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Objective: Bipolar disorder carries a high risk of suicide. Identification of risk factors is important. The aim of this study was to study risk factors for suicide in a large cohort of men and women with bipolar disorder., Method: A prospective cohort study using clinical data from the Swedish National Quality Register for Bipolar Affective Disorder (BipoläR). The outcome variable was suicide captured in the Cause of Death Register between 2004 and 2014. Hazard ratios (HR) were calculated using Cox proportional hazards models., Results: Of 12 850 persons (4844 men and 8006 women) with bipolar disorder, 90 (55 men and 35 women) died by suicide during the follow-up period (between 1 and 10 years). Male sex (HR 2.56), living alone (HR 2.45), previous suicide attempts (HR 4.10), comorbid psychiatric disorder (HR 2.64), recent affective episodes (HR 2.39), criminal conviction (HR 4.43), psychiatric inpatient care (HR 2.79), and involuntary commitment (HR 3.50) were significant risk factors for suicide. Several of the statistically significant risk factors for suicide in bipolar disorder differed between men and women., Conclusions: Risk factors for suicide in bipolar disorder include factors associated with suicide in general, but also diagnosis-specific factors., (© 2018 The Authors. Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.)

Objective: The Danish psychiatric system has gone through several structural changes in the last four decades. The deinstitutionalization of the mental healthcare system was implemented in Denmark in the late 1970s with the intention of increasing out-patient treatment. One of the aims in the reorganization was to treat the patient in the local environment rather than during long-term hospitalization. This study focuses on the changes in the utilization of hospital facilities., Method: Using register data from secondary healthcare treatment of patients diagnosed with schizophrenia in Denmark 1970-2012, we analysed the development in the use of hospital facilities., Results: Our major finding was a 220% increase between 1970 and 2012 in the total number of hospital admissions due to schizophrenia each year, while at the same time the number of annual schizophrenia bed days was reduced by 76%. Furthermore, the readmission rate within a year after discharge with a diagnosis of schizophrenia reached 70% in 2012 compared to 51% in 1970. Finally, the total bed occupancy continued to rise over the four decades and has exceeded 100% in several years since 1999., Conclusion: The findings indicate that the reorganization of the Danish mental healthcare system has created a problem of 'revolving door' schizophrenia patients' who since the 1970s have been increasingly hospitalized but for shorter periods. Possible explanations of the findings are premature discharge of patients with schizophrenia due to lack of beds or/and that community psychiatry has not been providing adequate relapse prevention., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To examine factors associated with the number of psychiatric admissions per in-patient suicide and the suicide rate per 100,000 in-patient years in psychiatric hospitals., Method: Random-effects meta-analysis was used to calculate pooled estimates, and meta-regression was used to examine between-sample heterogeneity., Results: Forty-four studies published between 1945 and 2013 reported a total of 7552 in-patient suicides. The pooled estimate of the number of admissions per suicide calculated using 39 studies reporting 150 independent samples was 676 (95% CI: 604-755). Recent studies tended to report higher numbers of admissions per suicide than earlier studies. The pooled estimate of suicide rates per 100,000 in-patient years calculated using 27 studies reporting 95 independent samples was 147 (95% CI: 138-156). Rates of suicide per 100,000 in-patient years tended to be higher in more recent samples, in samples from regions with a higher whole of population suicide rate, in samples from settings with a shorter average length of hospital stay and in studies using coronial records to define suicide., Conclusion: Rates of in-patient suicide in psychiatric hospitals vary remarkably and are disturbingly high. Further research might clarify the extent to which patient factors and the characteristics of in-patient facilities contribute to the unacceptable mortality in psychiatric hospitals., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To investigate the relationship between cannabis use and mental health., Method: A cross-sectional analysis in a sample of 17 698 individuals with a mean age of 22 years (SD: 4.2). Participants provided information on the amount and initial age of cannabis use and history of psychiatric hospitalizations through a web-based questionnaire. To quantify Δ(9) -tetrahydrocannabinol exposure, we operationalized cannabis use as the amount of money spent on cannabis per week over the last month. The odds ratio of having a history of psychiatric hospitalizations was the primary outcome measure., Results: We found a dose-response relationship between the amount of cannabis use and the odds for psychiatric hospitalization. Adjusted odds ratios for hospitalization increased with the amount of cannabis consumed from 1.6 (95% CI: 1.1-2.3) in incidental users to 6.2 (95% CI: 4.3-8.9) in heavy users (>€25/week). Our data suggested that concomitant drug use was an intermediate factor. Exposure to cannabis before the age of 12 years was found to carry a 4.8 (95% CI: 2.9-7.8) times increased odds for past psychiatric hospitalizations., Conclusion: We conclude that early and heavy uses of cannabis are each and independently associated with poor mental health in its users., (© 2010 John Wiley & Sons A/S.)

