Medisch-psychiatrischeunit in algemeen ziekenhuis: Effectieve gecombineerde somatische en psychiatrische zorg?

Introduction: A MPU is an inpatient facility in a general hospital for diagnosis and treatment of complex patients with a combination of severe somatic and severe psychiatric disorders. Expertise in dealing with severe behavior problems on general medical wards for such complex patients is often insufficient. This decreases adequate somatic and psychiatric work up and treatment. The most frequent indications for admission to a MPU are hindrance of somatic and psychiatric evaluation due to behavioral problems and disruption of a somatic ward due to lack of expertise in dealing with (psychiatric) behavior problems. Some hospitals the Netherlands have an MPU. Data on indications and treatment effect are scarce. This paper is reports on observational data of such a unit. During admission on this eight bedded Unit, the somatic specialist is the primary physician with the psychiatrist as co-therapist. The MPU has closed ward facilities when indicated. The aim of this study was to report on indications for admission and effect of medical and psychiatric treatment provided on an MPU. Methods and Design: Of all patients admitted in 2011 to the MPU of the VU medical centre in Amsterdam the medical records were retrospectively analyzed. Data were collected on reasons for referral, somatic and psychiatric diagnoses. Using a global clinical assessment scale derived from the Clinical global Impression Scale (CGI) and the Health of the Nation Outcome Scale (HoNOS) at the moment of admission and discharge somatic and psychiatric treatment goals, as formulated in the initial treatment plan were assessed. Results: 139 admissions were recorded with a very large variety of somatic and psychiatric problems. As measured with the adapted version of the CGI, 91% of goals concerning somatic treatment, and 85% of goals set for psychiatric treatment were realized. HoNOS scores decreased significantly in severity on both somatic and psychiatric items. The total HoNOS scores decreased on average 3.8 points. Most frequent referring specialists were General Medicine, Neurology and Traumatology. Most frequent reasons for admission were aggression or uncontrollable behavior (17%), need of closed ward facilities (13%) and need of intensive psychiatric care apart from somatic care (10%). A wide variety of somatic diagnoses on admission were noted. Delirium was the most frequent psychiatric diagnosis on discharge (24%). Conclusion: Data on daily care on an MPU are scarce. This observational study indicates that an MPU may be effective in providing integrated care to a very diverse group of patients with a combination of medical and psychiatric problems. Such patients are at risk as admission to a regular medical ward is often hampered by complexity of combined somatic and psychiatric as well as behavioral problems. A prospective research design with a comparator group not admitted to such a unit is necessary in order to establish effectively. In such a design cost-effectiveness should also be taken into account.