Skip to main content
SpringerLink
Log in

A Study on Recidivism in the Psychiatric Emergency Room

  • Published:
Annals of Clinical Psychiatry

Abstract

Our goal in this retrospective study was to assess empirical risk factors for repeat visits to the psychiatric emergency room. This information may be useful for targeted prevention and cost-effective service planning. Over a 7-month period, 400 (18%) of 2212 patients were repeat visitors, accounting for 36% of all visits. A diagnosis of a psychotic disorder at the first visit was a risk factor for a repeat visit, especially in young patients. Substance abuse, as suggested by positive urine toxicology, decreased the likelihood of recidivism, but positive toxicology screens in young schizophrenic patients increased the chances of a repeat visit. In a 1-month consecutive sample of 311 patients, unemployment and homelessness were stronger correlates than a clinical diagnosis of schizophrenia. These findings support previous evidence that psychiatric emergency services are often used by underprivileged patients. We suggest that a rational preventive approach to reduce recidivism in psychiatric emergency services may include substance abuse treatment and case management for young schizophrenics and community outreach projects for socially disadvantaged patients. Compliance of recidivist patients poses a difficult task for case managers and community psychiatrists. More studies are needed to assess the efficacy of these interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Ellison JM, Hughes DH, White KA: An emergency psychiatry update. Hosp Commun Psychiatry 1989; 40:250-260

    Google Scholar 

  2. Munves P, Trimboli F, North A: A study of repeat visits to a psychiatric emergency room. Hosp Commun Psychiatry 1983; 34:634-638

    Google Scholar 

  3. Surles R, McGurrin M: Increased use of psychiatric emergency services by young chronic mentally ill patients. Hosp Commun Psychiatry 1987; 38:401-405

    Google Scholar 

  4. Ellison JM, Blum NR, Barsky AJ: Frequent repeaters in a psychiatric emergency service. Hosp Commun Psychiatry 1989; 40:958-960

    Google Scholar 

  5. Hansen TE, Elliott KD: Frequent psychiatric visitors to a Veterans Affairs Medical Center emergency care unit. Hosp Commun Psychiatry 1993; 44:372-375

    Google Scholar 

  6. Spooren D, De Backquer D, Van Heeringen K, Jannes S: Repeated psychiatric referrals to Belgian emergency departments: A survival analysis of the time between first and second episodes. Eur J Emerg Med 1997; 4:61-67

    Google Scholar 

  7. Huffine CL, Craig TJ: Social factors in the utilization of an urban psychiatric emergency service. Arch Gen Psychiatry 1974; 30:249-255

    Google Scholar 

  8. Bassuk E, Winter R, Apsler R: Cross-cultural comparison of British and American psychiatric emergencies. Am J Psychiatry 1983; 140:180-184

    Google Scholar 

  9. Sullivan PF, Bulik CM, Forman SD, Mezzich JE: Characteristics of repeat users of a psychiatric emergency service. Hosp Commun Psychiatry 1993; 44:376-380

    Google Scholar 

  10. Craig TJ, Lin S, El-Defrawi M, Goodman A: Clinical correlates of readmission in a schizophrenic cohort. Psychiatr Q 1985; 57:5-10

    Google Scholar 

  11. Padgett DK, Struening EL: Influence of substance abuse and mental disorders on emergency room use by homeless adults. Hosp Commun Psychiatry 1991; 42:834-838

    Google Scholar 

  12. Haywood TW, Kravitz HM, Grossman LS, Cavanaugh JL, Davis JM, Lewis DA: Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 1995; 152:856-861

    Google Scholar 

  13. Havassy BE, Hopkin JT: Factors predicting utilization of acute psychiatric inpatient services by frequently hospitalized patients. Hosp Commun Psychiatry 1989; 40:820-823

    Google Scholar 

  14. Swigar M, Astrachan B, Levine M, Mayfield W, Radovich C: Single and repeated admissions to a mental health center: Demographic, clinical and use of service characteristics. Int J Soc Psychiatry 1991; 37:259-266

    Google Scholar 

  15. Sanguineti VR, Samuel SE, Schwartz SL, Robeson MR: Retrospective study of 2,200 involuntary psychiatric admissions and readmissions. Am J Psychiatry 1996; 153:392-396