Objective: To describe the suicide rates of psychiatric in-patients in the canton of Zurich for the period 1992-2004, and to determine putative risk factors., Method: The data were derived from the psychiatric case register of the canton Zurich. The analyses were based on person-years calculations and standardised mortality ratios. Additional information was assessed via case records., Results: During the 13-year period the standardised mortality ratio was 48.9. The risk of suicide was particularly high in patients with personality and affective disorders. Most suicides occurred during regular leave periods, despite the fact that clinical assessment had indicated there was no suicide risk for the patient., Conclusion: The suicide risk of in-patients is distinctly higher than in the general population. A better assessment of suicide risk before regular leave periods could lead to a decrease of suicides in in-patient settings, as well as a more rigorous treatment of borderline cases, and of affective and psychotic symptoms.

Objective: To assess the effectiveness of psychiatric clinical case management., Method: Subjects with at least three admissions in the previous 2 years were randomized into a clinical case management group (CMG; n = 122) and a standard care group (SCG; n = 95). Individuals who refused or were not located were included in a third, non-randomized no-treatment group (NTG; n = 153). Parameters assessed included utilization of in-patient services and psychosocial functioning., Results: We found no difference between the CMG and the SCG in psychosocial functioning as evaluated by interviewers, and no difference between the three groups in hospitalization. In subjects' self-ratings, the CMG showed slight improvement in psychosocial functioning., Conclusion: Clinical case management did not prove itself superior to standard care in a revolving door population.

Objective: Research on the prevalence and causes of in-patient aggression has been hindered by the use of different methods for measuring aggression. Since Palmstierna and Wistedt presented the Staff Observation Aggression Scale (SOAS) in 1987, this data collection method has been used in various studies, which may make comparisons more useful., Method: Studies with SOAS aggression data were compiled using MEDLINE, the Internet, and references from SOAS papers., Results: Reviews of studies on psychometric properties suggest fair to good inter-rater reliability and validity for SOAS assessments. The number of aggressive incidents per patient per year found on acute admissions wards (n = 38) considerably varied, with a range of 0.4-33.2 incidents (mean = 9.3)., Conclusion: Although the aggression data included in the present review were obtained in highly comparable ways, substantial differences in aggression rates between wards were still found. Some countries (e.g. the Netherlands) appear to have a relatively high incidence of aggression on acute wards., (Blackwell Munksgaard 2004)

Objective: We seek to investigate socio-economic differences in psychiatric in-patient care regarding admission, treatment and outcome., Method: This study is undertaken on a comprehensive and exhaustive psychiatric case register of all psychiatric in-patient care carried out in Belgium in 1997 and 1998 (n=144 754)., Results: Lower socio-economic groups were more likely to be compulsorily admitted, to be cared for in a non-teaching or psychiatric hospital, to be admitted in a hospital with unexpectedly long average length of stay and to be admitted to a ward with a more severe case-mix. They were less likely to receive antidepressants and psychotherapies. The improvements in functioning and in symptoms were also less favourable for these groups. The lowest group had a higher risk of dying in the hospital., Conclusion: Psychiatric in-patient care is associated with moderate socio-economic differences in access, treatment and outcome. Further research is needed to clarify the causes of such disparities.

