- Email: [email protected]
P.8.a.017 The revolving door phenomenon: an epidemiologic characterisation at a psychiatric department of a Portuguese university hospital
S620
P.8.a. Other topics (clinical)
extent generalized anxiety disorder (2%). Reduced motivation was significantly higher in depressive disorders, there was a positive correlation between the degree of severity of depressive disorders with reduced motivation and mental fatigue, while there was a negative correlation between the severity of depressive disorders with general fatigue, physical fatigue and reduced activity. Conclusion: Fatigue is a presentation not uncommonly pointing to an underlying psychiatric condition. Sometimes psychiatric complaints cannot be expressed verbally by the patient although suffering from psychiatric symptoms, commonly those of depressive disorders. References [1] Christodoulou, 2005. The assessment and measurement of fatigue. In fatigue as a window to the brain (edited by John Deluca), pp 19−35. Massachusetts Institutes of Technology Press. Cambridge Center. [2] Harvey et al., 2009. Harvey S, Wadsworth M., Wessley P. et al., 2009: Etiology of chronic fatigue syndrome: Testing popular hypotheses using a national birth cohort study. Psychosomatic Medicine 70:488–495. [3] Lesley M. and Arnold M.D. (2008): Understanding Fatigue in Major Depressive Disorder and Other Medical Disorders. Psychosomatics; 49:185–190.
P.8.a.017 The revolving door phenomenon: an epidemiologic characterisation at a psychiatric department of a Portuguese university hospital S. Pereira1 ° , C. Miguel1 , C. Pereira1 , H. Firmino1 . 1 Hospitals of the University of Coimbra, Psychiatry, Coimbra, Portugal Background: The deinstitutionalization with the closure of large psychiatric hospitals, led to the emergence of an important subgroup of patients with severe mental disorders, who have in common a high rate of hospital readmissions. These readmissions within a short period of time, constitute the so-called revolving door phenomenon. There is no consensus regarding the definition of this phenomenon. We consider as revolving door at least 3 admissions in a period of 2 years. Purpose: The authors of this work propose presenting the results of a retrospective study, with descriptive and quantitative approaches, whose objective was to characterize the patients considered as the revolving door subgroup. Methods: 67 patients were selected by the Department of statistics of HUC. All of these patients had at least 3 admissions in a period of 2 years (2008 and 2009) in the Psychiatric department at HUC. The data were obtained by consulting the medical files of these 67 patients. The authors evaluated several variables related to the patient (socio-demographic factors, prior psychiatric history, duration of illness, . . . ) and to the hospital admission (voluntary/ involuntary admission, duration of the hospitalization during the study, previous hospitalizations, . . . ). The group of patients who was considered as the revolving door group was compared to a control group. Statistical analysis was performed with the program SPSS using Chi 2, Student’s t, Fischer and Spearman tests. Results: The revolving door phenomenon was more frequently found in the range of 30 to 49 years (50%). Most of these patients belonged to the single/divorced Group (60%). About 33% of patients had no socio-familial support. The Group of psychosis was the group most often involved (47%) with essentially schizophrenia (25.4%). The factor most often found as the cause of these readmissions was the discontinuation of the medication (60%). Psychosocial factors were incriminated in 73% of cases. About 17% of patients were submitted to an involuntary hospitalization.
26% of patients had some form of aggressiveness at the time of the hospitalization. Female patients were more associated to bipolar disease (p = 0.001), a regular psychiatric follow-up (p = 0.05) and adherence to pharmacological therapy (p = 0.027). Male patients were more associated to drug addiction (p = 0.035), schizophrenia (p = 0.05), aggression (p = 0.035) and non-adherence to therapy (p = 0.027). The psychosis were positively related with younger ages (p = 0.001), non-adherence to pharmacological therapy (p < 0.001), aggression (p < 0.001), involuntary hospitalization (p = 0.001), anti psychotic depot (p < 0.001), greater number of previous admissions (p = 0.015). Conclusions: Male patients are more involved in the revolving door phenomenon. They are younger and are often psychotic with comorbid drug addiction. Due to the lack of insight, they discontinue more frequently pharmacological therapy leading to uncontrolled psychosis with episodes of aggression and subsequent involuntary hospitalization. Female patients are older and suffer more from mood disorders. Psychosocial factors are involved. Contrary to men, women adhere more to pharmacological therapy. Another cause of revolving door is also the lack of social support that was aggravated by the deinstitutionalization. References [1] Botha U.A. et al. 2010 The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Soc. Psychiat. Epidemiol, 45: 461–468. [2] Dias Neto D.et al. 2008 Characterization of readmissions at a Portuguese psychiatric hospital: an analysis over a 21 month period. Eur. J. Psychiatr, 22(2): 69−76. [3] Oyffe I. et al. 2009 Revolving door patients in a public Psychiatric hospital in Israel: cross sectional study. Croat. Med. J., 50: 575–582.
