Journal of Psychiatry Depression & Anxiety Category: Clinical Type: Research Article
"Revolving Door" In Psychiatric Units Seems To Remain a Common Phenomenon in the 21st Century
- Eduardo Calmon De Moura1, Fernando Venturini1, Paula Andrea S Bastos1, Lourdes Conceição Martins1, Yara Dadalti Fragoso2*
- 1 Department Of Psychiatry, Postgraduate Program In Health Sciences, Universidade Metropolitana De Santos, São Paulo, Brazil
- 2 Department Of Neurology, Universidade Metropolitana De Santos, São Paulo, Brazil
*Corresponding Author:Yara Dadalti Fragoso
Department Of Neurology, Universidade Metropolitana De Santos, São Paulo, Brazil
Received Date: May 03, 2017 Accepted Date: Jun 14, 2017 Published Date: Jun 28, 2017
To assess the frequency of readmissions and the characteristics of patients undergoing two or more hospitalizations for the same psychiatric condition.
Analyses of retrospective data from medical records of patients admitted to the Intensive Mental Healthcare Unit of Santos, Brazil between January 2010 and August 2016. Psychiatric patients admitted to the unit at least three times were considered to fulfill the “revolving door” criteria.
From a total of 2579 admissions in the period of the study, 636 (24.6%) were considered to be “revolving door” cases. Patients fulfilling this “revolving door” criteria were younger (p=0.001), predominantly male (59.1%), and remained hospitalized for 4.8 days longer than other patients (p=0.01). The most frequent diagnoses for patients fulfilling the “revolving door” criteria were non-affective psychotic disorders (39.6%) and cases of use of psychoactive substances (30.3%). It was common for patients to present a combination of two or more diagnoses.
Nearly one quarter of patients admitted to a specialized healthcare unit in Santos, Brazil was cases of “revolving door”.
In the coastal region of the state of Sao Paulo, a psychosocial care center was created in the late 1980s with the aim of providing 24-hour extra-hospital care for psychiatric patients. This unit attends patients from an extensive region of the state of São Paulo, Brazil, with around two million inhabitants. Despite the noticeable improvement in psychiatric care in this region since then, many patients seem to be systematically readmitted to Hospital, in a so-called “revolving door” phenomenon . The objective of this study was to assess the frequency of readmissions and the characteristics of patients undergoing two or more hospitalizations for the same psychiatric condition.
|Mental and Behavioral Disorders||Groups|
|Total Number of Patients||“Revolving Door”|
|Organic (including symptomatic) mental disorders||47||2.9||12||1.4|
|Mental and behavioral disorders due to psychoactive substance use||432||26.4||258||30.3|
|Schizophrenia, schizotypal and delusional disorders||670||41||338||39.6|
|Mood (affective) disorders||307||18.8||113||13.3|
|Neurotic, stress-related and somatoform disorders||27||1.7||6||0.7|
|Adult personality and behavior disorders||75||4.6||39||4.6|
Diagnoses of 636 patients admitted to the Intensive Mental Healthcare Unit in Santos, Brazil between January 2010 and August 2016. The main diagnoses for admission were schizophrenia and related disorders, followed by psychoactive substance use. These were also the main reasons leading to repetitive admissions, characterizing the “Revolving Door” patient. Note that patients may present more than one diagnosis.
In China, the significant factors associated to re-hospitalization of psychiatric patients was the previous number of hospitalizations  and previous length of stay in hospital . The population of recidivist patients in the present study showed high rates of psychoactive drug usage. At least in Brazil, this seems to be a major reason for re-hospitalization .
There are few studies on the subject of personality disorders and readmissions. A recent study in the USA showed that the readmission rate was 30% when patients presented personality disorders together with substance abuse . A previous Brazilian study reported this rate to be 19% , and the present study found that 4.6% of the sample had personality disorders alone or in combination with other diagnoses.
Danish researchers consider the “revolving door” phenomenon to be a reflection of the present policy of premature discharge of patients with schizophrenia . The same authors consider that community psychiatry may not be providing adequate relapse prevention, thus leading to readmissions. Newer drugs may help to change this scenario , but it is important to remember that medication noncompliance is the most common cause of relapse among “revolving door” schizophrenia inpatients . In addition, readmission rates are not a suitable indicator of quality of care in psychiatry but may be an important aspect of planning of mental health services .
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Citation:de Moura EC, Venturini F, Bastos PAS, Martins LC, Fragoso YD (2017) “Revolving Door” In Psychiatric Units Seems To Remain a Common Phenomenon in the 21st Century. J Psychiatry Depress Anxiety 3: 008.
Copyright: © 2017 Eduardo Calmon de Moura, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.