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Paul E. Garfinkel
Treatment of Eating Disorders
April J Zhu, B Timothy
Treatments for Anorexia Nervosa: A Review of Published Studies and Promising
Allan S Kaplan
Psychiatric Inpatient Care for People With a Dual Diagnosis: Patient Profiles
and Lengths of Stay
Philip Burge, Hélène Ouellette-Kuntz,
Haider Saeed, Bruce McCreary, Dana Paquette, Franklin Sim
Geriatric Psychiatrists: Why Do They Do It? A Delphi Study
Susan Lieff, Diana Clarke
of Blood Counts During Clozapine Treatment to Serum Concentrations of
Clozapine and Nor-Clozapine
L Kola Oyewumi, Zack Z Cernovsky, David J Freeman, David
Up is Hard to Do: The Heartbreak of Dichotomizing Continuous Data
David L Streiner
Resistance in Anorexia Nervosa and the Pervasiveness of Ethics in Clinical
Use in Obese Patients With Binge Eating Disorder: An Open Study
Jose C Appolinario, Leonardo F Fontenelle, Marcelo Papelbaum,
Joao R Bueno, Walmir Coutinho
Depressed Child and Adolescent. 2nd ed.
Assessment of Dangerousness: Empirical Contributions
Feeling of What Happens: Body and Emotion in the Making of Consciousness
Evolution of Psychoanalysis: Contemporary Theory and Practice
gériatrique: esquisse d'une histoire médicale par l'élaboration de son
les maladies mentales: les troubles de l'enfance et de l'adolescence
to the Editor
Who Develops Severe or Fatal Adverse Drug Reactions to Selective Serotonin
Canadian and American Psychiatrists' Attitudes Toward Dissociative Disorder
Onset of Schizophrenia Following Autocastration
World Trade Center Disaster
Thyroid Hormones, Mood, and Behaviour
Acute Psychiatric Inpatient Care for People With a Dual Diagnosis: Patient
Profiles and Lengths of Stay
Philip Burge, MSW, RSW1,
Hélène Ouellette-Kuntz, BScN, RN, MSc2,
Haider Saeed, BA, MSc3,
Bruce McCreary, MD, FRCPC4,
Dana Paquette, BA, MSc5,
Franklin Sim, MD, FRCPC6
Objective: This study describes characteristics of psychiatry
inpatients with developmental disabilities (DD) and their admissions
to psychiatry wards in 2 acute care hospitals. It also compares
differences in lengths of stay between admissions of this group
with a comparison sample of inpatient admissions without DD.
Method: A retrospective chart review was conducted on all
individuals with DD who were psychiatric inpatients at 2 Kingston,
Ontario, general hospitals, within a 4-year period (1994 to 1998).
A comparison sample of admissions of patients without DD was chosen.
Frequency tables were used to describe the inpatients with DD and
to describe the 2 samples of admissions. Nonparametric statistics
were used to compare the median length of stay between the 2 samples.
Associations between length of stay and other covariates were explored
within the sample of patient admissions with DD.
Results: The 62 individuals with DD had 101 admissions over
the study period. Suicidal ideation was the most common admission
reason (46%), and mood disorder was the most common discharge diagnosis
(29%). The median length of stay for patients with DD was 8 days,
which did not differ meaningfully from the comparison sample. Variables
that were significantly associated with length of stay among individuals
with DD included sex, referral source, and diagnosis.
Conclusions: When individuals with DD are psychiatric inpatients,
their length of stay is affected by some factors that have been
identified in previous studies not specific to DD (for example,
referral source and diagnosis). Our finding that male patients with
DD have longer lengths of stay than do female patients in the same
sample has not been reported in previous research.
- Contrary to what is commonly thought, this study did not
find that individuals with developmental disabilities (DD)
have longer admissions.
- Given the policy directions to depopulate residential
institutions for individuals with DD and to downsize provincial
psychiatric hospitals, the study results provide a baseline
to monitor policy and program decisions impacting people
with a dual diagnosis.
- Our extensive study, now under way, will shed more light
on the interplay between age, disposition, and DD as factors
relevant to length of stay for psychiatric inpatient care.
- The sample size of this preliminary study did not allow
us to explore fully several relations between DD and length
- Many potentially relevant factors associated with length
of stay could not be investigated due to the retrospective
nature of the study.
- The study was confined to 1 urban community in Ontario,
so its findings may not be generalizable to other jurisdictions.
Key Words: dual diagnosis, length of stay, admissions,
developmental disabilities, mental retardation, acute care
Soins psychiatriques actifs des patients hospitalisés
présentant un diagnostic mixte : profils des patients et
durées de séjour
The DSM-IV definition of mental retardation (MR)known as
developmental disability (DD) in Ontariospecifies the existence
of significantly subaverage intellectual functioning
(that is, an IQ of approximately 70 or lower); adaptive functioning
deficits or impairments; and onset before age 18 years (1). The
term dual diagnosis refers to individuals with DD and
an additional mental disorder. In a systematic literature review,
Yu and Atkinson concluded that 38% of people with DD also had another
mental disorder (2), which is twice as high as the 1-year prevalence
of mental disorders in the general Ontario population (19%) (3).
The prevalence of additional mental disorders among individuals
with DD living in regional institutions has been found to be roughly
60% (4,5). Further, studies have confirmed a high use of psychiatric
services among former residents of institutions (68). Due
to government policy dictating the downsizing and closure of these
institutions, the demand for community-based mental health services
for this high-needs population will increase.
General hospitals will increasingly be expected to provide acute
inpatient mental health care for individuals with a dual diagnosis
living in the community. Mental health and developmental service
planners have recognized hospital-based acute psychiatric care as
a key component of a communitys system of mental health supports
(9,10). Little is known, however, about the experience of patients
with DD in acute inpatient psychiatric units.
The only Canadian investigation of hospital psychiatric service
provision to individuals with a dual diagnosis published to date
was done over 15 years ago.
Addington, Addington, and Ens conducted a retrospective chart
review of all patients with a dual diagnosis admitted to 2 Calgary
general hospitals over a 2-year period (11). They gathered information
on several descriptive variables and compared the mean length of
stay of this sample (24.3 days) with that of patients without DD.
Results revealed similar profiles of admissions for the 2 groups
and showed no significant difference in average length of stay between
To begin to understand drivers of length of stay for psychiatric
care, a literature review from the general psychiatric population
was conducted. The review showed that the following variables are
associated with longer admissions: increased age (1217), planned
vs emergency admissions (13), discharge to a long-term care facility
(18), and the presence of schizophrenia or the presence of a mood
disorder (13,16,1921). Conversely, the following factors tend
to be associated with a decreased length of stay: discharge home
or to another inpatient facility (18,22) and the presence of a neurotic
disorder or the presence of a substance-related disorder (16,19,23).
Sex is often determined to be an insignificant predictor of length
of stay; only 1 study reviewed concluded that female patients stay
in hospital longer (13). These variables have not been extensively
studied among individuals with DD.
The current studys purpose was to develop a profile of individuals
with DD who were admitted to general hospitals for acute psychiatric
care. In addition, their admissions were compared with a sample
of patient admissions without DD. An analysis of factors associated
with length of stay for subjects with DD was also performed. We
can use this information to inform policy and program development
related to service delivery to this population.