P.8.a.018 Impact of methylphenidate treatment on the rate of accidents in adults with Attention Deficit Hyperactivity Disorder (ADHD) M. Marin1 ° , G. Ponce1 , I. Martinez1 , G. Rubio1 . de Octubre, Dept. of Psychiatry, Madrid, Spain
1 Hospital
12
Background: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder clinically characterized by impaired attention and impulse control, hyperactive behavior, inner restlessness and emotional dysregulation, that often continuous to manifest symptoms into adulthood. The prevalence rate of adults who meet the full criteria for ADHD is estimated to range from 1% to 4%. Moreover, in 40% to 60% of the affected children symptoms persist in adulthood. Longitudinal follow-up studies have extensively documented impairment in academic, occupational, social and emotional domains of functioning in adults with ADHD. In addition, recent studies have found an association between adults with ADHD and domestic, industrial and traffic accidents. Moreover, some studies report an improvement of driving abilities under methylphenidate treatment. This is due to methylphenidate’s action over sustained attention, visual orientation and visual-motor reaction coordination. Objectives: To investigate domestic, industrial and driving outcomes in ADHD adults at baseline and under methylphenidate treatment for a period of one year. We hypothesized that patients under treatment with methylphenidate will show a lower rate of accidents compared to non-treated subjects. Methods: We performed an observational 1-year follow-up study. Subjects were 60 ADHD adults (49 males and 11 females), aged between 18 and 45 years, who were diagnosed at baseline
P.8.a. Other topics (clinical)
extent generalized anxiety disorder (2%). Reduced motivation was significantly higher in depressive disorders, there was a positive correlation between the degree of severity of depressive disorders with reduced motivation and mental fatigue, while there was a negative correlation between the severity of depressive disorders with general fatigue, physical fatigue and reduced activity. Conclusion: Fatigue is a presentation not uncommonly pointing to an underlying psychiatric condition. Sometimes psychiatric complaints cannot be expressed verbally by the patient although suffering from psychiatric symptoms, commonly those of depressive disorders. References [1] Christodoulou, 2005. The assessment and measurement of fatigue. In fatigue as a window to the brain (edited by John Deluca), pp 19−35. Massachusetts Institutes of Technology Press. Cambridge Center. [2] Harvey et al., 2009. Harvey S, Wadsworth M., Wessley P. et al., 2009: Etiology of chronic fatigue syndrome: Testing popular hypotheses using a national birth cohort study. Psychosomatic Medicine 70:488–495. [3] Lesley M. and Arnold M.D. (2008): Understanding Fatigue in Major Depressive Disorder and Other Medical Disorders. Psychosomatics; 49:185–190.
