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[德国精神病医院对患有多动障碍的未成年人和成年人的日间护理/住院精神科治疗:基本情况、诊断及共病情况]

[Day care/inpatient psychiatric treatment of minors and adults with hyperkinetic disorder in German psychiatric hospitals : Basic conditions, diagnoses and comorbidities].

作者信息

Büchsel Rebecca, Belz Michael, Wiltfang Jens, Wolff-Menzler Claus, Kis Bernhard

机构信息

Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, v. Siebold-Str. 5, 37075, Göttingen, Deutschland.

出版信息

Nervenarzt. 2020 May;91(5):433-438. doi: 10.1007/s00115-019-0762-y.

Abstract

BACKGROUND

Hyperkinetic disorders (HKD, ICD-10 F90.‑) have increasingly been the focus of research literature in recent years. Empirical studies analyzing the care situation in psychiatric clinics are so far primarily available for a few health insurances. This study analyzed a German sample from 2015 consisting of inpatient as well as day care psychiatric treatment cases from all statutory health insurances focusing on the care situation and differentiating between minor vs. adult patients with the main diagnosis HKD.

MATERIAL AND METHODS

The study was based on the treatment relevant indicators in psychiatry and psychosomatics (VIPP) database, which contains data according to §21 of the Hospital Remuneration Act (KHEntgG). A total of 896 treatment cases with the diagnosis of HKD from the year 2015, based on anonymized routine records from 41 psychiatric clinics, were analyzed.

RESULTS

The basic conditions for inpatient/day care psychiatric treatment significantly differed between minor vs. adult patients. Minors travelled greater distances to the treatment site, received more therapy units and stayed longer in the psychiatric clinic than adults. Significant differences were also found between the subgroups concerning the main diagnoses according to ICD-10 coding as well as comorbid mental disorders.

CONCLUSION

Due to greater distances from their residence to a psychiatric hospital for minors, extension of capacities with a focus on child and youth psychiatry seems to be a reasonable conclusion. Simultaneously, the intensity of treatment seems to be lower for adult patients, despite a greatly increased number of secondary diagnoses and thus anticipated psychological stress. Transition difficulties from child and youth psychiatry to adult psychiatry may be a possible explanation for this discrepancy.

摘要

背景

近年来,多动障碍(HKD,国际疾病分类第十版F90. - )越来越成为研究文献的焦点。迄今为止,分析精神科诊所护理情况的实证研究主要针对少数几家健康保险公司。本研究分析了2015年来自德国的一个样本,该样本包括所有法定健康保险公司的住院及日间护理精神科治疗病例,重点关注护理情况,并区分主要诊断为HKD的未成年患者与成年患者。

材料与方法

该研究基于精神病学和身心医学治疗相关指标(VIPP)数据库,该数据库包含根据《医院报酬法》(KHEntgG)第21条规定的数据。基于41家精神科诊所的匿名常规记录,对2015年共896例诊断为HKD的治疗病例进行了分析。

结果

未成年患者与成年患者在住院/日间护理精神科治疗的基本条件上存在显著差异。与成年患者相比,未成年人前往治疗地点的距离更远,接受的治疗单元更多,在精神科诊所停留的时间更长。在根据国际疾病分类第十版编码的主要诊断以及共病精神障碍方面,各亚组之间也存在显著差异。

结论

由于未成年人住所到精神病院的距离更远,因此扩大以儿童和青少年精神病学为重点的服务能力似乎是一个合理的结论。同时,尽管成年患者的二级诊断数量大幅增加,从而预期心理压力增大,但他们的治疗强度似乎较低。儿童和青少年精神病学向成人精神病学的过渡困难可能是造成这种差异的一个可能原因。

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