Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2013-0018
Trends in Psychiatry and Psychotherapy
Original Article

Forty years of a psychiatric day hospital

Quarenta anos de um hospital de dia de psiquiatria

Rosário Curral; Rui Lopes; Celeste Silveira; Andreia Norton; Isabel Domingues; Fernando Lopes; Elisabete Ramos; António Roma-Torres

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Abstract

INTRODUCTION: Day hospitals in psychiatry are a major alternative to inpatient care today, acting as key components of community and social psychiatry. Objective: To study trends in the use of psychiatric day hospitals over the last decades of the 20th century and the first decade of the 21st century, focusing on patient age, sex, and diagnostic group, using data from Centro Hospitalar São João, Porto, Portugal. METHODS: Data corresponding to years 1970 to 2009 were collected from patient files. Patients were classified into seven diagnostic groups considering their primary diagnoses only. RESULTS: Mean age upon admission rose from 32.7±12.1 years in the second half of the 1970s to 43.5±12.2 years in 2005-2009 (p for trend < 0.001). Most patients were female (63.2%), however their proportion decreased from nearly 70% in the 1970s to 60% in the first decade of the 21st century. In males, until the late 1980s, neurotic disorders (E) were the most common diagnosis, accounting for more than one third of admissions. In the subsequent years, this proportion decreased, and the number of admissions for schizophrenia (C) exceeded 50% in 2004- 2009. In females, until the late 1980s, affective disorders (D) and neurotic disorders (E), similarly distributed, accounted for most admissions. From the 1990s on, the proportion of neurotic disorders (E) substantially decreased, and affective disorders (D) came to represent more than 50% of all admissions. CONCLUSIONS: Mean age upon admission rose with time, as did the percentage of female admissions, even though the latter tendency weakened in the last 10 years assessed. There was also an increase in the proportion of patients with schizophrenia.

Keywords

Day hospital, community psychiatry, mental disorders, mental health

Resumo

INTRODUÇÃO: Os hospitais de dia em psiquiatria representam atualmente uma das principais alternativas ao internamento, atuando como componentes chave na psiquiatria comunitária e social. OBJETIVO: Avaliar tendências na utilização de um hospital de dia no período compreendido entre as últimas décadas do século 20 e a primeira década do século 21, com foco em idade, sexo e grupo diagnóstico, usando dados do Centro Hospitalar São João, Porto, Portugal. MÉTODOS: Dados correspondentes aos anos 1970 a 2009 foram coletados dos prontuários clínicos. Os pacientes foram classificados em sete grupos diagnósticos, tendo em conta o diagnóstico principal. Resultados: A idade média na admissão aumentou de 32.7±12.1 anos na segunda metade da década de 1970 para 43.5±12.2 anos em 2005-2009 (p < 0.001). A maioria dos pacientes era do sexo feminino (63.2%), no entanto sua proporção diminuiu de cerca de 70% na década de 1970 para 60% na primeira década do século 21. Nos homens, até o final dos anos 1980, o grupo das perturbações neuróticas (E) era o diagnóstico mais comum, representando mais de um terço das admissões. Durante os anos seguintes, essa proporção diminuiu, e o número de admissões por esquizofrenia (C) alcançou mais de 50% no período de 2004-2009. Nas mulheres, até o final dos anos 1980, as perturbações afetivas (D) e as perturbações neuróticas (E), distribuídas similarmente, respondiam pela maioria das admissões. A partir dos anos 1990, a proporção das perturbações neuróticas (E) diminuiu substancialmente, e as perturbações afetivas (D) passaram a corresponder a mais de 50% do total das admissões. Conclusões: A idade média na admissão aumentou com o tempo, e verificou-se uma maior porcentagem de admissões no sexo feminino, embora esta última tendência tenha sido atenuada nos últimos 10 anos avaliados. Houve também um aumento na proporção de pacientes com esquizofrenia.

Palavras-chave

Hospital de dia, psiquiatria comunitária, transtornos mentais, saúde mental

References

Cameron DE. The day hospital; an experimental form of hospitalization for psychiatric patients. Mod Hosp. ;69:60-2.

Volovik VM, Zachepitskii RA. Treatment, care, and rehabilitation of the chronic mentally ill in the U.S.S.R. Hosp Community Psychiatry. ;37:280-82.

Sadock BJ, Sadock VA, Ruiz P, Kaplan HI. Kaplan & Sadock's comprehensive textbook of psychiatry. .

Shorter E. A historical dictionary of psychiatry. .

Pang J Jr. Partial hospitalization. An alternative to inpatient care. Psychiatr Clin North Am. ;8:587-95.

Creed F, Black D, Anthony P. Day-hospital and community treatment for acute psychiatric illness. A critical appraisal. Br J Psychiatry. ;154:300-10.

Krizay J. Partial Hospitalization: facilities, cost and utilization. .

Vaughan PJ. The disordered development of day care in psychiatry. Health Trends. ;15:91-4.

