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Benzodiazepines are commonly prescribed since the 1960, when they replaced barbiturics. Although there is no doubt about their efficacy in treating anxiety, insomnia or other psychiatric disorders, we should also take into account the fact that these drugs are easily misused.
In this work we analyze the intake of benzodiazepines among patients hospitalized due to medical problems.
Retrospective review of clinical histories of patients attended by the Drug Unit of the Psychiatry Service in the last twelve months. Bibliographical review of the theme. Data analyzed using the SPSS software 15.0 version.
45 patients were subjected to our survey, 41 of them male. 66% were HIV Positive patients, and the most frequent cause of hospitalization was pneumonia (51’1%). Most of the patients attended were drug abusers (see the graphic below). When the benzodiazepines abusers were asked how they obtained them, 40’6% recognized the got them without prescription, 25% said they got them legally, and 34’4 answered that they got them legally but also without prescription. 62’5% of the patients usually took alprazolam.
Benzodiazepine abuse, in particular alprazolam, is quiet common among the patients we see.
In half of the cases the use of benzodiazepines could have worsen the prognosis of the patients.
One of the most important prognostic factors in patients diagnosed with schizophrenia is the number of hospitalizations they need during their life. In this work we describe risk factors which determinate psychotic relapse.
Retrospective review of the clinical histories of patients diagnosed with schizophrenia who needed hospitalization during the year 2008 using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.
- Socio-demographic: We collected a total of 57 patients, 60% were men and 77,2% were single who lived with their families. 52,8% only had Primary education and 14% had been to University. 38,6% were pensioner and 12,3% workers.
- Risk factors: 54,4% had abandoned their medication, 7% had had recent modifications in their medication, and 35,1% received long acting antipsychotic. 42,1% were identified as substance users.
- 40,4% had been diagnosed with schizophrenia more than three years ago; 57,9% had had less than 3 previous hospitalizations, and 54,4% need hospitalization the previous year.
Male under 30 years old have more risk of needing more hospitalizations. The main risk factor for suffering new psychotic episodes is the medication nonadherence, modifying medication only causes new episodes in few patients. Patients receiving long-acting antipsychotic agents suffer less psychotic relapse. Substance abuse among schizophrenia patients is a major complicating factor since almost half of the hospitalizations are related to it.
Ramón y Cajal Hospital is the reference medical centre for Madrid-Barajas airport. Passengers arriving at the airport who need medical assistance are brought to this hospital. A percentage of these passengers require psychiatric evaluation and frequently need to be admitted into the ward for a certain length of time.
Perform a descriptive analysis of the socio-demographic and clinical variables of inward psychiatric patients referred from Madrid-Barajas airport.
Revise retrospectively clinical histories of inward psychiatric patients referred from Madrid-Barajas airport in the last 5 years.
Data is analyzed using the SPSS software 15.0 version.
We collected 99 patients, 54 of them (54.5%) are males. The 38.4% of the sample is in the age range between 25 and 34 years, and the 26.3% are between 35 and 44 years old. The most frequent countries of origin are European countries (57.6% of the sample). 28 patients of that group (49.1%) are Spanish citizens. Other 26% percent of the patients are from Centre or South-America. The most common syndromic diagnosis at discharge is psychotic disorder (62.6%) followed by affective disorder (22.2%).
We can deduce from these data that the usual patient referred from Madrid-Barajas airport to the emergencies department for psychiatric attention is a male, between 25 and 34 years of age, from a European country, with a psychotic disorder that usually ends up in an admission into the psychiatric hospitalization unit.
Suicide is a major and preventable public health problem. Risk factors may vary with age, gender, or ethnic group, being substance abuse one of the most frequent.
To investigate the relation of substance related disorder and suicide attempt.
Review of the suicidal attempts of patients with personal history of substance related disorder attended during the year 2010.
We identified 85 cases.
Alcohol (64″3%) and cocaine (47″7%) were the two most identified substances. Cannabis (17″2%) and heroin (23″06%) were less consumed. Benzodiacepines abuse was very frequent among the patients attended (38″2%).
Previous attempts were found in 43″8% of the patients.
Drug overdose was the most commonly method used (98″4%), especially with benzodiacepines and antidepressants, but non psychiatric drugs were also frequent. Substance overdosage or intoxication was the second most frequent method used (23%), and poisoning the third (9%). Most of times these methods were presented with concomitant drug overdose.
Defenestration threats were very rare (2″34%), and always associated with hospitalization request by the patient.
We did find significant differences when studying triggers (family, partnership, economical or others) compared with non substance abusers suicidal attempts.
- Chronic substance misuse and acute substance abuse is associated with a higher risk of suicide, what may be explained by the disinhibiting effects of psychoactive substances.
- As benzodiazepine misuse is associated with suicide, special care must be taken when prescribing to at risk patients such as substance abusers
Ramón y Cajal Hospital is the reference centre for Madrid-Barajas airport. Passengers at the airport who need medical assistance are brought to this hospital. A percentage of these passengers require psychiatric evaluation and frequently need to stay inward for a certain term.
Calculate the approximate costs derived from the inward stay at the Psychiatry ward of patients referred from Madrid-Barajas airport.
Revise retrospectively clinical histories of inward psychiatric patients referred from Barajas airport in the last 5 years. The Department of Economic management of the hospital has provided the costs of stay at the Psychiatry ward for the year 2007 (395 euros per day). Data is analyzed using the SPSS software 15.0 version.
The average stay of these patients is 13.96 days. Then, the average cost is 5514.2 euros. Extrapolating these data to our sample, we notice that being the reference centre for an international airport supposes an estimated cost of 545.905.8 euros (109181.16 per year) due to inward stay of psychiatric patients.
The psychiatric attention to the airport population represents an economic extra charge that has an impact on the hospital and the National Health System. We only expose the charge derived from inward stay. To obtain a more realistic overall result we should add the costs of the attention at the emergency room to the result above.
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