[Analysis of psychiatric hospital cases in Hamburg 1988-1994--developmental trends, health care deficiencies and prospects].

For the first time it was possible to study psychiatric inpatient treatment over a period of 7 years in a major German city (Hamburg) using data of 77% of all psychiatric inpatient cases collected by health insurance agencies. Among the most prominent results is the fact that 4 out of 8 illnesses with the highest sum of inpatient days of all treatment cases are psychiatric cases. These are schizophrenia, neurotic disorders, affective psychoses and alcohol abuse. Schizophrenia is the diagnosis which adds up to the highest amount of inpatient days in Hamburg hospitals. Of all psychiatric diagnoses, 35% show up in somatic departments, mainly internal medicine. This is especially true for alcohol and drug abuse, neurotic and personality disorders and organic psychoses. The greatest part of these cases were hospitalised for 0 to 3 days only, which points to the importance of crisis intervention provided by somatic departments. By introducing new offers of low threshold detoxification for drug abuse in psychiatry it was possible to increase the percentage of cases treated in psychiatry departments in the years 1993/94 as compared to 1988/89. During the same period the share of cases suffering from all kinds of psychoses decreased in psychiatry whereas the percentage of cases with drug abuse, neurotic and personality disorders rose. In nonpsychiatric departments, diseases seen in the context of alcoholism as well as neuroses and functional disorders prevail among the group of mental disorders. In internal medicine 6% of all cases are related with all kinds of addiction including its respective somatic consequences and 2-3% with neurotic and psychosomatic disorders. Looking at the amount of inpatient days 11.2% are spent for treating alcohol abuse, alcohol psychoses and diseases of liver and pancreas by patients of 15 to 65 years of age. In the light of these results it is suggested to set up psychiatric liaison-services in somatic departments, especially in internal medicine, to deal with psychosomatic and neurotic disorders and of course, alcoholism. This would help to lower hospitalisation costs. The introduction of motivational approach to the treatment of alcoholism in internal medicine departments appears warranted. Such changes of approach would result in new points of emphasis also in psychiatry.