    Google Scholar 

  16. Dhossche D, Rubinstein J: Drug detection in a suburban psychiatric emergency room. Ann Clin Psychiatry 1996; 8:59-69

    Google Scholar 

  17. Norusis MJ: SPSS. Chicago: SPSS; 1994.

    Google Scholar 

  18. Regier D, Farmer M, Rae D, et al.: Comorbidity of mental disorders with alcohol and other drug use: Results from the Epidemiologic Catchment Area (ECA) study. JAMA 1990; 264:2511-2518

    Google Scholar 

  19. Dixon L, Haas G, Weiden PJ, Sweeney J, Frances AJ: Drug abuse in schizophrenic patients: Clinical correlates and reasons for use. Am J Psychiatry 1991; 148:224-230

    Google Scholar 

  20. Cuffel BJ, Heithoff KA, Lawson W: Correlates of patterns of substance abuse among patients with schizophrenia. Hosp Commun Psychiatry 1993; 44:247-256

    Google Scholar 

  21. Kovasnay B, Bromet E, Schwartz JE, Ram R, Brandon L: Substance abuse and onset of psychotic illness. Hosp Commun Psychiatry 1993; 44:567-571

    Google Scholar 

  22. Soyka M, Albus M, Kathmann N: Prevalence of alcohol and drug abuse in schizophrenic inpatients. Eur Arch Psych Clin Neurosci 1993; 242:362-372

    Google Scholar 

  23. Linszen D, Dingeman P, Lenior M: Cannabis use and the course of recent onset schizophrenic disorders. Arch Gen Psychiatry 1994; 51:273-279

    Google Scholar 

  24. Hambrecht M, Hafner H: Substance abuse and onset of schizophrenia. Biol Psychiatry 1996; 40:1155-1163

    Google Scholar 

  25. Tsuang JW, Lohr JB: Effects of alcohol on symptoms in alcoholic and nonalcoholic patients with schizophrenia. Hosp Commun Psychiatry 1994; 45:1229-1230

    Google Scholar 

  26. Serper MR, Alpert M, Richardson NA, Dickson S, Allen MH, Werner A: Clinical effects of recent cocaine use on patients with acute schizophrenia. Am J Psychiatry 1995; 152:1464-1469

    Google Scholar 

  27. Addington J, Duchak V: Reasons for substance abuse in schizophrenia. Acta Psychiatr Scand 1997; 96:329-333

    Google Scholar 

  28. Drake RE, Wallach MA: Substance abuse among the chronic mentally ill. Hosp Commun Psychiatry 1989; 40:1041-1046

    Google Scholar 

  29. Osher FC, Drake RE, Noordsy DL, et al.: Correlates and outcomes of alcohol use disorder among rural outpatients with schizophrenia. J Clin Psychiatry 1994; 55:109-113

    Google Scholar 

  30. Dixon L, McNary S, Lehman A: Substance abuse and family relationships of persons with severe mental illness. Am J Psychiatry 1995; 152:456-458

    Google Scholar 

  31. Brunette MF, Mueser KT, Xie H, Drake RE: Relationships between symptoms of schizophrenia and substance abuse. J Nerv Ment Dis 1997; 185:13-20

    Google Scholar 

  32. Drake R, Osher F, Wallach M: Alcohol use and abuse in schizophrenia: A prospective community study. J Nerv Ment Dis 1989; 177:408-414

    Google Scholar 

  33. Pristach C, Smith C: Medication compliance and substance abuse among schizophrenic patients. Hosp Commun Psychiatry 1990; 41:1345-1348

    Google Scholar 

  34. Owen RR, Fischer EP, Booth BM, Cuffer BJ: Medication noncompliance and substance abuse among patients with schizophrenia. Psychiatr Serv 1996; 47:853-858

    Google Scholar 

  35. Wilder JF, Plutchnik R, Conte HR: Compliance with psychiatric emergency room referrals. Arch Gen Psychiatry 1977; 34:930-933

    Google Scholar 

  36. Chen A: Non-compliance in community psychiatry: A review of clinical interventions. Hosp Commun Psychiatry 1991; 42:282-287

    Google Scholar 

  37. Appleby L, Dyson V, Luchins D, Cohen L: The impact of substance use screening on a public psychiatric inpatient population. Psychiatr Serv 1997; 48:1311-1316

    Google Scholar 

  38. Franklin J, Solovitz B, Mason M, Clemons J, GE M: An evaluation of case management. Am J Public Health 1987; 674-678

  39. Curtis J, Millman E, Struening E, D'Ercore A: Effects of case management on rehospitalization and utilization of ambulatory care services. Hosp Commun Psychiatry 1992; 43:895-908

