Hallak J E C, Crippa J A S, Vansan G, Zuardi A W
Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Braz J Med Biol Res. 2003 Sep;36(9):1233-40. doi: 10.1590/s0100-879x2003000900014. Epub 2003 Aug 19.
The aim of this study was to determine if the diagnostic profile of inpatients of a psychiatric unit in a general hospital influences the length of stay. The results of a retrospective survey comprising the first 16 years of operation of the Psychiatric Unit of the Ribeirão Preto General Hospital (PURP) showed that the progressive increase observed in the length of stay correlated with the increase in percentage of schizophrenia diagnosis, after the 8th year of hospital operation, and of affective disorders, after the 12th year. The length of hospitalization kept increasing until the 16th year, even though there was no change in the diagnostic profile of the patients admitted to the unit. In a prospective study encompassing the next six months, 61 inpatients were evaluated with the Structured Clinical Interview for DSM-III-R and the Brief Psychiatric Rating Scale (BPRS). The results showed that 82% of the inpatients fulfilled the diagnostic criteria for the schizophrenic or affective disorder spectrum at admission, with a discharge rate slower than for other diagnoses, although the length of hospitalization did not significantly differ among diagnostic categories. The results further demonstrated that in every diagnostic category more than 50% of the patients stayed in hospital for more than one week after reaching a BPRS score equal to 6, indicative of discharge. Overall, these data suggest that the increase in length of hospitalization may be due to a higher percentage of patients with a diagnosis of schizophrenia and affective disorder admitted to the PURP. In addition, patients with low symptomatic levels remained in hospital longer than they should have.
本研究的目的是确定综合医院精神科住院患者的诊断概况是否会影响住院时间。一项对里贝朗普雷图综合医院精神科（PURP）运营的前16年进行的回顾性调查结果显示，在医院运营第8年后，住院时间的逐渐增加与精神分裂症诊断百分比的增加相关，在第12年后与情感障碍诊断百分比的增加相关。尽管该科室收治患者的诊断概况没有变化，但住院时间一直增加到第16年。在一项涵盖接下来六个月的前瞻性研究中，对61名住院患者使用《精神疾病诊断与统计手册》第三版修订本的结构化临床访谈和简明精神病评定量表（BPRS）进行了评估。结果显示，82%的住院患者入院时符合精神分裂症或情感障碍谱系的诊断标准，其出院率低于其他诊断，尽管不同诊断类别之间的住院时间没有显著差异。结果还进一步表明，在每个诊断类别中，超过50%的患者在BPRS评分达到6分（表明可出院）后仍住院超过一周。总体而言，这些数据表明，住院时间的增加可能是由于PURP收治的精神分裂症和情感障碍诊断患者比例较高。此外，症状水平较低的患者住院时间比应有的时间更长。
