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QUALIFICATION FOR ADMISSION TO INTENSIVE PSYCHOTHERAPY IN A DAY HOSPITAL FOR NEUROTIC DISORDERS

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Author(s): Sobanski, Jerzy A. | Klasa, Katarzyna | Rutkowski, Krzysztof | Dembinska, Edyta | Müldner-Nieckowski, Łukasz

Journal: Psychiatria i Psychoterapia
ISSN 1895-3166

Volume: 7;
Issue: 4;
Start page: 20;
Date: 2011;
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Keywords: qualification for psychotherapy | day hospital | intensive psychotherapy treatment

ABSTRACT
Introduction: Qualification for treatment of neurotic disorders in a day hospital is connected with a process of selection carried out by experienced therapists – psychiatrists and psychologists – of patients for intensive, everyday group psychotherapy, combined withelements of individual therapy, as well as with the patients’ own decisions, made by them between ambulatory visits. Expectations and motivations of patients are the crucial indicators for the process of treatment. These factors influence the patients’ commitment to treatment and the optimal utilization of the resources of ambulatory selecting facility and of the therapeutic day hospital.Aim: Description and analysis of the process of selection for intensive psychotherapy treatment, ongoing in a day hospital for neurotic disorders. Assessment of this process effectiveness on its particular stages. Material: Data regarding attendance of patients in the years 2004-2005. The analyzed group consisted in total of 3108 persons, including 1679 patients registered in 2004 and 1429 registered in 2005. Method: Analysis of the number of actually attended visits on particular stages of diagnostics before admission to a day hospital. Comparison of proportions of patients registered for 2 consecutive visits in the ambulatory clinic, attending or cancelling visits, and finally admitted to a day hospital or referred-out to other health care institutions.Results: Many patients do not come for the preset diagnostics visits, the next numerous group is referred for treatment in other health care institutions. Selection, in a largest part, is done at the first stage of initial psychiatric examination, which contributes to smaller inhibition of the selection process by more time-consuming psychological examination – elaborate biographical interview and questionnaires-based diagnostics. It has also been concluded that referrals out of the analyzed institution concerned mostly the disorders not included by the insurance company in the treatment contract for the institution, e.g. organic brain disorders,drug-dependencies, psychotic schizophrenic disorders and affective disorders, while the next group contained patients suffering from disorders fitting the profile of the treatment provided by the institution (neurotic and personality disorders), but not being able to comply to treatment program because of life context, general health conditions, insufficient motivation, decreased control of autoagressive impulses etc.Conclusions: Admission for treatment in the day hospital is connected with a significant selection of patients, carried out during initial ambulatory visits by both: staff and the patients themselves. The majority of referrals to hospitals and ambulatory psychiatric clinics (PZP) result from initial psychiatric examination, while referrals to psychotherapy clinics (e.g. for personality disorders) often occur later. Referral for treatment outside the institution sometimes turns out to be necessary even after several weeks from the beginning of theambulatory selection examinations. Resignations of patients in a form of absences without any notification, cancelling visits or informing about the decision during the visit are frequent. Effectiveness of the selection process – connected with patients-candidates’ groupcomposition, and with the specific setting of intensive treatment – cannot be easily improved because of the specificity of intensive psychotherapy. Disrupting the relatively burdening diagnostics probably decreases the number of dropouts during treatment in a day hospital.
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