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Tijdschrift voor Psychiatrie 63 (2021) 9, 614 - 622


Treatment effect of an urban acute psychiatric clinic: a prospective cohort study

K.J. Nusselder, U. Nabitz, M. Jalink, J. Peen

Background A clinical admission is a frightening event, especially in a crisis situation, and above all when it comes with legal measures. The effectiveness of an acute crisis admission has been demonstrated in a Cochrane review, but cohort studies of a clinic setting are not yet available.
Aim To assess and determine the treatment effects after a crisis admission in a metropolitan acute psychiatric clinic of patients with severe mental illness (SMI patients).
Method In the context of routine outcome monitoring, the 12 HoNOS scores at admission and discharge (pre- and post-measurements) were rated by clinicians. The data of 1423 patients were analyzed by a statistician.
Results The crisis admissions have a substantial positive clinical effect: 76 percent of the patients improved, 16 percent was stable and 10 percent worsened (effect size ES = 1.2). The patients improved most in regard to psychotic problems, aggressiveness and social problems. This applies equally to patients who have been admitted voluntarily, as well as to patients with a legal measure. The admission duration of patients is two months, except for patients with compulsory treatment (seclusion, sedation, forced medication). In this case the treatment duration prolongs to three months.
Conclusion Acute short-term clinical admission is an effective part of the clinical and outpatient treatment chain for patients with severe mental illness (SMI). A substantial treatment effect is achieved by the crisis admission. These findings are an important addition to the Cochrane review.