Diferencias en la efectividad clínica y funcional, entre trastornos psiquiátricos, de un hospital de día psiquiátrico de agudos para pacientes con enfermedad mental aguda

• Javier Vázquez-Bourgon ^[2] ; Elsa Gómez Ruiz ^[3] ; Fernando Hoyuela Zatón ^[3] ; Luis Salvador Carulla ^[1] ; Rosa Ayesa Arriola ^[2] ; Diana Tordesillas Gutiérrez ^[4] ; Benedicto Crespo Facorroa ^[2]
  1. [1] Australian National University

     Australian National University

     Australia

     
  2. [2] Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España. Facultad de Medicina, Universidad de Cantabria, Santander, España. Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Santander, España
  3. [3] Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
  4. [4] Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla-Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España. Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Santander, España. Unidad de Neuroimagen y Servicios Tecnológicos, IDIVAL, Santander, España

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• Localización: Revista de psiquiatría y salud mental, ISSN 1888-9891, ISSN-e 1989-4600, Vol. 14, Nº. 1, 2021, págs. 40-49
• Idioma: español
• DOI: 10.1016/j.rpsm.2019.04.001
• Títulos paralelos:
  • Differences between psychiatric disorders in the clinical and functional effectiveness of an acute psychiatric day hospital, for acutely ill psychiatric patients
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• Dialnet Métricas: 2 Citas
• Resumen
  • español

    Introducción El tratamiento intensivo y agudo en unidades psiquiátricas de ingreso a tiempo parcial puede representar una alternativa eficaz a los ingresos hospitalarios a tiempo completo. Sin embargo, existe evidencia que indica que estos dispositivos podrían no ser igualmente eficaces para todos los trastornos psiquiátricos.

    El objetivo primario del estudio fue explorar las diferencias entre los principales grupos de diagnóstico psiquiátrico en la efectividad de un programa de hospitalización parcial aguda, así como identificar predictores de respuesta al tratamiento.

    Material y métodos El estudio se realizó en un hospital psiquiátrico de día. La gravedad clínica se evaluó mediante las escalas BPRS, CGI y HoNOS. También se recogieron variables sociodemográficas. Los pacientes se agruparon en 4grupos diagnósticos amplios (psicosis no afectiva, bipolar, depresión, trastornos de la personalidad).

    Resultados Se seleccionó a 331 participantes, 115 de los cuales (34,7%) fueron diagnosticados de psicosis no afectiva, 97 (28,3%) de trastorno bipolar, 92 (27,8%) de trastorno afectivo y 27 (8,2%) de trastorno de personalidad. Los pacientes con trastorno bipolar mostraron una mayor mejoría BPRS (F = 5,30; p = 0,001) y CGI (F = 8,78; p < 0,001) que aquellos que presentaban psicosis o trastorno depresivo. Estancias más prolongadas en el hospital de día y una mayor gravedad inicial (BPRS) fueron factores predictores de buena respuesta. La tasa de reingreso en unidad psiquiátrica a los 30 días del alta fue del 3% y del 11,8% en los siguientes 6 meses.

    Conclusiones El cuidado intensivo en una unidad psiquiátrica de día es factible y eficaz para los pacientes con un trastorno mental agudo. Sin embargo, esta eficacia difiere entre los grupos de diagnóstico

  • English

    Introduction Intensive treatment in acute day-care psychiatric units may represent an efficient alternative to inpatient care. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder.

    The primary aim of this study was to explore differences between main psychiatric diagnostic groups, in the effectiveness of an acute partial hospitalization program. And, to identify predictors of treatment response.

    Material and methods The study was conducted at an acute psychiatric day hospital. Clinical severity was assessed using BPRS, CGI, and the HoNOS scales. Main socio-demographic variables were also recorded. Patients were clustered into 4wide diagnostic groups (i.e.: non-affective psychosis; bipolar; depressive; and personality disorders) to facilitate statistical analyses.

    Results A total of 331 participants were recruited, 115 of whom (34.7%) were diagnosed with non-affective psychosis, 97 (28.3%) with bipolar disorder, 92 (27.8%) with affective disorder, and 27 (8.2%) with personality disorder. Patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F=5.30; P=0.001) and CGI (F=8.78; P<0.001) than those suffering from psychosis or depressive disorder. Longer length of stay in the day-hospital, and greater baseline BPRS severity, were identified as predictors of good clinical response. Thirty-day readmission rate was 3%; at long-term (6 months after discharge) only 11.8% (N=39) of patients were re-admitted to a psychiatric hospitalization unit, and no differences were observed between diagnostic groups.

    Conclusions Intensive care in an acute psychiatric day hospital is feasible and effective for patients suffering from an acute mental disorder. However, this effectiveness differs between diagnostic groups

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