1. MADELYN CABRERA, PSY.D. JESUS PEREZ, PSY.D. CITRUS HEALTH NETWORK, INC HIALEAH, FL Patient Diagnostic Differences and Demographics at an Adult Crisis Stabilization Unit

2. Adult Crisis Stabilization Unit (ACSU) A designated Baker Act receiving facility  24 bed capacity  Adult population  Length of stay varies, most under 1 week Admission Status  Voluntary admission  Involuntary admission

3. Adult Crisis Stabilization Unit (ACSU) Admission Criteria Treatment Protocol Discharge Criteria

4. Literature Review Bowers et al. (2008) conducted an extensive literature review on Psychiatric Intensive Care Units  Findings:  Mean patient age: 30’s  Majority of patients were male  Schizophrenia: about 50 % of patients  Next largest group: Mania at 20%  Majority were single and unemployed  Mean lengths of stay of seven days or less

5. Literature Review: Diagnostic Differences Berg (2009) examined referrals to an acute psychiatry department at day and night for diagnostic differences  Findings:  47.9% were female and 52% were male  Patients with psychotic disorders comprised (26%), affective disorders 25%, substance abuse disorders (17%), personality disorders (13%), and crises/anxiety disorders (12%)  Mean stay: less than 9 days

6. Literature Review: Diagnostic Differences Blader (2011) examined data from facility-level surveys regarding diagnostic trends from acute care inpatient services in U.S. from 1996 to 2007  Diagnostic trends noted:  Anxiety diagnoses became less likely throughout survey years  Impairments and behavioral disturbances of hospitalized patients may have grown more acute  Patients with psychotic disorder diagnoses continued to have LOSs that remained the highest

7. Literature Review: Diagnostic Differences Primary Dx% of PopulationLOS Substance28.34.40 Depression26.85.70 Psychosis20.310.68 Bipolar17.67.16 Anxiety4.533.66 Other2.506.94 2006-2007, Adults

8. United States 2010 Census 308.7 million people resided in the U.S. on April 1 st, 2010 In June 2013, U.S. Census estimate was 316,057,326 In regards to ethnicity/race in 2010 Census:  Largest growth was seen in Hispanic population: 50.5 million  Non-Hispanic population grew relatively slower over the decade at about 5 percent U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

9. United States 2010 Census U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

10. United States 2010 Census U.S. Census Bureau. (2011, March). Overview of Race and Hispanic Origin: 2010. Retrieved July 10, 2013, from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

11. Miami-Dade County 2010 Census 2,496,435 million people resided in Miami-Dade The largest Racial or Ethnic Group: Hispanic at 65 percent  Black/African American, 17.1 percent  White, 15.4 percent  Others, 2.5 percent Miami-Dade County is the 1 st most populated county in Florida U.S. Census Bureau. (2013, May). 2006-2010 American Community Survey 5 Year Estimates. Retrieved June 26, 2013, from http://www.census.gov/acs/www/data_documentation/summary_file/

12. Miami-Dade County 2010 Census U.S. Census Bureau. (2013, May). 2006-2010 American Community Survey 5 Year Estimates. Retrieved June 26, 2013, from http://www.census.gov/acs/www/data_documentation/summary_file/

13. Miami-Dade County 2010 Census Additional Facts:  Population growth of 11 percent for Miami-Dade  Non-Hispanic White population: 17.7 percent decline  Non-Hispanic Black/African American population: 0.3 percent decline  Median Age of Females: 39.4  Median Age of Males: 36.9 Miami-Dade County Research Section, Department of Planning and Zoning. (2011, May). 2006-2010 2010 Census Data: Demographics of commission districts in Miami-Dade. Retrieved June 26, 2013, from http://www.miamidade.gov/redistricting/library/district-demographics.pdf

14. Research Question How does the ACSU at Citrus Health Network in Miami-Dade County compare to the literature on diagnostic trends and other inpatient admission characteristics? What are the implications of this data?

15. Method Data Source  Analyzed archival data from 2001 to 2010  Age, gender, primary diagnoses, and total length of stay Analysis Utilized  Comparisons made through SPSS with crosstabs

16. Results Frequencies of our sample:  N=8216  Average age: 42.20  Average length of stay: 4 days  Gender:  Females: 46 %  Males: 54 %

17. Results Primary Admission  Psychosis 39.2%  Depressive 16.9%  Bipolar 12.3%  Anxiety 0.8%  Adjustment 11.9%  Alcohol /Substance Related 12.9%  Delirium/Dementia 2.3%

18. Results Axis I% Females% Males Depression64.735.3 Psychosis40.859.2 Bipolar52.447.6 Anxiety50.849.2 Substance25.674.4 Conduct2574 Developmental0100 Dementia34.865.2

19. Results Axis I01’02’03’04’05’06’07’08’09’10’ Depression20.520.220.119.817.712.115.614.315.714.8 Psychosis4943.538.342.73941.137.235.534.934.7 Bipolar6.89.512.910.412.211.112.313.619.418.8 Anxiety.71.1.3.9.61.0.6.51.21.0 Substance6.99.111.012.114.117.1 18.713.012.4 Conduct20.520.220.119.817.712.115.614.315.714.8 Develop.00000.010 00 Dementia2.41.23.32.62.52.62.22.82.41.1

20. Results

22. Reason for Admission FrequencyPercent Suicidal Threat/Ideation 289235.2 Suicidal Attempt3003.7 Self Injurious Behaviors 1241.5 Homicidal Threats/ideation 1481.8 Aggressive Behaviors115414.0 Neglect2252.7 Psychosis7519.1 Others132116.6

23. Discussion Compared to the literature, there is a higher frequency of psychosis Diagnostic Trends

24. Limitations Skewed sample, primarily Hispanic Focuses on one particular crisis unit

25. Future Directions Closer look at Characteriological Features Any correlation between psychosis and substance use Control variables for transferred patients Protective and Risk factors

26. References Berg. J. E. (2009). Referrals to an acute psychiatry department at day and night. Are there diagnostic differences? Journal of Psychiatric Intensive Care, 5, 95-98. Blader, J.C. (2011). Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Archives of General Psychiatry. Published online August 1, 2011. Bowers et al. (2008). Psychiatric intensive care units: A literature review. International Journal of Social Psychiatry, 54, 56-68.

27. Questions?