Sociodemographic and Clinical Correlates Associated with the Frequent Service Users in an Italian Psychiatric Emergency Department

Abstract

Background: The aim of the present study is to identify the main sociodemographic and clinical correlates associated with frequent service users (FSUs) in an Italian psychiatric emergency department. Methods: This study is an observational and prospective clinical investigation. All subjects (N = 549) consecutively admitted to the Psychiatric Inpatient Unit of the IRCCS Ospedale Policlinico San Martino ((Genoa, Italy) were recruited over a period of 18 months. Results: On average, FSUs were more likely to be single (75.0% vs. 64.0, p = 0.001), younger (38.79 years ± 14.68 vs. 45.94 years ± 16.94, p = 0.028), with an earlier onset (20.15 years ± 7.22 vs. 29.33 years ± 15.96, p < 0.001), and longer length of hospitalisation (13.65 days ± 12.40 vs. 9.89 ± 10.15, p = 0.006) compared to non-FSUs. While bipolar disorder was the most common primary diagnosis in both FSUs and non-FSUs, cluster B personality disorder was particularly elevated in FSUs (30.3% vs. 10.4%, p < 0.001). Furthermore, FSUs were more prone to substance use disorder (63.6% vs. 40.0%, p < 0.001), particularly cannabis (45.5% vs. 15.3%, p < 0.001), cocaine (33.3% vs. 10.4%, p < 0.001), and heroin (19.7% vs. 5.8%, p < 0.001), and were more likely to have non-suicidal self-injuries (21.2% vs. 6.8%, p < 0.001). FSUs were significantly more likely to be discharged against medical advice (18.2% vs. 5.6%, p < 0.001) or to have at least one escape attempt from the psychiatric ward (12.1% vs. 0.8%, p < 0.001). Conclusions: Specific clinical and social profiles of patients who repeatedly utilised the services of a psychiatric emergency department have been identified. Our findings can be used to develop suitable structures to support and reintegrate FSUs into society and work life.

Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables

“…A semi-structured interview, used in a previous published paper [27], was administered to all subjects to collect basic data, as follows: sociodemographic variables (age, gender, marital and occupational status, educational level, living situation, type of discharge, and migrant status), clinical characteristics (primary psychiatric diagnosis, age at onset, duration of illness, non-suicidal self-injuries, first hospitalization, length of current hospitalization in days, long hospitalization (defined as a time over 21 days), type of admission (voluntary or involuntary), need of mechanical restraint, presence of psychiatric and/or medical comorbidity, positive family history of psychiatric disorders). All patients were diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) [28].…”

“…All patients were diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) [28]. The diagnoses at discharge were divided into the following subgroups: schizophrenia and related disorders, bipolar and related disorders, depressive disorders, personality disorders, and others (including the remaining psychiatric and nonpsychiatric disorders such as social admission, mental retardation, or major neurocognitive disorders) [27].…”

Advances in the Diagnosis and Management of Psychosis

“…It is of particular interest to understand the socio-demographic profile of the emergency psychiatric care users [7] and to deliver structured approaches for the assessment of involuntary treatment [8], because it is involuntary treatment that is supposed to address the most prominent risk behaviors resulting from psychosis, and yet it constitutes one of the most outstanding ethical issues in the management of psychotic disorders. Schizophrenia anxiety is a fundamental and complex condition, differentiated from "neurotic" anxiety, which may be better attuned to social and cultural norms in terms of common sense.…”

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review

“…Patients must adhere to certain requirements, such as taking prescribed medication and attending appointments, even if they stay in the community. Non-compliance with these stipulations typically leads to rehospitalization in a psychiatric facility [26,27], especially among those commonly referred to as "revolving-door patients" who struggle to maintain their recovery and adhere to prescribed treatment regimens, thereby requiring recurrent hospitalization [28,29]. Coercive outpatient programs are considered less restrictive than hospitalization, aiming to enhance individual autonomy.…”