Objective: To study the association between hospitals' operating conditions and the risk of early readmission. The hypothesis was that high patient turnover might lead to a rise in the risk of readmission soon after discharge (within 30 days)., Method: A multivariate model including hospital and patient variables was tested using Cox's regression analysis, adjusting for clustering effects. The material included data from 20 hospitals, with 5,520 patients in the final model., Results: High patient turnover (annual discharges per bed) was significantly associated with an increased risk of readmission (hazard ratio (HR)= 3.37 (95% CI = 2.39-4.75)). In addition, being discharged from a ward with relatively low access to therapists increased the hazard further., Conclusion: High patient turnover at the discharging ward was found to increase the patients' hazard of early readmission. This observation supports the hypothesis of a link between the operation conditions of the hospitals and patient outcome on a short time-scale.

Objective: The purpose of this study was to describe suicides' contacts with various parts of the health-care system., Method: Data on 472 people who committed suicide in a Danish County (Funen) in the period of April 1 1991 to December 31 1995 were searched in the Danish Psychiatric Central Register, the National Patient Register, the National Health Insurance and Odense Pharmacoepidemiologic Database., Results: In total, 97.5% of the suicides were recaptured in at least one of these registers. Forty-two per cent had been hospitalized in psychiatric departments. Within the last month before death, 66% consulted a general practitioner, 13% and 7%, respectively, were discharged from a psychiatric hospital and general hospital., Conclusion: The registers used provided a comprehensive registry-based description of suicides' contacts with the health-care system. The most prominent features were the high prevalence of psychiatric morbidity and the high rate of contacts with GPs close to suicide.

Objective: To report and discuss differences between schizophrenic patients in the community and those in maximum security care., Method: Comparison of 193 community schizophrenic patients with 169 in high security care. Data included case notes, interviews and cognitive tests., Results: Compared to high security patients, community patients tended to be female and married. They had higher school achievement, higher premorbid IQ and better occupational levels, were less likely to have a family history of alcohol abuse, to have had police contact and to have attempted suicide. They had more frequent shorter psychiatric admissions and fewer current and lifetime schizophrenic symptoms. Logistic regression models discriminated the groups with considerable accuracy., Conclusion: Patients needing high security care may be recognizable when schizophrenia is first diagnosed. Progression to the State Hospital seems to result from schizophrenia together with other factors such as deprivation rather than from a worse schizophrenic process per se.

Objective: We wanted to study the prevalence and characteristics of dangerousness among female psychiatric patients., Method: A national survey was performed in Norway, covering all psychiatric in- and out-patient units., Results: There were 329 persons reported to have a psychiatric disorder and to satisfy our criteria for dangerousness, giving a total prevalence of 9.9/100000 adults. There were 54 women, giving a female prevalence of 3.1/100 000. When compared to a matched sample of the men, fewer women were out-patients or had had jail sentences. We found no sex differences with regard to frequencies of psychosis, mental retardation, personality disorders, or drug or alcohol abuse. The women had an increased frequency of suicide-related and self-injurious behaviours and previous commitment for arson., Conclusion: The prevalence of women with psychiatric disorders who are considered to be dangerous was 3.1/100 000. The dangerous men did not show higher frequencies than the women for psychopathology, drug abuse, behaviour or criminality.

We investigated the possible differences in the utilization of psychiatric hospital beds among five social security areas in Finland, and the association between the variables related to the psychiatric services and the use of hospital beds. The use of hospital beds varied quite distinctly among these areas, as did the total rate of in-patients, readmissions, and rates of in-patients with psychotic and affective disorders. The treatment practices appeared to vary as the length of stay (LOS) and the rate of committal differed regionally in a significant manner. There was a significant positive correlation between the total rate of in-patients and the rate of readmitted patients (r=0.92, P<0.001), and a significant negative correlation between the number of visits per worker in out-patient care and the rate of readmissions (r=-0.94, P<0.001).

