Inpatient clinical research: its importance in psychiatry and psychopharmacology

We have outlined the essential components found in an inpatient psychiatry research unit from the point of patient recruitment through discharge. In virtually every phase of a patient's hospitalization on the unit, there is the potential for significant tension between research and clinical goals. We conclude that, as Braff and associates have suggested, clinical and research interests are compatible when both receive appropriate support. We have also discussed the potential advantages of an inpatient research setting for patient care. Because of the washout period, there is greater opportunity for an extended diagnostic assessment and response to the therapeutic milieu alone. The attention and priority patients receive during the research phase can be of significant therapeutic benefit. Findings from research protocols can be used to help with diagnosis and clinical care. Working on an inpatient research unit provides residents and other trainees with special learning experiences. In particular, observational and diagnostic skills are sharpened. Techniques of non-pharmacologic behavioral management are added to the trainees' repertoire of therapeutic interventions. By nature, the research experience promotes creative thinking and problem solving. In this era of fiscal restrictions and cost accountability in medicine, potential advantages for immediate patient care and for staff training are only secondary reasons which justify the existence of inpatient research centers in psychiatry. We must also ask what specific and unique research information an inpatient research setting offers compared to less expensive outpatient research environments. The first factor to be considered is the ability to study individuals whose illness is so severe as to make outpatient management difficult or impossible. It is becoming increasingly clear that for many categories of psychiatric disorders, there is a spectrum of severity of possible behavioral manifestations seen in affected individuals. In depressive illness, for example, the spectrum of expression appears to range from dysthymic disorder to major depressive disorder with psychotic features. Individuals with more severe symptomatology tend to create the greater cost to society because of their correspondingly greater degree of dysfunctional behavior, need for repeated and extended hospitalization, requirement for social services, etc. Such individuals, therefore, need to be studied in a research setting at least as much as patients with milder manifestations of psychiatric illness. This would not be possible without the control, structure, and staffing found in an inpatient setting.(ABSTRACT TRUNCATED AT 400 WORDS)