Treatment concepts of day hospitals for general psychiatric patients. Findings from a national survey in Germany

Symptom course in inpatient and day clinic treatment of depression: Results from the INDDEP-Study

BACKGROUND

In major depression (MDD), hospital treatment is an option in more severe cases or if outpatient treatment failed. Psychosomatic hospitals in Germany provide treatment programs with multimodal psychotherapy, either in an inpatient or a day hospital setting. In the context of health care research, this study aimed (1) to compare characteristics of patients treated in psychosomatic day hospitals and inpatient units, (2) to compare the effectiveness of both treatment modalities.

METHODS

A naturalistic design was chosen to achieve external validity. 604 consecutive patients were assessed at admission, discharge and a 3-month follow-up. Primary outcome was defined as a reduction of depressive symptomatology (QIDS-C), secondary outcomes comprise overall functioning and quality of life. For a comparison of effectiveness, inpatient and day hospital samples were matched according to known predictors of outcome.

RESULTS

The few differences found between the inpatient and day hospital sample were related to severity of depression and physical impairment. Inpatients more often got antidepressant medication. Additionally, inpatients were treated significantly longer, due to a subgroup of patients with somatic co-morbidity. There were no differences when comparing effectiveness.

LIMITATIONS

When comparing treatment effectiveness, possible bias cannot be ruled out. There was no randomization or untreated control group.

CONCLUSIONS

In patients with a more severe depression and somatic co-morbidity, inpatient treatment might be preferred as compared to day hospital treatment. However, most patients can be treated in both settings.

Understand me; believe in me; accept me as I am: perceptions of psychiatry of later life service

Context The emergence of mental health services for older people is a relatively recent development in Ireland. Therefore, it is important to determine strengths and limitations of this modern-day care service. A starting point is to enquire from those who have been in receipt of their service and/or their respective carers. Aim This study aims to identify and describe the perceptions and experiences of past service users (SUs) and their carers, while in receipt of services from an acute mental health day hospital for Psychiatry of Later Life and to explore their needs/supports.

METHODS

A qualitative, exploratory, descriptive design was employed. Purposive sampling achieved a sample of 13 SUs and six carers. Inclusion criteria set were that the SU had a diagnosis of a psychiatric disorder; had the capacity to make an informed consent and communicate verbally and the SU was discharged from the service between January and July 2011. Finally, carers of SUs in receipt of the service during this time were also included. Data were subjected to thematic, field analysis. Findings 'Person centredness' emerged as an overarching theme. Six inter-related subthemes revealing how SUs and carers viewed their care emerged from the interviews: 'therapeutic engagement'; 'preservation of self-integrity'; 'collaborative care'; 'integrated care'; 'social gains'; and 'the relationship between the expectation, subsequent engagement and the perceived outcome of care'.

CONCLUSIONS

Findings concluded that high levels of care exist within this service. Strengths lie in the development of a therapeutic relationship, preservation of self-integrity, social gains and robust elements of person-centred holistic, integrated and collaborative care Recommendations support the enhancement of a cohesive planned approach to admission, discharge/transition (integrated pathway).

Hospitalization replacement technologies in the Russian Federation

The article presents data on different forms of hospitalization replacement technologies in foreign countries and in the Russian Federation. The author describes an experience of administering medical aid according to individual profiles under the conditions of hospitalization replacement technologies.

Inpatient or day clinic treatment? Results of a multi-site-study

Objective: This naturalistic study aimed to identify criteria which are of relevance for making a decision as to whether inpatient or day hospital treatment is indicated.

Methods: In 567 patients who were consecutively admitted to 10 departments of psychosomatic medicine (day hospital or inpatient setting) in Germany, symptom severity at admission and discharge was measured (Symptom-Check-List-90-R, Global Assessment of Functioning). Before admission, clinicians rated aspects that might be important for differential indication (Rating Scale of Indication Criteria). A regression analysis was conducted to reveal relationships between outcome in each setting and possible predictors (criteria of relevance).

Results: At admission inpatients and day clinic patients already showed some differences referring to aspects clinicians used to select patients for each setting. Good outcome in day hospital patients was associated with a high motivation and higher burdens at home, whereas reduced drive and loss of interest was correlated with a less favourable course. Inpatients did less well if their symptoms were triggered by situations at home and if they showed a high potential for regression.

Conclusion: Results give first hints for criteria which are relevant for making a decision between inpatient and day hospital treatment in psychosomatic medicine.

Longitudinal assessment of psychotherapeutic day hospital treatment for elderly patients with depression

OBJECTIVE

Although previous studies suggested that psychiatric day hospital care is a valuable alternative to inpatient treatment, its effectiveness for elderly patients is disputed. Small number of cases, poor definition of the psychotherapeutic setting, and absence of systematic assessment at different time points may explain the observed discrepancies. We performed an assessment of a psychiatric day hospital treatment combining individual and group psychotherapy in a series of 122 elderly depressed outpatients.

METHODS

The Geriatric Depression Scale, Short Form Survey, as well as a Therapeutic Community Assessment Scale and Group Evaluation Scale were repeated at admission, 3, 6, 12 months and discharge. The day hospital program was based on psychotherapeutic treatment combining individual and group settings. All patients presented with major depression or a depressive episode of bipolar disease. Variables included severity of depressive symptoms, quality of life, adhesion to therapeutic community treatment and progress in groups of psychotherapy, art-therapy, and psychomotricity.

RESULTS

There was a significant reduction of depressive symptoms, and improvement in mental quality of life across all time points studied. Adhesion to therapeutic community increased from admission to discharge. This was also the case for the progress in group therapy for all three groups used, yet the evolution of this parameter at intermediate time points was highly variable. Neither demographic characteristics, nor pharmacological treatment or presence of stressful life events predicted the clinical improvement.

CONCLUSIONS

Psychotherapeutic care program in day hospitals may improve clinical status and quality of life in elderly depressed patients.

From general day hospital treatment to specialized treatment programmes

Approximately one third of day hospitals in Europe can be designated as predominantly psychotherapeutic. They address mainly patients with personality disorders (PD), but also eating disorders and chronic mood and anxiety disorders without PD. As day treatment programmes tend to become associated with mental health centers, their treatment intensity also tends to become reduced. Available data suggest that approximately 10 hours of treatment a week is sufficient. Is such treatment more effective than specialized outpatient treatment? This research question will probably set the agenda in the years to come. In response to this challenge, day treatment should become more specialized. Data from the Norwegian Network of Psychotherapeutic Day Hospitals (n = 2.205) demonstrate that the majority of day treatment patients suffer from borderline and avoidant PD. Programmes for patients with borderline PD are well developed. The authors call for programme development for patients with avoidant PD.