Occasional and frequent repeaters in a psychiatric emergency room

Repeated use of a psychiatric emergency room (PER) is inadequate, and revolving door patients represent a burden on PER. Their socio-demographic and diagnostic profiles need to be better documented to enable early identification.

A retrospective study was undertaken over a 16-month period following the initial visit. Non-repeaters, occasional (2-3 contacts) or frequent repeaters (4 or more) were compared with univariate and logistic regression techniques.

Frequent repeaters - 4% of 2,470 patients and 15% of 3,511 contacts - were more likely to be younger socially handicapped males stressed by grief, pharmaceutical drug misusers and self-referred with no previous hospitalization history. The diagnostic profile was a mixture of severity (psychosis) and less structured complaints (secondary depressive disorder). Disposition upon first contact was temporary hospitalization at PER revealing case assessment difficulties. A continuum of social disability from occasional to frequent repetition of contact was observed.

Repeaters have characteristics that may permit early identification. Their diagnosis, a mixture of non-specific complaints and primarily residual or disorganized schizophrenia, defies evaluation and adequate treatment. Networking with services able to provide help for this type of patient would alleviate the burden on PER. If not available within the community, the development of an ad hoc program should be considered.