MADELYN CABRERA, PSY.D.JESUS PEREZ, PSY.D.

CITRUS HEALTH NETWORK, INCHIALEAH, FL

Patient Diagnostic Differences and Demographics at an Adult

Crisis Stabilization Unit

Adult Crisis Stabilization Unit (ACSU)

A designated Baker Act receiving facility 24 bed capacity Adult population Length of stay varies, most under 1 week

Admission Status Voluntary admission Involuntary admission

Adult Crisis Stabilization Unit (ACSU)

Admission Criteria

Treatment Protocol

Discharge Criteria

Literature Review

Bowers et al. (2008) conducted an extensive literature review on Psychiatric Intensive Care Units

Findings: Mean patient age: 30’s Majority of patients were male Schizophrenia: about 50 % of patients Next largest group: Mania at 20% Majority were single and unemployed Mean lengths of stay of seven days or less

Literature Review: Diagnostic Differences

Berg (2009) examined referrals to an acute psychiatry department at day and night for diagnostic differences

Findings: 47.9% were female and 52% were male Patients with psychotic disorders comprised (26%),

affective disorders 25%, substance abuse disorders (17%), personality disorders (13%), and crises/anxiety disorders (12%)

Mean stay: less than 9 days

Literature Review: Diagnostic Differences

Blader (2011) examined data from facility-level surveys regarding diagnostic trends from acute care inpatient services in U.S. from 1996 to 2007

Diagnostic trends noted: Anxiety diagnoses became less likely throughout survey

years Impairments and behavioral disturbances of hospitalized

patients may have grown more acute Patients with psychotic disorder diagnoses continued to

have LOSs that remained the highest

Literature Review: Diagnostic Differences

Primary Dx

% of Population

LOS

Substance 28.3 4.40

Depression 26.8 5.70

Psychosis 20.3 10.68

Bipolar 17.6 7.16

Anxiety 4.53 3.66

Other 2.50 6.94

2006-2007, Adults

United States 2010 Census

308.7 million people resided in the U.S. on April 1st, 2010

In June 2013, U.S. Census estimate was 316,057,326

In regards to ethnicity/race in 2010 Census: Largest growth was seen in Hispanic population: 50.5

million Non-Hispanic population grew relatively slower over

the decade at about 5 percent

U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

United States 2010 Census

Hispanic/Latino Origin and Race

Hispanic or LatinoNot Hispanic or LatinoWhite Alone

U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

United States 2010 Census

Race/Ethnic Groups

WhiteBlack or African AmericanAmerican Indian and Alaska NativeAsianNative Hawaiian or Other Pacific IslanderOther Race

U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

Miami-Dade County 2010 Census

2,496,435 million people resided in Miami-Dade

The largest Racial or Ethnic Group: Hispanic at 65 percent Black/African American, 17.1 percent White, 15.4 percent Others, 2.5 percent

Miami-Dade County is the 1st most populated county in FloridaU.S. Census Bureau. (2013, May). 2006-2010 American Community Survey 5 Year Estimates. Retrieved June

26, 2013, from http://www.census.gov/acs/www/data_documentation/summary_file/

Miami-Dade County 2010 Census

Race/Ethnic Groups

HispanicWhiteBlack/African Amer-icanAmerican IndianAsianPacific Islander

U.S. Census Bureau. (2013, May). 2006-2010 American Community Survey 5 Year Estimates. Retrieved June 26, 2013, from http://www.census.gov/acs/www/data_documentation/summary_file/

Miami-Dade County 2010 Census

Additional Facts: Population growth of 11 percent for Miami-Dade

Non-Hispanic White population: 17.7 percent decline Non-Hispanic Black/African American population: 0.3

percent decline

Median Age of Females: 39.4 Median Age of Males: 36.9

Miami-Dade County Research Section, Department of Planning and Zoning. (2011, May). 2006-2010 2010 Census Data: Demographics of commission districts in Miami-Dade. Retrieved June 26, 2013, from http://www.miamidade.gov/redistricting/library/district-demographics.pdf

Research Question

How does the ACSU at Citrus Health Network in Miami-Dade County compare to the literature on diagnostic trends and other inpatient admission characteristics?

What are the implications of this data?

Method

Data Source Analyzed archival data from 2001 to 2010

Age, gender, primary diagnoses, and total length of stay

Analysis Utilized Comparisons made through SPSS with crosstabs

Results

Frequencies of our sample: N=8216 Average age: 42.20 Average length of stay: 4 days Gender:

Females: 46 % Males: 54 %

Gender

FemalesMales

Results

Primary Admission Psychosis 39.2% Depressive 16.9% Bipolar 12.3% Anxiety 0.8% Adjustment 11.9% Alcohol /Substance Related 12.9% Delirium/Dementia 2.3%

Results

Axis I % Females % Males

Depression 64.7 35.3

Psychosis 40.8 59.2

Bipolar 52.4 47.6

Anxiety 50.8 49.2

Substance 25.6 74.4

Conduct 25 74

Developmental 0 100

Dementia 34.8 65.2

Results

Axis I 01’ 02’ 03’ 04’ 05’ 06’ 07’ 08’ 09’ 10’

Depression

20.5 20.2 20.1 19.8 17.7 12.1

15.6

14.3

15.7

14.8

Psychosis 49 43.5 38.3 42.7 39 41.1

37.2

35.5

34.9

34.7

Bipolar 6.8 9.5 12.9 10.4 12.2 11.1

12.3

13.6

19.4

18.8

Anxiety .7 1.1 .3 .9 .6 1.0 .6 .5 1.2 1.0

Substance

6.9 9.1 11.0 12.1 14.1 17.1

17.1

18.7

13.0

12.4

Conduct 20.5 20.2 20.1 19.8 17.7 12.1

15.6

14.3

15.7

14.8

Develop. 0 0 0 0 0 .01 0 .01 0 0

Dementia 2.4 1.2 3.3 2.6 2.5 2.6 2.2 2.8 2.4 1.1

Results

Gender LOS Age

Female 3.80 43.35

Male 3.93 41.22

Total 3.86 42.20

Results

Diagnosis LOS Average Number

Adjustment 1.44 975

Anxiety 2.12 65

Bipolar 3.90 1014

Dementia/Delirium 2.28 187

Depressive 3.40 1385

Psychosis 5.68 3222

Substance Related 2.12 1061

Results

Reason for Admission

Frequency Percent

Suicidal Threat/Ideation

2892 35.2

Suicidal Attempt 300 3.7

Self Injurious Behaviors

124 1.5

Homicidal Threats/ideation

148 1.8

Aggressive Behaviors

1154 14.0

Neglect 225 2.7

Psychosis 751 9.1

Others 1321 16.6

Discussion

Compared to the literature, there is a higher frequency of psychosis

Diagnostic Trends

Limitations

Skewed sample, primarily Hispanic

Focuses on one particular crisis unit

Future Directions

Closer look at Characteriological Features

Any correlation between psychosis and substance use

Control variables for transferred patients

Protective and Risk factors

References

Berg. J. E. (2009). Referrals to an acute psychiatry department at day and night. Are there diagnostic differences? Journal of Psychiatric Intensive Care, 5, 95-98.

Blader, J.C. (2011). Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Archives of General Psychiatry. Published online August 1, 2011.

Bowers et al. (2008). Psychiatric intensive care units: A literature review. International Journal of Social Psychiatry, 54, 56-68.

Questions?