Predictors of inpatient psychiatric admission in patients presenting to the emergency department: the role of dimensional assessment

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• 作者：Federico Dazzi ; M.D.^a ; ^c ; ^{f.dazzi@unimarconi.it" class="auth_mail" title="E-mail the corresponding author} ; ^{federicodazzi@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Angelo Picardi ; M.D.^b ; Luigi Orso ; M.D.^c ; Massimo Biondi ; M.D.^c
• 关键词：Dimensional assessment ; Emergency psychiatry ; Psychiatric admission ; Psychopathological dimension ; Admission predictor
• 刊名：General Hospital Psychiatry
• 出版年：2015
• 出版时间：November-December 2015
• 年：2015
• 卷：37
• 期：6
• 页码：587-594
• 全文大小：320 K

文摘

To identify which patient factors predict psychiatric hospitalization in patients presenting to the emergency department and to examine the role of the dimensional approach to psychopathology in predicting hospitalization.

Methods

We consecutively recruited 312 patients undergoing psychiatric evaluation in the emergency room of a hospital in Rome over a 6-month period. Patients were rated on the SVARAD (Scala per la Valutazione Rapida Dimensionale), a scale designed for the rapid assessment of the main psychopathological dimensions. Information about patient history, as well as sociodemographic and clinical variables, was also collected. Univariate analysis was performed to detect the variables associated with recommendation of psychiatric hospitalization. Multiple logistic regression analysis was used to identify independent predictors of hospitalization and compare their strength. A replication study was performed in another hospital on a random sample of 118 patients.

Results

In both studies, patients who were recommended for psychiatric hospitalization showed significantly higher levels of anger/aggressiveness, apathy, impulsivity, reality distortion, thought disorganization and activation. Multivariate analysis identified psychopathological dimensions (reality distortion, impulsivity, apathy), diagnosis of psychotic or mood disorders and proposal for compulsory admission as independent predictors of psychiatric hospitalization. Hierarchical regression analysis revealed that the dimensional evaluation was the strongest predictor.

Conclusions

Our findings suggest that, in emergency setting, a systematic dimensional assessment may usefully complement the categorical assessment. Future research should aim at developing an operational assessment model, including both categorical and dimensional approaches to psychopathology.