Chaput Yves J A, Lebel Marie-Josée
Department of Psychiatry, Douglas Hospital, McGill University, Montreal, Quebec, Canada.
BMC Psychiatry. 2007 Oct 29;7:60. doi: 10.1186/1471-244X-7-60.
Frequent users of the psychiatric emergency service (PES) place a heavy burden upon the mental health care delivery system. The aim of this study was to identify distinct temporal or geographical patterns of PES use by these patients as potential markers for their early detection.
Diagnostic profiles were obtained for patients making an intermediate (4 to 10) or a high (11 or more) number of visits to a general hospital PES in Montreal (Canada) between 1985 and 2004. Between-group comparisons were made with regards to several parameters. These included the time intervals between consecutive visits, visit clustering (single, repeating, and the time interval to the first cluster) and visits made to three other services where data was similarly acquired from 2002 to 2004.
The two multiple visit groups differed with regards to diagnostic profiles and actual time between consecutive visits (significantly shorter in patients with 11 or more visits). Patients with 11 or more visits were more likely to have a single cluster (3 or more visits/3 months) or repeating clusters (4 visits/3 months) in their patterns of use. Personality disorders were more prevalent in patients with single clusters as they were, along with schizophrenia, in those with repeating clusters. In addition, clusters were found to occur sufficiently early so as to be potentially useful as markers for early detection. Ten percent of those with 11 or more visits and 16% of those with an intermediate number of visits frequented at least one other PES. A small number of patients, primarily those with substance abuse, made over 50% of their visits to other services.
Temporal and geographical patterns of use differed significantly between the multiple visit groups. These patterns, combined with distinct diagnostic profiles, could potentially lead to the more rapid identification and treatment of specific sub-groups of multiple visit patients.
精神科急诊服务（PES）的频繁使用者给精神卫生保健服务系统带来了沉重负担。本研究的目的是确定这些患者使用PES的不同时间或地理模式，作为早期发现他们的潜在标志。
获取了1985年至2004年间在加拿大蒙特利尔一家综合医院PES就诊次数为中等（4至10次）或高（11次或更多）的患者的诊断资料。对几组参数进行了组间比较。这些参数包括连续就诊之间的时间间隔、就诊聚类情况（单次、重复以及首次聚类的时间间隔）以及在2002年至2004年间从其他三项服务获取类似数据的就诊情况。
两个多次就诊组在诊断资料和连续就诊的实际时间方面存在差异（就诊11次或更多次的患者时间间隔明显更短）。就诊11次或更多次的患者在使用模式上更有可能出现单次聚类（3次或更多次就诊/3个月）或重复聚类（4次就诊/3个月）。人格障碍在单次聚类患者中更为普遍，在重复聚类患者中，人格障碍和精神分裂症也更为普遍。此外，发现聚类出现得足够早，有可能作为早期发现的标志。就诊11次或更多次的患者中有10%，就诊次数中等的患者中有16%至少去过另一家PES。少数患者，主要是那些有药物滥用问题的患者，超过50%的就诊是在其他服务机构。
多次就诊组之间的使用时间和地理模式存在显著差异。这些模式，结合不同的诊断资料，可能会导致更快地识别和治疗多次就诊患者的特定亚组。
