Sudden death in psychiatric patients

1998 ◽  
Vol 172 (4) ◽  
pp. 331-336 ◽  
Author(s):  
David Ruschena ◽  
Paul E. Mullen ◽  
Philip Burgess ◽  
Stephen Cordner ◽  
Justin Barry-Walsh ◽  
...  
Keyword(s):  
Sudden Death ◽  
Affective Disorders ◽  
Suicide Risk ◽  
Excess Mortality ◽  
Substance Misuse ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Community Based ◽  
Case Register ◽  
Community Based Services

BackgroundThe present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner.MethodsA matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both inpatient and community-based services.ResultsSudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders.ConclusionsThe rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

scholarly journals Organization of Community Psychiatric Services in Finland

10.17816/cp64 ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 55-64
Author(s):  
Jyrki Korkeila
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Economic Recession ◽  
Psychiatric Services ◽  
Severe Mental Disorders ◽  
Community Based ◽  
Institutional Settings ◽  
Primary Organization ◽  
Methods Of Treatment ◽  
Rapid Transformation

Background. The Finnish psychiatric treatment system has undergone a rapid transformation from operating in institutional settings to a adopting a community-based approach, through implementation of national plans; this process was carried out quickly, due to a severe economic recession in the early 1990s. Methods. This paper is a narrative review, based on relevant documents by national authorities, academic dissertations and published scientific literature, between 1984 and 2018, as well as the interviews of key experts in 2019. Results. The municipality is currently the primary organization, responsible for all health services. Municipalities may also work together in organizing the services, either through unions of municipalities or hospital districts. Services are to a great extent outpatient-oriented. The number of beds is one fifth of the previous number, around four decades ago, despite the increase in population. In 2017, 191,895 patients in total (4% of Finns) had used outpatient psychiatric services, and the number of visits totalled 2.25 million. Psychotherapy is mainly carried out in the private sector by licensed psychotherapists. Homelessness in relation to discharged psychiatric patients has not been in evidence in Finland and deinstitutionalization has not caused an increase in the mortality rate among individuals with severe mental disorders. Conclusion. Psychiatric patients have, in general, benefitted greatly from the shift from institutions to the community. This does not preclude the fact that there are also shortcomings. The development of community care has, to date, focused too heavily on resource allocation, at the expense of strategic planning, and too little on methods of treatment.

Mortality Among Patients with Psychiatric Illness a Ten-Year Case Register Study in an Area with a Community-based System of Care

1995 ◽  
Vol 166 (6) ◽  
pp. 783-788 ◽  
Author(s):  
Francesco Amaddeo ◽  
Giulia Bisoffi ◽  
Paola Bonizzato ◽  
Rocco Micciolo ◽  
Michele Tansella
Keyword(s):  
Poisson Regression ◽  
Psychiatric Patients ◽  
Age Groups ◽  
System Of Care ◽  
Register Study ◽  
First Year ◽  
Community Based ◽  
Pattern Of Care ◽  
Case Register ◽  
Specialist Services

BackgroundMost studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples.MethodThis was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982–1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated.ResultsThe overall SMR was 1.63 (95% CI = 1.5–1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% CI = 1.9–2.6), among patients who were admitted to hospital (SMR = 2.23; 95% CI = 1.9–2.6), among younger age groups (SMR = 8.82; 95% CI = 4.9–14.6) and in the first year after registration (SMR = 2.32; 95% CI = 1.8–2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% CI = 3.0–4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role.ConclusionsThe overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration.

scholarly journals Urban Mental Health Initiative: Developing Interdisciplinary Collaboration, the Role of the Family Physician in Management of Severe Mentally Ill Patients

2021 ◽  
Vol 27 (1) ◽  
pp. 104-119
Author(s):  
Seyed Kazem Malakouti ◽  
◽  
Amirabbas Keshavarz Akhlaghi ◽  
Fatemeh Shirzad ◽  
Vahid Rashedi ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Family Physician ◽  
Urban Areas ◽  
Psychiatric Patients ◽  
Community Based ◽  
Urban Mental Health ◽  
The Family ◽  
Community Based Services

