II day hospital nell'esperienza della Clinica Psichiatrica Universitaria di Novara

Objective: The aim of the study was to evaluate the use of Partial Hospitalisation (PH) vs. Full Hospitalisation (FH) in an attempt to identify the demographic and clinical characteristics that are most frequently associated with this type of therapeutic provision in the University Psychiatric Ward of Maggiore delta Carità Hospital in Novara. The catchment area of the Novara Mental Health Department has about 182,000 inhabitants, of whom 56% are resident in Novara itself. The Department has one hospital psychiatric ward (under university direction) with 14 beds for Ordinary Treatment (FH) and 2 beds for Day Hospital Treatment (PH), with 1.7 members of staff per bed. Methods: We selected all the medical records relating to admissions on FH and PH to the University Psychiatric Ward of Maggiore della Carità Hospital in Novara between 1.1.2003 and 31.12.2004. These records were used to collect data regarding demographic characteristics (sex, age) of patients and also social-demographic characteristics (only for PH patients) and clinical information (diagnosis according to ICD-9-CM-system in force in the Italian National Health Service, year of hospitalisation, kind of hospitalisation, length of hospitalisation). All collected data were entered in a computer database (Excel for Microsof Office XP) for the statistical analysis. The chisquare non parametric test (software SPSS 11.0) was also used. Results: We analysed 176 cases of PH involving 134 patients (mean age 38.79 years) and 893 cases of FH (mean age 43.74 years). We made a descriptive analysis of social and demographical characteristics of DH patients, including education, marital status, occupation and household. The mean duration of FH is 10.87 days. For PH the mean duration of hospitalisation was 7.69 days (Table I). The majority of FH involved female gender (53.7%). The large majority of PH involved female gender (70.1%) (Table III). The most frequent diagnoses were: personality disorder (35.1% in PH vs. 29.7% in FH), schizophrenic psychosis (17.9% in PH vs. 29.7% in FH), affective psychosis (18.7% in PH vs. 12.1% in FH), eating disorder (13.4% in PH vs. 0.7% in FH), neurotic disorders (6.0% in PH vs. 6.6% in FH), alcohol- or drug-related disorders (4.5% in PH vs. 6.1% in FH). Organic disorders were only diagnosed in the group of FH (Table IV). Conclusions: PH patients compared with FH patients were more often female (70.1% with a p value < 0.01), young (52.5% < 40 years old with a p value < 0.01), with a diagnosis of affective psychosis (18.7% with a p value < 0.05) or eating disorder (13.4% with a p-value < 0.01). Patients involved in FH vs. patients involved in PH. Treatment were more often affected by Schizophrenic psychosis (29.7% with a p value < 0.01) or organic disorder (4.6% with a p value < 0.05). Day Hospital Service in the University Psychiatric Ward at Novara Hospital may be an effective, cheaper alternative to complete hospitalisation in a large number of cases. There is a project for the evaluation of results of FH vs. PH, involving the use of symptom severity appraisal scales on the first and last day of treatment.