Publication

Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder

van Kranenburg, G. D., van den Brink, R. H. S., Mulder, W. G., Diekman, W. J., Pijnenborg, G. H. M. & Mulder, C. L., 3-Sep-2019, In : BMC Psychiatry. 19, 1, 9 p., 270.

Research output: Contribution to journalArticleAcademicpeer-review

APA

van Kranenburg, G. D., van den Brink, R. H. S., Mulder, W. G., Diekman, W. J., Pijnenborg, G. H. M., & Mulder, C. L. (2019). Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder. BMC Psychiatry, 19(1), [270]. https://doi.org/10.1186/s12888-019-2254-9

Author

van Kranenburg, G. D. ; van den Brink, R. H. S. ; Mulder, W. G. ; Diekman, W. J. ; Pijnenborg, G. H. M. ; Mulder, C. L. / Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder. In: BMC Psychiatry. 2019 ; Vol. 19, No. 1.

Harvard

van Kranenburg, GD, van den Brink, RHS, Mulder, WG, Diekman, WJ, Pijnenborg, GHM & Mulder, CL 2019, 'Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder' BMC Psychiatry, vol. 19, no. 1, 270. https://doi.org/10.1186/s12888-019-2254-9

Standard

Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder. / van Kranenburg, G. D.; van den Brink, R. H. S.; Mulder, W. G.; Diekman, W. J.; Pijnenborg, G. H. M.; Mulder, C. L.

In: BMC Psychiatry, Vol. 19, No. 1, 270, 03.09.2019.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

van Kranenburg GD, van den Brink RHS, Mulder WG, Diekman WJ, Pijnenborg GHM, Mulder CL. Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder. BMC Psychiatry. 2019 Sep 3;19(1). 270. https://doi.org/10.1186/s12888-019-2254-9


BibTeX

@article{2d57f4d77a284430b495325e6a9cd882,
title = "Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder",
abstract = "Background The treatment of homeless dual-diagnosis patients (i.e., those with severe mental illness and substance-use disorder) is difficult and often fails. For patients in the Netherlands who had not responded to earlier voluntary and compulsory treatment, a new treatment facility - Sustainable Residence (SuRe) - was developed to offer long-term compulsory in-patient treatment. Aim of the study To study patterns of changes in clinical and functional outcomes during treatment at SuRe and how these relate to eventual treatment outcome. Methods On the basis of the intensity of care needed after four years, three groups of patients were distinguished (total n = 165): those discharged to a less restrictive and less supportive setting (n = 70, 42{\%}), those still hospitalized at SuRe at the end of the four-year study period (n = 69, 42{\%}) and those referred to a more appropriate setting (n = 26, 16{\%}). Random coefficient analysis was used to examine differences between groups regarding changes in clinical and functional outcomes during treatment. During treatment, outcomes were monitored using Routine Outcome Assessment. Results All three groups made small but significant improvements on global psychosocial functioning, distress and therapeutic alliance (effect sizes (ES) 0.11 to 0.16 per year). Patients who were discharged to a less restrictive setting showed small to moderate improvement in risk to self and others, psychiatric symptoms, and skills for daily living (ES 0.19-0.33 per year and 0.42-0.73 for their mean 2.2-year treatment period). Patients remaining at SuRe showed a small increase in risk to self (ES 0.20 per year; 0.80 for their treatment period of four years or more). Oppositional behaviour was consistently greater in referred patients than in the other groups (ES 0.74-0.75). Conclusion Long-term compulsory treatment appeared to have helped improve clinical and functional outcomes in a substantial proportion (42{\%}) of previously severely dysfunctional, treatment-resistant dual-diagnosis patients, who could then be discharged to a less restrictive and less supportive environment. However, risk-to-self increased in a similar proportion. A smaller number of patients (16{\%}) showed marked oppositional behaviour and needed a higher level of care and protection in another facility.",
keywords = "Severely mentally ill (SMI), Dual diagnosis, Compulsory treatment, Treatment resistant, Routine outcome assessment, PEOPLE, CARE",
author = "{van Kranenburg}, {G. D.} and {van den Brink}, {R. H. S.} and Mulder, {W. G.} and Diekman, {W. J.} and Pijnenborg, {G. H. M.} and Mulder, {C. L.}",
year = "2019",
month = "9",
day = "3",
doi = "10.1186/s12888-019-2254-9",
language = "English",
volume = "19",
journal = "BMC Psychiatry",
issn = "1471-244X",
publisher = "BMC",
number = "1",

}

RIS

TY - JOUR

T1 - Clinical effects and treatment outcomes of long-term compulsory in-patient treatment of treatment-resistant patients with severe mental illness and substance-use disorder

AU - van Kranenburg, G. D.