Introduction: Mental health in Iran was approved in 1988. However, and then this program was integrated into the primary care system in our country and was implemented within the villagers' family physician program with great success. In urban areas, there is no structured health network. However, regarding the demographic changes in the country's population, huge sprawling of cities, and the changes in urban-rural population proportion, demands for a coherent plan to provide mental health services to the urban population are felt more than ever. This study aimed to investigate the feasibility and establishment of a model of urban mental health network for severe psychiatric patients. Methods: This plan is based on resource reviews, Use the experiences of other countries, Model World Health Organization, The services available in the country currently run by the beneficiary organizations, Description of the responsibilities of the responsible organizations, Collaboration between the Ministry of Health and various organizations responsible for mental health, Having the views of national expert and international constant in this field from other countries cooperated with the aim of examining how to compile a coherent and integrated urban health service plan. This model is estimated by community-based services for 100,000 people. Results: The proposed model for providing immediate psychiatric services with greater cohesion and increasing training and skills capacity among staff 110, 115, 1480, and 123 services, as well as a space for hospitalization of 3 to 5 emergency patients next to the public hospital, is recommended. Depending on the number of patients in a population of 100,000, we will need community-based services, including 2 to 3 home visit teams to cover 80 patients per team, and 3 daily centers to provide services to 40 patients. If community-based services are provided, we will need 12 acute psychiatric beds and 5 beds for mid-term rehabilitation to provide inpatient services. In terms of employment and accommodation, 50 patients will need supported employment, respectively, and two apartments with an area of about 60 meters will be needed to accommodate about eight people. The provision of the above services requires the equal participation of the interested organizations. The family physician will play an essential role in continuing medical care for severe and mild psychiatric patients under the constant supervision of specialists Discussion and Conclusion: To achieve a better model of mental health services in cities that can cover a wide range of people in urban areas and at various levels from prevention and care to treatment and rehabilitation, we need the coordination between the organizations providing these services for the accurate planning of the interests of each organization, elimination of duplicate services, and saving human capital and resources of the country.

Cancer mortality among psychiatric patients treated in a community-based system of care: a 25-year case register study

2013 ◽  
Vol 49 (5) ◽  
pp. 693-701 ◽  
Author(s):  
Giovanni Perini ◽  
Laura Grigoletti ◽  
Batul Hanife ◽  
Annibale Biggeri ◽  
Michele Tansella ◽  
...  
Keyword(s):  
Cancer Mortality ◽  
Psychiatric Patients ◽  
System Of Care ◽  
Register Study ◽  
Community Based ◽  
Case Register

Case register study of suicide risk in mental disorders

1999 ◽  
Vol 175 (4) ◽  
pp. 322-326 ◽  
Author(s):  
David Baxter ◽  
Louis Appleby
Keyword(s):  
High Risk ◽  
Personality Disorder ◽  
Mental Disorders ◽  
Suicide Risk ◽  
Large Scale ◽  
Psychiatric Patients ◽  
Young Patients ◽  
Initial Contact ◽  
Case Register

BackgroundThere have been few large-scale studies of long-term suicide risk in mental disorders in the UK.AimsTo estimate the long-term risk of suicide in psychiatric patients.MethodA sample of 7921 individuals was identified from the Salford Psychiatric Case Register. Mortality by suicide or undetermined external cause during a follow-up period of up to 18 years was determined using the NHS Central Register; suicide risks were estimated as rate ratios.ResultsSuicide risk was increased more than ten-fold in both genders: the rate ratio for males was 11.4; for females it was 13.7. The risk was highest in young patients, but high risk continued into late life. The diagnoses with the highest risk were schizophrenia, affective disorders, personality disorder and (in males) substance dependence. Risk was also associated with recent initial contact and number of admissions but not comorbidity.ConclusionsThe suicide risks estimated in this study are generally higher than those previously reported, notably in schizophrenia and personality disorder, and in previous in-patients. Patients with these high-risk diagnoses, an onset of illness within the previous 1–3 years, or more than one previous admission should be regarded as priority groups for suicide prevention by mental health services.

scholarly journals Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

2009 ◽  
Vol 39 (11) ◽  
pp. 1875-1884 ◽  
Author(s):  
L. Grigoletti ◽  
G. Perini ◽  
A. Rossi ◽  
A. Biggeri ◽  
C. Barbui ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
General Population ◽  
Mental Health Problems ◽  
Systems Of Care ◽  
Psychiatric Patients ◽  
Psychiatric Hospitals ◽  
Community Based ◽  
Case Register ◽  
Associated Risk Factors

BackgroundMost mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.MethodAll subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.ResultsThe overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6–1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4–2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5–328.6) and personality disorders (20.87, 95% CI 5.2–83.4).ConclusionsThis study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.

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