In the present paper a sample of patients using psychiatric in-patient care only is characterized and analysed with regard to characteristics of the psychiatric services. This paper forms part of the Nordic Comparative Study on Sectorized Psychiatry, designed to investigate contact rates and use of psychiatric care by new patients in 7 catchment areas in 4 Nordic countries during a 1-year follow-up. One-year treated incidence cohorts were used. The logistic regression analysis revealed that the variable 'psychiatric service' was one of the statistically significant determinants of using only in-patient care during the follow-up. The diagnostic groups with the highest probability of using only in-patient care were dependencies and functional psychoses. The following factors were associated with a high risk of using only in-patient care: older age, being referred by another psychiatrist, having received previous psychiatric in-patient care, male sex, being retired, and not living with one's parents or a partner. Patients who used only in-patient care had fewer admissions and days in in-patient care than others during the 1-year follow-up period. Lack of 24-hour emergency services in out-patient care correlated positively with the use of only in-patient care.

This study was designed to elucidate psychiatric admission rates for native Swedes and foreign-born individuals during the period 1991-1994, when Sweden had a great influx of refugees. During the same period, and even earlier, psychiatric in-patient care had been reduced. Tests of differences between Swedes and foreign-born individuals in first psychiatric admission rates were performed using Poisson regressions, and the risk of a readmission was assessed using a proportional hazard model. Foreign-born individuals and native Swedes, both males and females, showed a similar admission pattern with regard to the number of admissions. Foreign-born males under 55 years of age and foreign-born females under 35 years of age had significantly higher admission rates than native Swedes. In total, native Swedes, both males and females, were hospitalized for a significantly longer period than the foreign-born subjects. About 43% of the patients were readmitted. The risk of a readmission was significantly increased among those with a high rate of internal migration. The high admission rates for young foreign-born individuals might be explained by a high incidence of mental illness owing to the trauma of being violently forced to migrate, acculturation difficulties, or unsatisfactory social circumstances such as high unemployment. The shorter hospitalization time could be due to undertreatment or less serious mental illness.

Controlled clinical trials in the UK have shown folate deficiency in psychiatric patients, and it has been suggested that such deficiency is most likely to occur among patients with affective disorders. Studies have led to the use of folate as an adjunct to therapy in such patients. The present paper describes a preliminary investigation into the red cell folate status of psychiatric patients in a general hospital unit compared with age- and sex-matched healthy controls, using up-to-date assays and strict entry criteria and overall improved methods on previous studies. The study showed that, although there is a trend for psychiatric patients to have lower serum folate levels than controls, there is no statistically significant difference in folate levels as measured by red cell folate, a more reliable measure of folate status, between healthy controls and psychiatric patients, and all but one of the patients had normal haematological indices.

The aim of this paper was to explore the factors necessitating psychiatric hospital care in a Finnish multi-centre study of general hospital in-patients referred for psychiatric consultation. The study group consisted of 1251 patients referred to psychiatric hospital (n = 181) and a comparison group (n = 1070) consisting of subjects who were not referred. Differences between groups were studied by univariate analysis. Logistic regression analysis was used both to assess the factors contributing to referral to psychiatric hospital and to create predictive models. The validity of the models was analysed by means of receiver operating characteristic (ROC) curves in an independent sample. Psychiatric hospital care during the previous 5 years was associated with a 3.7-fold (odds ratio) increased risk of hospitalization. A diagnosis of psychosis was associated with a 2.9-fold increased risk, and attempted suicide as a reason for consultation was associated with a 2.1-fold increased risk. Not being married doubled the risk, and the odds ratio was also high in cases of poor psychosocial functioning (as assessed by Global Assessment of Functioning (GAF) score). The predictive model differentiated reasonably well between those patients who were hospitalized and the other patients. In conclusion, this multi-centre study of factors predictive of referral to psychiatric hospital among general hospital patients revealed that the most important determinants were previous psychiatric care, diagnosis of psychosis or severe depression, attempted suicide, being unmarried, and poor psychosocial functioning as assessed by GAF score.

