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Biomedical subjects

J Heinik

Publications and source records attributed to J Heinik.

At least 37 records · Page 2Linked to original sources
PubMed1997

Length of hospitalization and disposition of elderly vs younger delirium patients in psychiatric hospitals.

Although it is commonly accepted that delirium patients require the full facilities of general hospitals, practical experience has shown that delirium patients of all ages continue to be admitted to psychiatric institutions. The present study was designed to detect any differences in the length of hospitalization and disposition (discharge back to the community, transfer to a general hospital, death during the index hospitalization, transfer to another psychiatric hospital) between elderly (> 65 years) and younger delirium patients admitted to psychiatric hospitalization. Our hypothesis was that the prognosis (represented in this study by the above-mentioned measures) of elderly delirium patients in a psychiatric hospital would be poorer compared with younger delirium patients. We studied psychiatric case register data of 805 patients with delirium admitted to psychiatric hospitals during the period 1984-1993. Our sample was divided into four ICD-9-CM categories: delirium in dementia, delirium tremens (DT), drug-induced delirium, and acute and subacute delirium. No significant differences in the length of hospitalization were found between < 65- and > 65-year-old patients in the categories studied. There were disposal differences between the two age groups in the acute and subacute delirium parameters, but findings in the other categories were similar. Practical implementation of the results in terms of appropriate place of management of delirium patients in a psychiatric hospital is discussed.

Adult↗
PubMed1996

[Discharge of elderly schizophrenics after prolonged hospitalization].

Discharge of patients from psychiatric institutions has received great attention in recent decades from both the research and clinical points of view. This study identifies and characterizes long-stay, elderly, schizophrenic patients considered candidates for discharge. Of 62 patients aged 60 years and over, residing in open wards of a large public psychiatric hospital for more than a year, 31 fulfilled DSM-3R criteria for schizophrenia. They constituted a "young-old" population, in prolonged, continuous psychiatric hospitalization, who became ill early in life. Their educational and occupational achievements were relatively limited. A mild degree of psychopathology was found, with more negative than positive symptoms of schizophrenia. Their psychiatric symptoms necessitated constant treatment with neuroleptics at moderate to high dosage. Scores on cognitive tests were lower than those of normal age-matched individuals, and indicated a diffuse, cognitive deficit. They fulfilled current criteria for being independent (no need for help in activities of daily living) or "fail" (some help needed). In most there was impaired social and occupational functioning. Suitability for referral to suggested alternatives to psychiatric hospitalization in the community or in the geriatric system is discussed.

Activities of Daily Living↗
PubMed1996

[Psychiatric hospitalization for delirium in Israel].

Despite growing recognition that patients in delirium merit the full facilities of general hospitals, they still continue to be admitted to psychiatric hospitals. The Israel national psychiatric case register data of psychiatric in-patients with delirium was examined. During 1984-1993, 805 patients with a diagnosis of delirium were admitted to psychiatric hospitals, constituting 0.86% of total psychiatric admissions. 4 major categories were identified: dementia with delirium (33.4%) delirium tremens (DT; 26.9%), drug-induced delirium (10.0%) and acute and, subacute delirium (29.5%). About half were under 65 years of age. Clinical variables associated with emergency psychiatric hospitalization were not found in most cases. Average in-patient stay for dementia with delirium was longer than the national average for active psychiatric hospitalization. A significant proportion of patients in all categories were hospitalized longer than a month. In dementia with delirium, there were both high rates of death (18.1%) and of referrals to general hospitals (20.8%). The referral rate of cases of acute and subacute delirium to general hospitals was also high (16.2%). These outcome variables were much lower in DT and drug-induced delirium. The issue of "justification" of psychiatric hospitalization of cases of delirium is discussed. More accurate screening is suggested, as well as wider collaboration with other facilities responsible for the management of delirious patients.

Acute Disease↗
PubMed1996

[Enforced psychiatric hospitalization for dementia by the district psychiatrist].

Dementia syndromes in the elderly are characterized by progressive deterioration and clinical and functional heterogeneity. At times a psychiatric picture prevails, and at other times, somatic as well as cognitive aspects. Accordingly, management is conducted in separate facilities, psychiatric or geriatric, which are not closely connected. The Israel Mental Health Act practically permits psychiatric commitment of every case of dementia at a certain stage of the illness. We describe a 75-year-old woman with dementia who was committed to a psychiatric hospital by order of the district psychiatrist. After attenuation of psychiatric symptoms, she remained in hospital unnecessarily. Further deterioration in physical, as well as cognitive condition, required transfer to a nonpsychiatric facility. However, due to difficulties in transfer from psychiatric to geriatric facilities, this was not accomplished. We therefor suggest broadening the authority of the district psychiatrist to include transfer of patients with dementia to appropriate, nonpsychiatric, long-term treatment facilities on termination of psychiatric treatment.

