Askipios 2006 - Home-based Psychiatric Treatment: 2000-2005

HOME-BASED PSYCHIATRIC TREATMENT: 2000-2005

Ferentinos P, Zeikou E, Milonaki T, Kalabogia K, Fitsiou P, Tsitsopoulou M, Sakellaropoulos P 
Mental Health Institute for Children and Adults, Athens, Greece

Introduction

Home-based psychiatric treatment (HBPT), as applied by the Mental Health Institute for Children and Adults (MHICA), dates back to the 1970s. It was introduced by Professor P.Sakellaropoulos.

HBPT’s basic principle is that treatment is better provided in patients’ home, when possible.

Goals

  • HBPT’s main goal is to avoid hospitalization, which often brings about regression, self-depreciation, stigmatization, family’s guilt and induces patients’ persecutory fantasies. Compliance, responsibility and active participation in therapy are, thus, facilitated.
  • In parallel, the patient’s family is involved through consultation sessions. The patient and his family are dealt with as a whole even though the symptoms are not the same.
  • Another main goal of HBPT is continuity in psychiatric care after the crisis intervention. When the acute phase is over, therapy is encouraged to continue in an integrated medical and psychosocial treatment program in MHCIA.
  • Therefore, HBPT is not an isolated activity but it is incorporated in a treatment network, which combines medical and psychosocial therapies (drug therapy, psychotherapy, family therapy, Day Center services), in an attempt to respond continuously and cohesively to psychotic patients’ various needs.

Therapeutic team

The therapeutic team consists of mental health professionals of different specialties (psychiatrists, psychologists, nurses, social workers).

Eligible patients

HBPT is indicated for:

  • acute psychiatric patients
  • patients returning home after a long or short term hospitalization
  • outpatients, who have never been hospitalized (Mobile Units of Fokida and Evros)
  • stabilized patients with mobility problems

There can be combinations and modifications of technique according to psychopathology, family support, and risk issues.

Objective

This study presents findings regarding:

  • Patients considered eligible for HBPT (Intakes) between 2000 and 2005
  • Patients actually treated with HBPT between 2000 and 2005

Demographic Characteristics

  • 71 patients
  • 42 females (59.2%), 29 males (40.8%)
  • age 41.5 (±19.6) years


Marital Status
N %
Single 54 76,1
 Married 8 11,3
Widowed 5 7,0
Divorced 2 2,8
Separated 2 2,8
Total 71 100,0
Lives With
N %
Family 58 81,7
Relatives 2 2,8
Alone 11 15,5
Total 71 100,0

 

Education
N %
Primary School (6 Y) 7 9,9
Secondary School (9 Y) 11 15,5
Likeio (12 Y) 19 26,8
University (16-18 Y) 26 36,6
Technical University (15 Y) 2 2,8
Postgraduate Education (16+ Y) 4 5,6
Illiterate 1 1,4
Special Education 1 1,4
Total 71 100,0
Profession
N %
Businessman 4 5,6
Public Servant 10 14,1
Private Sector Employee 4 5,6
Unspecialised Worker 1 1,4
Retired 9 12,7
Student 8 11,3
Housewife 5 7,0
Unemployed 29 40,8
Total 70 98,6
Missing 1 1,4
Total 71 100,0
Occupational Status
N %
Full-Time 12 16,9
Part-Time 5 7,0
None 21 29,6
None Due To Psychiatric Disorder 33 46,5
Total 71 100,0

 

Living Area

Frequency Percent
Athina 14 19,7
Kallithea 6 8,5
Faliro 5 7,0
N.Irakleio    4 5,6
N.Smirni 4 5,6
Ag.Dimitrios 3 4,2
Glifada 3 4,2
Halandri 3 4,2
Kaisariani  3 4,2
Piraias 3 4,2
Zografou 3 4,2
Filothei 2 2,8
Menidi 2 2,8
Moshato 2 2,8
Argiroupoli 1 1,4
Dionisos 1 1,4
Drosia 1 1,4
Aigaleo 1 1,4
Elliniko 1 1,4
Koridallos   1 1,4
Nikaia 1 1,4
N.Psihiko    1 1,4
Perama 1 1,4
Peristeri 1 1,4
Tavros 1 1,4
Voula 1 1,4
Vrillisia 1 1,4
Xanthi 1 1,4
Total 71 100,0

clip image002

 