The purpose of this study was to identify the psychiatric and social factors associated with multiple admissions, especially for psychotic patients. Demographic and diagnostic information (based on the DSM-III-R) was collected on a computerized database for all patients admitted to the only psychiatric hospital in Geneva, Switzerland. Patients who had had at least three admissions over a period of 1 year were compared with a control group drawn from the total clinic population. In 1994, a total of 1575 patients were hospitalized, and 18% of these patients were readmitted for the third or more time. The principal diagnoses were psychotic disorders (25%), affective disorders (35%) and substance-related disorders (24%). The predictors of multiple admissions for psychotic patients were a comorbidity of substance-related disorder, longer duration of illness, female sex, younger age and poorer psychosocial adjustment during the past year. These results highlight the usefulness of a computerized psychiatric database. Indeed, early identification of the types of psychiatric patient who are likely to be readmitted is necessary to enable the planning and implementation of specific programmes of ambulatory care to prevent rehospitalization.

Two previous studies in Denmark found diverging results in analyzing trends in new cases of eating disorders in the psychiatric in- and day-patient services, although the same data source, the nationwide Danish Psychiatric Case Register, was used. The present study--also using information from the nationwide Danish Psychiatric Case Register, but correcting for several register biases--confirms a highly significant increase in new cases of eating disorders in psychiatric hospitals and wards. The increase is seen exclusively in younger females. The diverging results in the previously mentioned studies in Denmark may be ascribed to methodological issues.

A retrospective study of factors predicting readmissions and follow-up treatment was undertaken of all first-ever episodes of inpatient care (age under 65), excluding psychotic and organic mental disorders, during 1987 and 1988 in University Psychiatric Clinic in Turku City Hospital, Finland. The cohort consisted of 64 subjects, 24 men and 40 women. The study was carried out in the end of 1993, thus allowing about 5 years of follow-up. The diagnosis of personality disorder did not predict readmission. The only factor predicting readmission nearly significantly was not having a relationship. The incidence of the revolving door syndrome, defined as 4 or more admissions within 5 years, was 12.5%. Women had a greater risk of readmission, but not that of the revolving door. Patients who had psychotherapy as follow-up treatment showed a frequency of 8% for 4 or more admissions, whereas patients who had no follow-up treatment had a frequency of 21% for 4 or more readmissions. The only factor significantly predicting follow-up treatment arrangement was previous treatment contact.

The aim of this study was to explore the extent and the specific features of drop-out for patients having a first contact with an university psychiatric outpatient clinic in Italy over the course of 1 year and to determine which variables were associated with early termination of treatment. Of the 158 patients selected for this study, there was an overall 3-month drop-out rate following the first visit of 63%. Of the 59 patients who had returned once after the initial contact, 28 interrupted subsequently the treatment, although the therapist's plan included further visits. The overall drop-out rate at 3 months was thus 82%. The only 2 variables associated with drop-out rates were the patients' perception of the severity of their disorder and the psychiatric history: continuing patients were more frequently in agreement with the clinician's judgment as compared with those who dropped out and were more likely to have already been in psychiatric treatment.

Data from 7 psychiatric hospitals with defined catchment areas were analyzed; 14,195 episodes of treatment in acute psychiatry wards were recorded within 30 months. During their stay in hospital 196 patients died, 174 from natural causes and 22 by suicide, compared to the expected 32 deaths. Standardized mortality ratios (SMRs) were calculated for the different diagnostic and age groups, mortality risk being highest in organic mental disorder (SMR 7.55), followed by functional psychoses (SMR 4.55) and the "other disorders" (alcoholism, neurotic and related disorders, SMR 3.25). Roughly one half of the 196 deaths were due to cardiovascular disorders and pneumonia. In patients with nonorganic psychiatric syndromes, suicide was the most frequent cause of death (21 of 58 fatalities). With regard to the elevated mortality risk of patients with acute mental illness, a reduction of fatality rates from natural and unnatural causes should remain a major objective of hospital care in psychiatry.

