Psychiatry 2008 - September 2008 - (Page 47)

Research to Practice clinical psychologists, the hospitalization of a patient simply represents a last resort—a declaration that a patient’s clinical status has become so dire that attempting to manage his or her disease on an outpatient basis is either infeasible or too risky (e.g., due to the potential of harm to himor herself or to others) or both. In this way, acute psychiatric units are seen mostly as places where patients can be maintained safely and securely while they are administered treatment that does not fundamentally differ from what they would have received as an outpatient, with the exception perhaps of more intense psychosocial intervention. Few providers view the inpatient psychiatric setting as one which affords opportunities for specialized, aggressive, biologically based assessment and treatments that are not feasible on an outpatient basis. After all, psychiatry does not have the equivalent of intravenous infusions and monitoring of acute disease biomarkers that characterizes the inpatient treatment of patients hospitalized for medical conditions such as diabetic ketoacidosis, sepsis, or acute angina. When I first became the director of the adult inpatient psychiatric service at University of California San Diego (UCSD) Medical Center many years ago, I held those same conservative assumptions about psychiatric inpatient treatment. However, having nothing more than standard outpatient treatment approaches to offer profoundly ill inpatients eventually led me to adopt a philosophical orientation that inpatient units should leverage the inherent advantages and opportunities of the inpatient setting (e.g., the ability to monitor a patient 24 hours a day and adjust treatment [SEPTEMBER] Transforming the Psychiatric Inpatient Unit from Short-term Pseudo-asylum Care to State-of-the-art Treatment Setting by David Feifel, MD, PhD Psychiatry (Edgemont) 2008;5(9):47–50 INTRODUCTION In past “Research to Practice” articles, I have tried to point out areas where clinical practice did not comport with research-derived evidence in the field of psychiatry. One area where I believe psychiatry has failed to capitalize on prodigious knowledge accrued from research pertains to treatment of the patients hospitalized for psychiatric disorders. For most psychiatrists and Psychiatry 2008 47

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Psychiatry 2008 - September 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Letters to the Editor Use of Benzodiazepines in the Treatment of Anxiety Functional Neurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician Treatment of Comorbid Adolescent Cannabis Use and Major Depressive Disorder Risperidone Long-acting Injections: Successful Alternative Deltoid Muscle Injections for Refractory Schizophrenia Alcohol/Substance Misuse and Treatment Nonadherence: Fatal Attraction Transforming the Psychiatric Inpatient Unit from Short-term Pseudo-asylum Care to State-of-the-art Treatment Setting Journal Watch Classified Advertising Information for Authors

Psychiatry 2008 - September 2008

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