No abstract

BackgroundDropping out during the course of medical follow up is defined as an early therapy withdrawal without the agreement of the therapist. In a psychiatric crisis unit in Geneva, we empirically observed that almost 50 % of the patients were not showing up to their first appointments, which were scheduled for 3 to 7 days post discharge.MethodsThe aim of this naturalistic descriptive cohort study is to identify the demographic, patient and care-related predictive factors of dropout in a community-based psychiatric crisis centre. We included 245 consecutive outpatients followed-up for 4 to 6 weeks of intensive outpatient psychiatric treatment. Logistic regression models were built to examine the association between dropout and demographic, care and patient-related variables.ResultsAmong the 245 outpatients, dropout occurred in 37.5 % of cases, and it most frequently occurred (81.8 %) in the first 2 days of follow-up. Among care-related variables, referral by hospital units or private psychiatrists led to significantly lower levels of dropout compared to patients referred by the psychiatric emergency unit (respectively: OR = .32; p = .04; 95 % CI [.10, .93]; OR = .36; p = .04; 95 % CI [.13, .96]; OR = .22; p = .002; 95 % CI [.08, .58]). Among patient-related variables, younger age increased the risk of dropout (OR = .96; 95 %; p = .002; 95 % CI [.94, .99]). Anxiety and personality but not mood disorders were also related to higher rates of dropout (respectively: OR = 2.40; p = .02; 95 % CI [1.14, 4.99]; and OR = 1.98; p = .02; 95 % CI [1.09, 3.59]). Unipolar depression (72.2 %; OR = 1.47; p = .48; 95 % CI [.34, 1.21]) was the most frequent primary diagnosis in this sample.ConclusionsThis study makes clear the need for increased efforts to improve care adherence in young patients with anxious or personality disorders seen in emergency rooms because they are prone to early discontinuation of treatments. Future studies in this field are warranted to gain a better understanding into the complex reasons that surround discontinuation of care in outpatient settings.

Dissociative disorders are a set of disorders defined by a disturbance affecting functions that are normally integrated with a prevalence of 2.4 percent in industrialised countries. These disorders are often poorly diagnosed or misdiagnosed because of sharing common clinical features with psychotic disorders, but requiring a very different trajectory of care. Repeated clinical situations in a crisis centre in Geneva provided us with a critical overview of current evidence of knowledge in clinical and etiopathological field about dissociative disorders. Because of their multiple expressions and the overlap with psychotic disorders, we focused on the clinical aspects using three different situations to better understand their specificity and to extend our thinking to the relevance of terms “neurosis” and “psychosis.” Finally, we hope that this work might help physicians and psychiatrists to become more aware of this complex set of disorders while making a diagnosis.

rTMS applied to the left dorsolateral prefrontal cortex was safe and effective in an important subset of outpatients with a moderate to severe MDE in a naturalistic setting. Outcomes demonstrated response rates similar to research populations. Further larger studies are needed to confirm the safety and effectiveness of rTMS in naturalistic conditions.

Background: Brief therapy centers (BTCs) are outpatient mental health units based initially on a psychodynamic model of crisis intervention, and evolving later into a global care approach. The main objective of BTC is to provide mentally ill patients with a viable alternative to hospitalization. Methods: We undertook a retrospective study of 323 patients admitted to a BTC in Geneva in order to understand the evolution of our patients care over the changes in psychiatry over the last 2 decades. To this end, we considered predictive factors of relapse for 160 individuals with repeated "revolving door" admissions compared to 163 patients with a single admission to the BTC. To analyze data, we mainly use analysis of variance and logistic regression with SPSS software. Results: Living alone, lower socio-educational levels, unstable working conditions, crisis factor of professional trouble, and preexisting psychiatric conditions, such as depression, bipolar disorders, psychotic disorders or borderline personality disorder, that required multiple social and systemic interventions, and medical treatments (such as antipsychotics and mood stabilizers) increase probability that patients relapse and require multiple BTC admissions. Conclusions: The results of the present study that are considered as preliminary, support the development of ambulatory mental health units that attempt to adapt their intervention practices to different populations in order to prevent the revolving door phenomenon and therefore contribute to improve the global system of mental health.