AU - van den Brink, R. H. S.

AU - Mulder, W. G.

AU - Diekman, W. J.

AU - Pijnenborg, G. H. M.

AU - Mulder, C. L.

PY - 2019/9/3

Y1 - 2019/9/3

N2 - Background The treatment of homeless dual-diagnosis patients (i.e., those with severe mental illness and substance-use disorder) is difficult and often fails. For patients in the Netherlands who had not responded to earlier voluntary and compulsory treatment, a new treatment facility - Sustainable Residence (SuRe) - was developed to offer long-term compulsory in-patient treatment. Aim of the study To study patterns of changes in clinical and functional outcomes during treatment at SuRe and how these relate to eventual treatment outcome. Methods On the basis of the intensity of care needed after four years, three groups of patients were distinguished (total n = 165): those discharged to a less restrictive and less supportive setting (n = 70, 42%), those still hospitalized at SuRe at the end of the four-year study period (n = 69, 42%) and those referred to a more appropriate setting (n = 26, 16%). Random coefficient analysis was used to examine differences between groups regarding changes in clinical and functional outcomes during treatment. During treatment, outcomes were monitored using Routine Outcome Assessment. Results All three groups made small but significant improvements on global psychosocial functioning, distress and therapeutic alliance (effect sizes (ES) 0.11 to 0.16 per year). Patients who were discharged to a less restrictive setting showed small to moderate improvement in risk to self and others, psychiatric symptoms, and skills for daily living (ES 0.19-0.33 per year and 0.42-0.73 for their mean 2.2-year treatment period). Patients remaining at SuRe showed a small increase in risk to self (ES 0.20 per year; 0.80 for their treatment period of four years or more). Oppositional behaviour was consistently greater in referred patients than in the other groups (ES 0.74-0.75). Conclusion Long-term compulsory treatment appeared to have helped improve clinical and functional outcomes in a substantial proportion (42%) of previously severely dysfunctional, treatment-resistant dual-diagnosis patients, who could then be discharged to a less restrictive and less supportive environment. However, risk-to-self increased in a similar proportion. A smaller number of patients (16%) showed marked oppositional behaviour and needed a higher level of care and protection in another facility.

AB - Background The treatment of homeless dual-diagnosis patients (i.e., those with severe mental illness and substance-use disorder) is difficult and often fails. For patients in the Netherlands who had not responded to earlier voluntary and compulsory treatment, a new treatment facility - Sustainable Residence (SuRe) - was developed to offer long-term compulsory in-patient treatment. Aim of the study To study patterns of changes in clinical and functional outcomes during treatment at SuRe and how these relate to eventual treatment outcome. Methods On the basis of the intensity of care needed after four years, three groups of patients were distinguished (total n = 165): those discharged to a less restrictive and less supportive setting (n = 70, 42%), those still hospitalized at SuRe at the end of the four-year study period (n = 69, 42%) and those referred to a more appropriate setting (n = 26, 16%). Random coefficient analysis was used to examine differences between groups regarding changes in clinical and functional outcomes during treatment. During treatment, outcomes were monitored using Routine Outcome Assessment. Results All three groups made small but significant improvements on global psychosocial functioning, distress and therapeutic alliance (effect sizes (ES) 0.11 to 0.16 per year). Patients who were discharged to a less restrictive setting showed small to moderate improvement in risk to self and others, psychiatric symptoms, and skills for daily living (ES 0.19-0.33 per year and 0.42-0.73 for their mean 2.2-year treatment period). Patients remaining at SuRe showed a small increase in risk to self (ES 0.20 per year; 0.80 for their treatment period of four years or more). Oppositional behaviour was consistently greater in referred patients than in the other groups (ES 0.74-0.75). Conclusion Long-term compulsory treatment appeared to have helped improve clinical and functional outcomes in a substantial proportion (42%) of previously severely dysfunctional, treatment-resistant dual-diagnosis patients, who could then be discharged to a less restrictive and less supportive environment. However, risk-to-self increased in a similar proportion. A smaller number of patients (16%) showed marked oppositional behaviour and needed a higher level of care and protection in another facility.

KW - Severely mentally ill (SMI)

KW - Dual diagnosis

KW - Compulsory treatment

KW - Treatment resistant

KW - Routine outcome assessment

KW - PEOPLE

KW - CARE

U2 - 10.1186/s12888-019-2254-9

DO - 10.1186/s12888-019-2254-9

M3 - Article

VL - 19

JO - BMC Psychiatry

JF - BMC Psychiatry

SN - 1471-244X

IS - 1

M1 - 270

ER -

ID: 97132700