This study demonstrates a simple epidemiological method to evaluate the changes in service pattern for a defined catchment area after the establishment of a hospital-based community psychiatry service in Denmark. It measures the number of patients in contact with the service on 2 census days, before the new service was introduced and 3 years later, and deals with quantitative measures of sex, age, diagnosis and type of service contact. The services for 2 other areas are used as controls. A new community psychiatry service with an office situated outside the hospital is described and is shown to be superior to both the psychiatry service from the hospital and the rest of the hospital service: the number of inpatients and day patients were reduced by 42% vs 12% and 16% respectively. The number of outpatients increased by 104% in the new service compared with 23% for the service located at the hospital. The increase in outpatient care for the service outside the hospital was mainly caused by contact with middle-aged women with personality disorders.

By means of 4 cross-sections at 5-year intervals from 1972 to 1987, information on long-stay inpatients and daypatients was extracted from the computerized, cumulative psychiatric case register in Denmark. Long-stay refers to continuous hospitalization of more than 1 year. The prevalence of long-stay patients declined from 101 per 100,000 general population in 1972 to 38 per 100 000 in 1987. As the prevalence of all diagnoses declined, regardless of age and sex, it is suggested that the major cause of the observed trends is altered political and administrative strategies, influenced by and influencing altered capabilities and methods of treatment. The trends are described in detail and their implications discussed.

While the utilization of outpatient psychiatric care increased steeply in the last few decades, the number of beds in psychiatric hospitals declined continuously in most countries. The future need for psychiatric hospital beds is influenced by changes in psychiatric morbidity, the range of services offered by mental hospitals and the availability of alternative forms of care for the chronically ill. A prospective cohort study conducted in Mannheim showed that currently, at a favourable standard of complementary service provision, one quarter of the schizophrenic patients requiring institutional care for more than one year - schizophrenics are the largest group of mental patients in need of long-term residential care - still need to be treated in mental hospitals. Beyond this threshold value the costs of alternative care exceed those of a continuous inpatient treatment, and, concurrently with them, the burden upon the people involved grows. Estimates of the future need can be made on the basis of field surveys, utilization data of a population and an analysis of long-term trends by using case register data. Provided a well-functioning system of alternative and outpatient mental health services is available, psychiatric bed ratios covering the actual needs in developed countries seem to range from 0.5 to 0.8 per 1000 population over 15 for the short-stay group and from 0.3 to 0.6 per 1000 for long-stay patients. The uncertainty inherent in the estimates requires a sufficient degree of flexibility in service planning and a continuous monitoring to make adjustments to changed conditions possible.

A cohort representing all first-time admissions to Danish psychiatric institutions during the period April 1, 1970 to March 31, 1971 was followed for 10 years in the psychiatric register. The cohort comprised 5,881 males and 6,856 females aged 15 years or above. The revolving door population was delineated as (1) patients with minimum four admissions and no admission or discharge period lasting for more than one fourth of the observation period or (2) patients with minimum four admissions during the first one fourth of the observation period. The incidence rate was 3.14 males and 3.55 females per 1,000. Revolving door patients were younger than others, single or divorced, and lived in larger cities. They were more frequently referred to out-patient aftercare and discharged to their own home. A male diagnostic profile of schizophrenia, demential or organic psychoses, personality disorders and abuse emerged together with a female profile of manic depressive and psychogenic psychosis and neurosis. Twenty-one point nine percent of males and 13.0% of females had more than 10 admissions and 4.5% of males and 3.7% of females spent more than 5 years in hospital. High risk groups were 15-24 years old as 21% and 13% of young males respectively females became revolving door patients, and schizophrenics, as 46% of male and 30% of female schizophrenics became revolving door patients.

This study examines the distribution of sex, marital status and mental disorders among new referrals to outpatient clinics from two different urban environments. Differences in the distribution of marital status among patients and inhabitants in the two urban environments were tested with the "chi-square" method for each sex separately. In proportion to the population, significantly more married, separated and divorced women were referred from satellite communities than from traditional urban areas. When DSM-III diagnoses were taken into account, there were significantly more married women with "affective and anxiety disorders" in satellite communities. Similar differences were not observed among men in satellite and traditional urban communities. Social environment seems to be a major contributor to mental disorders in women. In addition, sex role plays an important part in the development of "affective and anxiety disorders" in married women. Sex role alone does not explain the findings of this study.

