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Editorial
Canadian Journal of Psychiatry: New Editor and New Policies
Joel Paris, MD
(PDF)

Guest Editorial
Risk Assessment in Psychiatric Practice
Kenneth Hashman, MD, FRCPC, DABPN
(PDF)

In Review
The Canadian Contribution to Violence Risk Assessment: History and Implications for Current Psychiatric Practice
Hy Bloom, LLB, MD, Christopher Webster, PhD, Stephen Hucker, MB, Karen De Freitas, MD
(PDF)

The Clinical Use of Risk Assessment
Graham D Glancy, MB, ChB, FRCPsych, FRCPC, Gary Chaimowitz, MB, ChB, FRCPC
(PDF)

The State of Contemporary Risk Assessment Research
Michael A Norko, MD, Madelon V Baranoski, PhD
(PDF)

Review Paper
Community Treatment Orders: Profile of a Canadian Experience
Ann-Marie A O’Brien, MSW, RSW, Susan J Farrell, PhD, CPsych*
(PDF)

International Dosage Differences in Fluoxetine Clinical Trials
Scott Patten, MD, Andrea Cipriani, MD, Paolo Brambilla, MD3, Michela Nosè, MD, Corrado Barbui, MD
(PDF)

Original Research
Panic-Agoraphobic Spectrum and Light Sensitivity in a General Population Sample in Italy
Letizia Bossini, MD, Mirko Martinucci, MD, Katia Paolini, MD, Paolo Castrogiovanni, MD
(PDF)

Psychotic Disorders Clinic and First-Episode Psychosis: A Program Evaluation
Suzanne Archie, MD, FRCPC, Jane Hamilton Wilson, RN, Kevin Woodward, BSc, Heather Hobbs, RN, Shelley Osborne, RN, Jean McNiven, RN
(PDF)

Screening for Mild Cognitive Impairment: Comparing the SMMSE and the ABCS
D William Molloy, MB, MRCPI, FRCPC, Timothy IM Standish, David L Lewis, PhD
(PDF)

Attention-Deficit Hyperactivity Disorder With and Without Obsessive–Compulsive Behaviours: Clinical Characteristics, Cognitive Assessment, and Risk Factors
Paul Daniel Arnold, MD, FRCPC, Abel Ickowicz, MD, FRCPC, Shirley Chen, MD, MPH, Russell Schachar, MD, FRCPC
(PDF)

Brief Communication
Validation de la version française de l’inventaire de détresse péritraumatique
Louis Jehel, MD, PhD, Alain Brunet, PhD, Sabrina Paterniti, MD, PhD, Julien D Guelfi, MD, Pr
(PDF)

Book Reviews
(PDF)

The Confinement of the Insane: International Perspectives, 1800–1965
Review by
Laurence Jerome, MD

Suicide in Children and Adolescents
Review by
Paul S Links, MD, FRCPC

Letters to the Editor
(PDF)

A Novel Form of Treatment Resistance in Anorexia Nervosa

Capgras Syndrome in the Modern Era: Self Misidentification on an ID Picture

Effectiveness of Risperidone in Delirium

Family-Oriented Rehabilitation for Unexplained Chronic Pain

Hypokalemia from Risperidone and Quetiapine Overdose

A Renewed Interest in Day Treatment

Quetiapine Therapy for Corticosteroid-Induced Mania

Letters to the Editor

A Renewed Interest in Day Treatment

Dear Editor: Day treatment, a form of partial hospitalization, can be helpful for patients who do not require inpatient care but who may benefit from more intensive care than is possible for outpatients. It differs from other forms of partial hospitalization (that is, day hospital and day care) in that it emphasizes both treatment and rehabilitation. Treatment is concerned with alleviating symptoms and recovery from illness. Rehabilitation focuses on the patient’s adapting to a disability and facilitates adaptive functioning in the community.

Historically, day treatment programs were offered to patients who were in some degree of remission from acute psychotic illness or to patients who suffered from long-term disorders (for example, personality disorders). Day treatment was viewed as superior to outpatient care because it provides more intensive treatment and rehabilitation. It experienced considerable use from the 1950s to the late 1980s. However, day treatment declined in the 1990s owing to inadequate funding arrangements and a move toward assertive community treatments.

Recently, this trend has reversed. Contributing to the renewed growth of day treatment is the recognition that, while many currently available treatments effectively reduce symptomatology, they often have minimal impact on functional impairments. This has contributed to high rates of relapse and recurrence. Multimodal treatments that focus on reducing illness and enhancing functional capacity are believed to offer an optimal intervention approach. Day treatment is seen as satisfying this need. It offers intensive and structured clinical services within a stable therapeutic milieu that typically incorporates group psychotherapy, biological psychiatry, milieu principles, and a systems orientation.

Many of the day treatment programs that have recently evolved differ from those used in the past. The newer day treatment programs are short-term (ranging from 3 to 12 weeks), whereas historically, day treatment lasted for several months. In addition, rather than being psychodynamically based, many of the new programs are guided by the principals of cognitive-behavioural therapy; nearly all new programs incorporate some insight-oriented interventions. Finally, the application of day treatment has expanded beyond the patient populations it served in the past. It is now being used for mood disorders (1), obsessive– compulsive disorder (2), postnatal depression (3), eating disorders (4), and substance abuse disorders (5). This is not to say that the field has abandoned day treatment for patients with longer-term difficulties. Indeed, several authors have argued for longer-term day treatment for patients with personality disorders, because their response to shorter-term programs tends to be less than optimal. Considerable empirical evidence exists for the use of day treatment for personality disorders (6).

With renewed interest comes a renewed call for more empirical research on this form of treatment. There is considerable need for studies to identify the types of disorders best suited to day treatment. Demonstration of clinical effectiveness and cost-effectiveness relative to usual outpatient care is also urgently required. Hopefully, with greater empirical support of day treatment, clinicians and administrators will further recognize its unique advantages for treating many of the debilitating and recurrent illnesses encountered in most outpatient settings.

References

1. Mazza M, Barbarino E, Capitani S, Sarchiapone M, De Risio S. Day hospital treatment for mood disorders. Psychiatr Serv 2004;55:436–38.

2. Bystritsky A, Saxena S, Maidment K, Vapnik T, Tarlow G, Rosen R. Quality of life changes among patients with obsessive-compulsive disorder in a partial hospitalization program. Psychiatr Serv 1999;50:412–14.

3. Boath E, Major K, Cox J. When the cradle falls II: the cost-effectiveness of treating postnatal depression in a psychiatric day hospital compared with routine primary care. J Affect Disord 2003;74:159–66.

4. Dancyger I, Fornari V, Schneider M, Fisher M, Frank S, Goodman B, and others. Adolescents and eating disorders: an examination of a day treatment program. Eating and Weight Disorders 2003;8:242–8.

5. Schumacher JE, Milby JB, Wallace D, Simpson C, Frison S, McNamara C, and others. Diagnostic compared with abstinence outcomes of day treatment and contingency management among cocaine-dependent homeless persons. Experimental and Clinical Psychopharmacology 2003;11:146–57.

6. Ogrodniczuk JS, Piper WE. Day treatment for personality disorders: a review of research findings. Harv Rev Psychiatry 2001;9:105–17.

John S Ogrodniczuk, PhD
Vancouver, British Columbia
Paul I Steinberg, MD
Edmonton, Alberta