HBPT intakes per year (2000-2005)

  N %
2000 9 12,7
2001 24 33,8
2002 12 16,9
2003 9 12,7
2004 7 9,9
2005 10 14,1
Total 71 100,0

clip image004

 

HBPT intakes per month (2000-2005)

Intakes per month
N %
January 7 9,9
February 5 7,0
March 8 11,3
April 8 11,3
May 7 9,9
June 7 9,9
July 7 9,9
September 4 5,6
October 5 7,0
November 7 9,9
December 6 8,5
Total 71 100,0

clip image006

 

Diagnosis

Diagnosis N %
Psychotic disorder 43 60,6
Affective disorder 14 19,7
Personality disorder 9 12,7
Anxiety disorder 2 2,8
Conduct disorder 1 1,4
Dementia 1 1,4
Mental disorder due to somatic illness 1 1,4
Total 71 100,0

clip image008

 

Clinical characteristics

  • 49 acute patients (69 %)
  • Duration of disease 7.5±9.7 years (0-38 y)
  • 18 patients (25.4%) had no former psychiatric treatment
  • 24 patients (33.8%) had no drug therapy in the past
  • 22 patients (31%) had 1-8 hospitalisations in the past
Outcome of former psychiatric treatment
N %
Improved 6 11,3
Remained stagnant 35 66,0
Deteriorated 6 11,3
Interrupted 5 9,4
Total 52 98,1
Missing 1 1,9
Total 53 100,0

 

 

B. PATIENTS ACTUALLY TREATED WITH HBPT
(2000-2005)

Demographic characteristics

  • 49 patients
  • 29 females (59.2%), 20 males(40.8%)
  • age 39.6 (±17.9) years
Marital status
N %
Single 38 77,6
Married 5 10,2
Widowed 2 4,1
Divorced 2 4,1
Separated 2 4,1
Total 49 100,0
Lives With
N %
Family 42 85,7
Relatives 1 2,0
Alone 6 12,2
Total 49 100,0
Occupational status
N %
Full-time 9 18,4
Part-time 5 10,2
None 10 20,4
None due to psychiatric disorder 25 51,0
Total 49 100,0

 

Diagnosis

Diagnosis
N %
psychotic disorder 28 57,1
affective disorder 11 22,4
personality disorder 6 12,2
anxiety disorder 2 4,1
conduct disorder 1 2,0
mental disorder due to somatic illness 1 2,0
Total 49 100,0

clip image010

 

Clinical characteristics

  • 32 acute patients (65.3%)
  • Duration of disease 7.6±9.8 years
  • 11 patients (22.4%) had no former psychiatric treatment
  • 16 patients (32.7%) had no drug therapy in the past
  • 14 patients (28.6%) had 1-3 hospitalisations in the past
Outcome of former psychiatric treatment
N %
improved 6 12,2
remained stagnant 21 42,9
deteriorated 6 12,2
interrupted 4 8,2
Total 37 75,5
Missing 12 24,5
Total 49 100,0

 

HBPT Features

  • Drug therapy: 46 patients (93.9%)
  • Psychotherapy: 49 patients (100%)
  • Parental counseling: 15 patients (30.6%)
Number of Therapists
N %
1 8 16,3
2 26 53,1
3 15 30,6
Total 49 100,0

 

HBPT course

  • 22 patients (44.9%) finalized treatment after 19.6 (±13.8) months;
  • 19 patients (38.8%) dropped out after 2.3 (±2.4) months;
  • 7 patients (14.3%) are still on treatment.

HBPT outcome

  • In total, 71.4% of patients improved and 28.6% remained stagnant.

CONCLUSION

  • Profile of the patient presenting for HBPT:
  • female,
  • around 40 years old,
  • single,
  • living with her family,
  • well-educated,
  • unemployed,
  • currently unoccupied,
  • psychotic,
  • disease onset before 7.5 years
  • in the acute phase
  • not hospitalised in the past
  • not improved with former treatment

 

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