Provost D, Bauer A. Trends and developments in public psychiatry in France since 1975. Acta Psychiatr Scand Suppl. ;(410):63-8.

Puzynski S, Moskalewicz J. Evolution of the mental health care system in Poland. Acta Psychiatr Scand Suppl. ;(410):69-73.

Schene AH, Faber AM. Mental health care reform in The Netherlands. Acta Psychiatr Scand Suppl. ;(410):74-81.

Vázquez-Barquero JL, García J, Torres-González F. Spanish psychiatric reform: what can be learned from two decades of experience?. Acta Psychiatr Scand Suppl. ;(410):89-95.

Briscoe J, McCabe R, Priebe S, Kallert S. A national survey of psychiatric day hospitals. Psychiatr Bull. ;28:160-63.

Kallert TW, Schönherr R, Schnippa S, Matthes C, Glöckner M, Schützwohl M. [Direct costs of acute day hospital care: results from a randomized controlled trial]. Psychiatr Prax. ;32:132-41.

Schene AH, Gersons BP. Effectiveness and application of partial hospitalization. Acta Psychiatr Scand. ;74:335-40.

Sledge WH, Tebes J, Rakfeldt J, Davidson L, Lyons L, Druss B. Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes. Am J Psychiatry. ;153:1065-073.

Dick P, Cameron L, Cohen D, Barlow M, Ince A. Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry. ;147:246-49.

Creed F, Black D, Anthony P, Osborn M, Thomas P, Tomenson B. Randomised controlled trial of day patient versus inpatient psychiatric treatment. BMJ. ;300:1033-037.

Priebe S, Jones G, McCabe R, Briscoe J, Wright D, Sleed M. Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: randomised controlled trial. Br J Psychiatry. ;188:243-49.

Kallert TW, Priebe S, McCabe R, Kiejna A, Rymaszewska J, Nawka P. Are day hospitals effective for acutely ill psychiatric patients? A European multicenter randomized controlled trial. J Clin Psychiatry. ;68:278-87.

Priebe S, McCabe R, Schützwohl M, Kiejna A, Nawka P, Raboch J. Patient characteristics predicting better treatment outcomes in day hospitals compared with inpatient wards. Psychiatr Serv. ;62:278-84.

Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H. Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care. Health Technol Assess. ;5:1-75.

Marshall M, Crowther R, Sledge WH, Rathbone J, Soares-Weiser K. Day hospital versus admission for acute psychiatric disorders. Cochrane Database Syst Rev. :CD004026-CD004026.

Parker S, Knoll JL. Partial hospitalization: an update. Am J Psychiatry. ;147:156-60.

Moscowitz IS. The effectiveness of day hospital treatment: a review. J Community Psychol. ;8:155-64.

Rosie JS. Partial hospitalization: a review of recent literature. Hosp Community Psychiatry. ;38:1291-299.

Hoge MA, Davidson L, Hill WL, Turner VE, Ameli R. The promise of partial hospitalization: a reassessment. Hosp Community Psychiatry. ;43:345-54.

Karterud S, Wilberg T. From general day hospital treatment to specialized treatment programmes. Int Rev Psychiatry. ;19:39-49.

Kallert TW, Glöckner M, Priebe S, Briscoe J, Rymaszewska J, Adamowski T. A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research. Soc Psychiatry Psychiatr Epidemiol. ;39:777-88.

Schene AH. Partial hospitalization. Textbook of community psychiatry. :283-93.

Schene AH, van Lieshout PA, Mastboom JC. Different types of partial hospitalization programs: results of a nationwide survey in The Netherlands. Acta Psychiatr Scand. ;78:515-22.

Mbaya P, Creed F, Tomenson B. The different uses of day hospitals. Acta Psychiatr Scand. ;98:283-87.

Rosie JS, Azim HF, Piper WE, Joyce AS. Effective psychiatric day treatment: historical lessons. Psychiatr Serv. ;46:1019-026.

Fernandes da Fonseca A, Rente F, Roma-Torres A, Geada JD, Barbedo de Oliveira A, Miranda L, Saraiva A. Serviço de Psiquiatria do Hospital São João - A Unidade do Hospital de Dia. .

Barreto J. Reorganização: linhas pragmáticas. .

Gelder MG, Andreasen NC, Lopez-Ibor JJ, Geddes JR. New Oxford textbook of psychiatry. .

The ICD-10 Classification of Mental and Behavioural Disorders: clinical descriptions and diagnostic guidelines. .

Heitor MJ, Barreto A, Brito I, Cepeda T, Correia H. Rede de referenciação de psiquiatria e saúde mental. .

McGrath J, Saha S, Welham J, El Saadi O, MacCauley C, Chant D. A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Med. ;2:13-3.

Aleman A, Kahn RS, Selten JP. Sex differences in the risk of schizophrenia: evidence from meta-analysis. Arch Gen Psychiatry. ;60:565-71.

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