially increased during the trial period. An alternative method of treatment designed to stimulate melatonin production by the pineal gland was employed. Two patients were kept in darkness for a period of four weeks. One improved markedly, the other only slightly. (+info)
PSYCHIATRIC PROGRAMS: THEIR MEDICAL INTEGRATION.
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The basic premise that psychiatry and medicine are one and the same discipline is advanced. Patients present with symptoms: sometimes largely the result of structural change, sometimes largely the result of emotional perturbation, but most frequently a mixture of both. The physician can never do his job satisfactorily without attention to the emotional problems of his patient, which is essentially the subject matter of psychiatry. He must have adequate training during his medical school years in order to recognize and handle emotional problems. The psychiatrically oriented general practitioner and the psychiatrist, who live in the community, are most valuable mental health resources and must have treatment facilities in the general hospital. Furthermore, hospital and medical insurance plans must be devised that will not penalize either doctor or patient when mental illness is recognized and dealt with in the most appropriate manner. (+info)
Bringing about change: the introduction of secure units.
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The introduction of regional secure units into the NHS was studied as one example of the diffusion of patient care innovations. As well as the general history of secure units events in four Regions were studied in detail for the period from 1974 up to mid-1983. It is concluded that secure units became gradually more acceptable over time as (i) the need for such units was recognized, (ii) the climate of opinion changed in psychiatric hospitals from seeing secure units as a retrograde step, following the acceptance of more open door policies, to seeing secure units as a prestige development which might safeguard the future of a particular hospital, (iii) government loosened the definitions of what secure units should be and how they should operate so that there was more room for different regions to assess their own needs. Regions which were able to move relatively fast on secure unit development were those where there was already a 'product champion' present to promote the ideas, usually a forensic psychiatrist, and where there was also managerial support and designated responsibility for secure unit development at local and regional level. It is concluded that while public reaction was a hindrance it did not slow down secure unit development as much as might have been expected. (+info)
Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine.
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OBJECTIVE: To compare two widely used drug treatments for people with aggression or agitation due to mental illness. DESIGN: Pragmatic, randomised clinical trial. SETTING: Three psychiatric emergency rooms in Rio de Janeiro, Brazil. SUBJECTS: 301 aggressive or agitated people. INTERVENTIONS: Open treatment with intramuscular midazolam or intramuscular haloperidol plus promethazine. MAIN OUTCOME MEASURES: Patients tranquil or sedated at 20 minutes. SECONDARY OUTCOMES: patients tranquil or asleep by 40, 60, and 120 minutes; restrained or given extra drugs within 2 hours; severe adverse events; another episode of agitation or aggression; needing extra visits from doctor during first 24 hours; overall antipsychotic load in first 24 hours; and not discharged by two weeks. RESULTS: 151 patients were randomised to midazolam, and 150 to haloperidol-promethazine mix. Follow up for the primary outcome was available for 298 (99%): 134/151 (89%) of patients given midazolam were tranquil or asleep after 20 minutes compared with 101/150 (67%) of those given haloperidol plus promethazine (relative risk 1.32 (95% confidence interval 1.16 to 1.49)). By 40 minutes, midazolam still had a statistically and clinically significant 13% relative advantage (1.13 (1.01 to 1.26)). After 1 hour, about 90% of both groups were tranquil or asleep. One important adverse event occurred in each group: a patient given midazolam had transient respiratory depression, and one given haloperidol-promethazine had a grande mal seizure. CONCLUSIONS: Both treatments were effective. Midazolam was more rapidly sedating than haloperidol-promethazine, reducing the time people are exposed to aggression. Adverse effects and resources to deal with them should be considered in the choice of the treatment. (+info)
Involuntary hospitalizations of patients with mental disorders in Vrapce Psychiatric Hospital: five years of implementation of the first Croatian law on protection of persons with mental disorders.
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AIM: To analyze data on the practice of involuntary hospitalizations of patients with mental disorders in Vrapce Psychiatric Hospital from January 1, 1998, when the Law on Protection of Persons with Mental Disorders came into power, to December 31, 2002; with particular reference to the changes and supplements to the Law on December 1999. METHOD: The data on patient's sex, age, and diagnosis were collected from the medical records. Patients were diagnosed according to ICD-10 criteria. When a patient had two or more diagnoses, he or she was placed in category of the primary diagnosis. Results were statistically analyzed by descriptive statistics and chi-square test. Statistical significance was set to p<0.01. RESULTS: The rate of involuntarily hospitalized patients increased by significantly from 1998 to 1999 (from 30.8% to 39.6%; p<0.01, chi square test). This rate decreased to 5.6% in 2000 (p<0.01), and continued to decrease in 2002 (3.5%). There was no difference between involuntarily hospitalized patients regarding sex in 1998 (p=0.302) and 1999 (p=0.136). Men were significantly more often involuntarily hospitalized than women in 2000, 2001, and 2002 (p<0.01). Schizophrenia and other psychotic disorders were the most common diagnoses among involuntarily hospitalized patients in each of the observed years. CONCLUSION: Changes and supplements to the Law on Protection of Persons with Mental Disorders from December 1999, which abolished the necessity for a written consent for hospitalization and the necessity for prescribed procedure of hospitalized persons who were mentally incompetent to consent for hospitalization, led to significant decrease in the number of involuntary hospitalizations. (+info)