Aged↗
PubMed1995

[Disturbed elderly patients in psychiatric hospitals].

There are few active psychogeriatric units in Israel. We studied several demographic characteristics, source of referral, psychiatric diagnosis, physical characteristics, length of hospital stay, and discharge referral in 214 disturbed patients over the age of 65. They were admitted for psychiatric hospitalization during 1993 and were relatively well physically, their diagnoses were heterogenous, and length of hospital stay was slightly less than the national average. Most were admitted from and discharged back to the community. These data should dissipate prevailing fears and prejudices regarding admission of elderly patients to psychiatric hospitals. More active psychogeriatric units are needed for the specific needs of this population.

Aged↗
PubMed1995

Diagnosis of dementia by different specialties.

The present study was undertaken to describe, explore and compare the specific methods and services provided by physicians of different specialties (general practitioners, geriatricians, neurologists, psychiatrists and geriatric psychiatrists) in the evaluation process of patients with suspected dementia in Israel. A self-administered questionnaire--mailed to 203 physicians (response rate 37%)--included items covering medical and specialty training, numbers of patients examined, evaluation approaches, use of formal diagnostic criteria, use of mini-mental tests, use of dementia severity rating scales, use of psychiatric and behavioral rating scales, and the use of laboratory examinations. Results indicate that the majority of physicians in all specialties either provided history taking, physical and neurological examination, or referred for it elsewhere. Deficiencies were noted regarding the use of psychiatric examination by the nonpsychiatric specialties, and provision of ADL evaluation by all specialties (except geriatricians). All specialties made a minimal use of neuropsychological tests. DSM-3/DSM-3R criteria for dementia were widely used by all specialties (except general practitioners). MMSE was the most widely used brief cognitive screening test. However, only a minority of general practitioners and psychiatrists made use of it. Laboratory tests in dementia evaluation were widely used by most physicians, irrespective of specialty. Further research is needed in order to define in more specific terms the advantages contributed by each specialty separately and in collaboration to the diagnostic process of dementia.

Activities of Daily Living↗
PubMed1995

Psychiatric hospitalization of senile and arteriosclerotic dementia patients by commitment order under the 1991 Israeli Mental Health Act.

Data regarding commitment orders issued by district psychiatrists for elderly patients aged 65 years or older were obtained from the national psychiatric case register. Out of a total of 2,284 commitment orders issued in Israel in the period 1 January 1992 to 30 June 1993 under the 1991 Mental Health Act, 191 (8.3%) involved patients aged 65 and over; these orders were issued for the commitment of 169 patients who suffered from the following ICD-9-CM diagnoses on discharge: senile and arteriosclerotic dementia; transient organic psychotic conditions; schizophrenic disorders; affective psychoses; paranoid states; or other psychiatric disorders. Demographic and clinical characteristics of the senile and arteriosclerotic dementia patients were compared with the same variables in the other diagnostic categories. Results showed that (a) involuntary commitment of senile and arteriosclerotic dementia patients involved a small minority of dementia sufferers; (b) it was usually the patients' first psychiatric admission; (c) most of the patients were discharged within a one-month period; and (d) most of the patients were referred for continuation of treatment in non-psychiatric institutions. Findings (c) and (d) characterized other diagnostic categories as well. The relevance of these findings to the Mental Health Act is discussed.

Aftercare↗
PubMed1993

Psychiatric hospitalization of dementia patients by commitment order in Israel.

Commitment order by a district psychiatrist is one of several modes of involuntary admission into a psychiatric hospital. Data regarding all the commitment orders by district psychiatrists in 1990 for elderly patients age 65 years or more were obtained from the national psychiatric case register. Demographic and clinical characteristics of patients diagnosed as ICD-9 senile organic psychotic conditions have been compared with the same characteristics of patients suffering from ICD-9 affective psychoses, schizophrenic disorders, paranoid states and transient organic psychotic conditions. The conclusions are: (a) Dementia patients are underrepresented in this sample of commitment orders; (b) from a demographic point of view dementia patients are no different from other psychiatric patients, age being the sole exception; and (c) from a clinical point of view dementia patients differ from other committed psychiatric patients in three ways: (i) their commitment is usually their first hospitalization; (ii) they are discharged from hospital within a two-month period; and (iii) they are referred for continuation of treatment in a non-psychiatric system. We conclude that psychiatric admissions under commitment order constitute a temporary solution for a very small group of dementia patients.

Aged↗