All first admitted in 1972 to Danish psychiatric institutions diagnosed schizophrenics at least once until September 1983 (310 males and 277 females) are followed up. The incidence of schizophrenics diagnosed at their first admission is 7.8 males and 3.4 females/100,000 inhabitants and when those diagnosed as schizophrenics only at a later admission are included the incidence is correspondingly 15.0 and 8.7. The number of in-patient days is highest in the first year and stabilizes at a lower level in the last 7 to 8 years of the follow-up. The patients spent proportionately more days in mental hospitals than in psychiatric departments in general hospitals. Hebephrenic schizophrenics predominate in mental hospitals. Schizophrenics diagnosed during their first admission spent 19.5% of the 10-year follow-up period in institutions, while schizophrenics diagnosed during a later admission spent 17.4% (NS). Males spent 19.7% of the 10-year follow-up period in institutions, females 16.0% (P less than 0.05).

The present investigation analyses the psychiatric service available to and utilized by a population in a geogrphically delimited area, namely the Randers area with a population of 108.928. During the period 1970-74, the average yearly rate of patients admitted to the three psychiatric institutions covering this area was per 1,000: 7.9 males and 9.1 females. During 1970-71, 1.2 males and 1.8 females per 1,000 were treated as outpatients in a psychiatric clinic affiliated to a psychiatric hospital, and a psychiatric outpatient clinic in a general hospital discharged 4.1 males and 7.7 females per 1,000. It seems probable that despite outpatient treatment the number of admissions increases slightly rather than decreases, and consequently, outpatient treatment cannot replace psychiatric admission.

A nation-wide cohort of 12,737 first admitted patients aged 15 years or more to Danish psychiatric institutions was followed in the Danish Case Register for a 10-year period. Long stay patients were delineated as: 1) patients whose first admission lasted for more than 1 year (new long-stay); or 2) patients who later had an admission lasting for more than 1 year (late long-stay). Together they comprised 420 males and 527 females with an incidence rate of 0.22 males and 0.27 females per 1,000. Up to age 65 males dominated, after 65 females dominated. Thirty-three percent of demential disordered and 24 of schizophrenics became long-stay patients. A multiple contingency analysis showed that the variables "age group", "main diagnosis", "size of municipality of residence" and "marital status" were independently associated with the outcome "long-stay". The two long-stay groups differed. New long-stay patients tended to be females, older, suffering from demential disorders and with a total hospital stay shorter than that of the long-stay population. In a multiple contingency analysis the variables "age group" and "main diagnosis" were independently associated with the outcome "new long-stay" and the variables "age groups", "main diagnosis" and "size of municipality of residence" with the outcome "late long-stay".

The rates of admissions in 1976-78 to all hospitals in Western Australia, both psychiatric and non-psychiatric, of patients with a primary psychiatric diagnosis were analysed specifically for country of birth and whether they lived in Perth or in country areas. Eastern European migrants had the highest hospitalization rates, and Southern European migrants the lowest. Rates for schizophrenia were high in the Eastern Europeans, and for alcoholism low in Southern European and Asian females and high in Northern European males. The United Kingdom migrants were most like the Australian born in regards to admission rates, diagnostic composition, and in the distribution of hospitalization patterns between psychiatrists and non-psychiatrists. Women, especially Southern European, in the country areas are at special risk to be admitted for neurosis/personality disorder.

A survey of all outpatients (n = 1135) attending a regional psychiatric hospital during a 3-month period. Psychoses constituted 72% and non-psychotic disorders 25%. Psychoses had a greater proportion of long-term attenders while non-psychotic disorders, though frequent (43%) among recent attenders, showed a high attrition rate. Demographic characteristics, patterns of attendance, selected clinical features, level of functioning and difficulties of management of the different diagnostic groups are presented and discussed. Reasons are adduced to explain why patients who were deemed suitable for transfer to other care had not been discharged from hospital. Steps taken to reduce the patient load and increase the efficiency of the services are described.