P.8.a.017 The revolving door phenomenon: an epidemiologic characterisation at a psychiatric department of a Portuguese university hospital S. Pereira1 ° , C. Miguel1 , C. Pereira1 , H. Firmino1 . 1 Hospitals of the University of Coimbra, Psychiatry, Coimbra, Portugal Background: The deinstitutionalization with the closure of large psychiatric hospitals, led to the emergence of an important subgroup of patients with severe mental disorders, who have in common a high rate of hospital readmissions. These readmissions within a short period of time, constitute the so-called revolving door phenomenon. There is no consensus regarding the definition of this phenomenon. We consider as revolving door at least 3 admissions in a period of 2 years. Purpose: The authors of this work propose presenting the results of a retrospective study, with descriptive and quantitative approaches, whose objective was to characterize the patients considered as the revolving door subgroup. Methods: 67 patients were selected by the Department of statistics of HUC. All of these patients had at least 3 admissions in a period of 2 years (2008 and 2009) in the Psychiatric department at HUC. The data were obtained by consulting the medical files of these 67 patients. The authors evaluated several variables related to the patient (socio-demographic factors, prior psychiatric history, duration of illness, . . . ) and to the hospital admission (voluntary/ involuntary admission, duration of the hospitalization during the study, previous hospitalizations, . . . ). The group of patients who was considered as the revolving door group was compared to a control group. Statistical analysis was performed with the program SPSS using Chi 2, Student’s t, Fischer and Spearman tests. Results: The revolving door phenomenon was more frequently found in the range of 30 to 49 years (50%). Most of these patients belonged to the single/divorced Group (60%). About 33% of patients had no socio-familial support. The Group of psychosis was the group most often involved (47%) with essentially schizophrenia (25.4%). The factor most often found as the cause of these readmissions was the discontinuation of the medication (60%). Psychosocial factors were incriminated in 73% of cases. About 17% of patients were submitted to an involuntary hospitalization.
26% of patients had some form of aggressiveness at the time of the hospitalization. Female patients were more associated to bipolar disease (p = 0.001), a regular psychiatric follow-up (p = 0.05) and adherence to pharmacological therapy (p = 0.027). Male patients were more associated to drug addiction (p = 0.035), schizophrenia (p = 0.05), aggression (p = 0.035) and non-adherence to therapy (p = 0.027). The psychosis were positively related with younger ages (p = 0.001), non-adherence to pharmacological therapy (p < 0.001), aggression (p < 0.001), involuntary hospitalization (p = 0.001), anti psychotic depot (p < 0.001), greater number of previous admissions (p = 0.015). Conclusions: Male patients are more involved in the revolving door phenomenon. They are younger and are often psychotic with comorbid drug addiction. Due to the lack of insight, they discontinue more frequently pharmacological therapy leading to uncontrolled psychosis with episodes of aggression and subsequent involuntary hospitalization. Female patients are older and suffer more from mood disorders. Psychosocial factors are involved. Contrary to men, women adhere more to pharmacological therapy. Another cause of revolving door is also the lack of social support that was aggravated by the deinstitutionalization. References [1] Botha U.A. et al. 2010 The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Soc. Psychiat. Epidemiol, 45: 461–468. [2] Dias Neto D.et al. 2008 Characterization of readmissions at a Portuguese psychiatric hospital: an analysis over a 21 month period. Eur. J. Psychiatr, 22(2): 69−76. [3] Oyffe I. et al. 2009 Revolving door patients in a public Psychiatric hospital in Israel: cross sectional study. Croat. Med. J., 50: 575–582.
P.8.a.018 Impact of methylphenidate treatment on the rate of accidents in adults with Attention Deficit Hyperactivity Disorder (ADHD) M. Marin1 ° , G. Ponce1 , I. Martinez1 , G. Rubio1 . de Octubre, Dept. of Psychiatry, Madrid, Spain
1 Hospital
12
Background: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder clinically characterized by impaired attention and impulse control, hyperactive behavior, inner restlessness and emotional dysregulation, that often continuous to manifest symptoms into adulthood. The prevalence rate of adults who meet the full criteria for ADHD is estimated to range from 1% to 4%. Moreover, in 40% to 60% of the affected children symptoms persist in adulthood. Longitudinal follow-up studies have extensively documented impairment in academic, occupational, social and emotional domains of functioning in adults with ADHD. In addition, recent studies have found an association between adults with ADHD and domestic, industrial and traffic accidents. Moreover, some studies report an improvement of driving abilities under methylphenidate treatment. This is due to methylphenidate’s action over sustained attention, visual orientation and visual-motor reaction coordination. Objectives: To investigate domestic, industrial and driving outcomes in ADHD adults at baseline and under methylphenidate treatment for a period of one year. We hypothesized that patients under treatment with methylphenidate will show a lower rate of accidents compared to non-treated subjects. Methods: We performed an observational 1-year follow-up study. Subjects were 60 ADHD adults (49 males and 11 females), aged between 18 and 45 years, who were diagnosed at baseline