    Google Scholar 

  40. Craig TJ, Bracken J: A case-control study of rapid readmission in a state hospital population. Ann Clin Psychiatry 1995; 7:79-85

    Google Scholar 

  41. Hellerstein D, Meehan B: Outpatient group therapy for schizophrenic substance abusers. Am J Psychiatry 1987; 144:1337-1339

    Google Scholar 

  42. Ries R, Ellingson T: A pilot assessment at one month of 17 dual diagnosis patients. Hosp Commun Psychiatry 1990; 41:1230-1233

    Google Scholar 

  43. Cornelius JR, Fabrega H, Maher PJ, et al.: Age effects on the clinical presentation of alcoholics at a psychiatric hospital. Compr Psychiatry 1997; 38:213-217

    Google Scholar 

  44. Ananth J, Vandewater S, Kamal M, Brodsky A, Gamal R, Miller M: Missed diagnosis of substance abuse in psychiatric patients. Hosp Commun Psychiatry 1989; 40:297-299

    Google Scholar 

  45. Claasen CA, Gilfillan S, Orsulak P, Carmody TJ, Battaglia J, Rush JA: Substance abuse among patients with a psychotic disorder in a psychiatric emergency room. Psychiatr Serv 1997; 48:353-358

    Google Scholar 

  46. Spooren DJ, Jannes C, Henderick H, van Heeringen K: Epidemiology of psychiatric emergency referrals in four regions of Belgium. Crisis 1996; 17:15-21

    Google Scholar 

  47. Lehman AF, Dixon LB, Kernan E, DeForge BR, Postrado L: A randomized trial of assertive community treatment for homeless persons with severe mental illness. Arch Gen Psychiatry 1997; 54:1038-1043

    Google Scholar 

  48. Surber RW, Winkler EL, Monteleone M, Havassy BE, Goldfinger SM, Hopkin JT: Characteristics of high users of acute psychiatric inpatient services. Hosp Commun Psychiatry 1987; 38:1112-1114

    Google Scholar 

  49. Goodpastor WA, Hare BK: Factors associated with multiple readmissions to an urban public psychiatric hospital. Hosp Commun Psychiatry 1991; 42:85-87

    Google Scholar 

  50. Lieberman PB, Baker FM: The reliability of psychiatric diagnosis in the emergency room. Hosp Commun Psychiatry 1985; 36:291-293

    Google Scholar 

  51. Strakowski SM, Hawkins JM, Keck PE, et al.: The effects of race and information variance on disagreement between psychiatric emergency service and research diagnoses in first-episode psychosis. J Clin Psychiatry 1997; 58:457-463

    Google Scholar 

  52. Craig TJ, Goodman AB, Haugland G: Impact of DSM-III on clinical practice. Am J Psychiatry 1982; 139:922-925

    Google Scholar 

  53. Klinkenberg WD, Calsyn RJ: The moderating effect of race on return visits to the psychiatric emergency room. Psychiatr Serv 1997; 48:942-945

    Google Scholar 

  54. Fennig S, Craig TJ, Tanenberg-Karant M, Bromet EJ: Comparison of facility and research diagnoses in first-admission psychotic patients. Am J Psychiatry 1994; 151:1423-1429

    Google Scholar 

  55. Brookoff D, Campbell EA, Shaw LM: The underreporting of cocaine-related trauma: Drug Abuse Warning Network Reports vs hospital toxicology tests. Am J Public Health 1993; 83:369-371

    Google Scholar 

  56. Sanguineti VR, Samuel SE: Reported prevalence of drug abuse comorbidity in a city-wide emergency rooms system. Am J Drug Alcohol Abuse 1993; 19:443-450

    Google Scholar 

  57. Albanese MJ, Bartel RL, Bruno RF, Morgenbesser MW, Schatzberg AF: Comparison of measures used to determine substance abuse in an inpatient psychiatric population. Am J Psychiatry 1994; 151:1077-1078

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of South Alabama College of Medicine, Mobile, Alabama

    Dirk M. Dhossche & Shareh O. Ghani

Authors
  1. Dirk M. Dhossche
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shareh O. Ghani
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dhossche, D.M., Ghani, S.O. A Study on Recidivism in the Psychiatric Emergency Room. Ann Clin Psychiatry 10, 59–67 (1998). https://doi.org/10.1023/A:1026162931925

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1026162931925

Search

Navigation