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Mortality Risk After Discharge From Psychiatric Care

Mortality Risk After Discharge From Psychiatric Care

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When I was the medical director of an inpatient unit years ago the average length of stay declined from 4 months to four days. Today, insurance dictates lengths of stay that often don't stabilize the psychiatric crisis and reduce risk factors. Instead, I believe the patient receives a message that even this level of care has been unsuccessful and the patient has been left with a belief that no options exist. Until pressure is applied to insurance to allow patients to reach remission in a psychiatric setting these risk factors will continue.

Brad @

Addendum:
"Manuel" is Manuel Mota-Castillo, M.D.
Chair Psychiatry and Director of Psychiatric Training
Burrell College of Osteopathic Medicine
Las Cruces, NM

Manuel @

Thank you Dr. Miller, for bringing to the forefront this important issue, which sometimes is trivialized. As indicated in your excellent article, the explanations can be multiple but there is one more that I would like to add and ask PT readers and yourself for your opinions: discharging a bipolar person on an antidepressant.
I have expressed before (in PT and other journals) my belief that antidepressants are a poison in the treatment of bipolar but I understand that respected and serious researchers still believe that given antidepressants in conjunction with mood stabilizers is fine and safe. For the past 2 years, I have been engaged solely in teaching and inpatient work and my experience with the patients that I see talks to the opposite.
Sadly, there are doctors and NPs (with no academic interest or even readers of psychiatric journals) that keep persons with a bipolar spectrum disorder on one and even two antidepressants, without a mood stabilizers. Most of the time I find those patients in the ICU, when they are consulted to psychiatry because of a suicide attempt.

Manuel @

Surprising that higher in females then in males for risk factor
As well, not surprised at addiction as contributing factor to increase risk of morbidly mortality, however I find it not probale to be related to admission vs not admitted. I would feel that apples to apples admit substance vs not admit substance we would see a dramatic reduction in morbidly mortality numbers.
Thoughts ?

Rhian @

One possibility: substance abusers who are far up the tolerance curve and are detoxed during admission are no longer physically tolerant after discharge, get out, dose themselves with their wonted dose and OD. This would be a higher risk for women who are, on average, smaller and more vulnerable to LD50 effects. Combinations of opioids and alcohol would be particularly likely to lead to such an outcome, although it's conceivable for meth as well.

Ellen @

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