Rabinowitz J, Slyuzberg M, Salamon I, Dupler S E
Bar Ilan University, Ramat Gan, Israel.
Bull Am Acad Psychiatry Law. 1995;23(4):595-606.
The goal of this study is to understand how different admission statuses of varying degrees of restrictiveness (informal, voluntary, emergency admission, and involuntary admission on medical certification) are used in the psychiatric emergency room. The study included 656 consecutively admitted patients from a psychiatric emergency room over 28 months. Data were analyzed univariately and using two discriminant function models. Only six (0.9%) patients were informal admissions. Voluntary admissions (24.9%, n = 163) tended to be for patients with affective disorders, those who were self-referred, suicidal risks, those who had a marital or family problem, and those who were over age 60. Nonvoluntary admissions (74.2%) tended to be for patients with schizophreniform symptoms and those referred by police or court. Involuntary admission on medical certification (53.2%, n = 349) tended to be for patients who were family referred, younger than 20 years old, had social interpersonal nonfamily stressors, were suicidal risks, were or had been married, had organic psychotic disorder, history of violence, and manic episode or schizophrenia. Emergency admission patients (21%, n = 138) were characterized by being between 40 to 50 years old, having a diagnosis of psychoactive substance abuse, having previous outpatient treatment, and having been referred by emergency service. The major difference between involuntary admissions and voluntary was that the former were more often actively psychotic or referred by police or court. The major difference between emergency admission and involuntary admission on medical certification seemed to be that patients with a more available support system, whose primary diagnoses was not substance abuse and who were suicidal, were preferred for involuntary admission on medical certification.
本研究的目的是了解不同限制程度的入院状态（非正式、自愿、紧急入院以及基于医学证明的非自愿入院）在精神科急诊室中的使用情况。该研究纳入了28个月内来自一家精神科急诊室的656例连续入院患者。数据进行了单变量分析，并使用了两个判别函数模型。只有6例（0.9%）患者是非正式入院。自愿入院患者（24.9%，n = 163）往往是患有情感障碍的患者、自我转诊的患者、有自杀风险的患者、有婚姻或家庭问题的患者以及60岁以上的患者。非自愿入院患者（74.2%）往往是有精神分裂症样症状的患者以及由警方或法院转诊的患者。基于医学证明的非自愿入院患者（53.2%，n = 349）往往是由家人转诊的患者、20岁以下的患者、有社会人际非家庭应激源的患者、有自杀风险的患者、已婚或曾已婚的患者、患有器质性精神障碍的患者、有暴力史的患者以及有躁狂发作或精神分裂症的患者。紧急入院患者（21%，n = 138）的特征是年龄在40至50岁之间、诊断为精神活性物质滥用、有过门诊治疗经历且由急诊服务转诊。非自愿入院和自愿入院之间的主要差异在于，前者更常为处于活跃精神病状态或由警方或法院转诊的患者。紧急入院和基于医学证明的非自愿入院之间的主要差异似乎在于，对于非物质滥用且有自杀倾向、有更完善支持系统的患者，更倾向于基于医学证明的非自愿入院。
