question: How does inpatient/outpatient psychiatric care help if medications take such a long time to start working?
comment: Without frequent monitoring, they have to rely on patient self-reporting, which can vary wildly in both reliability and awareness. Working within an intensive program like inpatient or outpatient allows docs to more closely monitor for side effects/compatibility, and to more rapidly adjust or change medications as necessary. Plus, for some issues, having the stable routine can be very helpful on its own.
passages: Another type of psychiatric hospital is medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective.
  
  Section::::Types.:Juvenile wards.
   “The likelihood of psychiatric hospital admission was significantly reduced by approximately 25% during the initial six-month court order…and by over one-third during a subsequent six-month renewal of the order…. Similar significant reductions in days of hospitalization were evident during initial court orders and subsequent renewals…. Improvements were also evident in receipt of psychotropic medications and intensive case management services. Analysis of data from case manager reports showed similar reductions in hospital admissions and improved engagement in services.”
   Outpatient treatment involves periodic visits to a psychiatrist for consultation in his or her office, or at a community-based outpatient clinic. Initial appointments, at which the psychiatrist conducts a psychiatric assessment or evaluation of the patient, are typically 45 to 75 minutes in length. Follow-up appointments are generally shorter in duration, i.e., 15 to 30 minutes, with a focus on making medication adjustments, reviewing potential medication interactions, considering the impact of other medical disorders on the patient's mental and emotional functioning, and counseling patients regarding changes they might make to facilitate healing and remission of symptoms (e.g., exercise, cognitive therapy techniques, sleep hygiene—to name just a few). The frequency with which a psychiatrist sees people in treatment varies widely, from once a week to twice a year, depending on the type, severity and stability of each person's condition, and depending on what the clinician and patient decide would be best.
   This approach centers on the early detection and treatment of early symptoms of psychosis during the formative years of the psychotic condition. The first three to five years are believed by some to be a critical period. The aim is to reduce the usual delays to treatment for those in their first episode of psychosis. The provision of optimal treatments in these early years is thought to prevent relapses and reduce the long-term impact of the condition. It is considered a secondary prevention strategy.
   Diagnostic overshadowing can lead to delays in treatment and inadequate medical treatment for physical health conditions in people with mental illnesses, leading to increased mortality and poorer treatment outcomes. The World Health Organization attributes lower life expectancy in people with intellectual disability or mental illnesses in part to diagnostic overshadowing. When a developmental disorder- such as Autism- is not diagnosed due to diagnostic overshadowing, this can lead to a delay in appropriate support being provided.
  
  Section::::Prevention.
   The slippery slope argument of "If government bodies are given power, they will use it in excess." was proven when 350-450 CTO's were expected to be issued in 2008 and more than five times that number were issued in the first few months. Every year there are increasing numbers of people subject to CTO's.
   After receiving ECT, “nurses will ensure the patient’s airway is maintained, monitor observations and administer prescribed medications to counter adverse effects…”. After ensuring the patient is stable, the nurse would observe for normal side effects and document those side effects. “There is a period of confusion and disorientation that rapidly follows the treatment; it clears quickly. With each successive treatment, the patient is left with an ongoing loss of memory which will gradually clear after the course of therapy is finished”. “Patients usually receive 6 to 12 treatments for full therapeutic benefit, but the number of ECT applications is titrated individually for each case”. In many cases, the client receives ECT multiple times per week and a gradual decrease in treatments once the therapeutic effect is reached and noticed by client and physician.
   Patients may also be treated for substance abuse following the administration of psychoactive substances containing amphetamine, caffeine, tetrahydrocannabinol, cocaine, phencyclidines, or other inhalants, opioids, sedatives, hypnotics, anxiolytics, psychedelics, dissociatives and deliriants. Clinicians assessing and treating substance abusers must establish therapeutic rapport to counter denial and other negative attitudes directed towards treatment. In addition, the clinician must determine substances used, the route of administration, dosage, and time of last use to determine the necessary short and long term treatments. An appropriate choice of treatment setting must also be determined. These settings may include outpatient facilities, partial hospitals, residential treatment centers, or hospitals. Both the immediate and long term treatment and setting is determined by the severity of dependency and seriousness of physiological complications arising from the abuse.
   BULLET::::- Aim to reduce the duration of untreated psychosis to less than 3 months
  
  BULLET::::- Maximum caseload ratio of 1 care coordinator to 10–15 clients
  
  BULLET::::- For every 250,000 (depending on population characteristics), one team
  
  BULLET::::- Total caseload 120 to 150
  
  BULLET::::- 1.5 doctors per team
  
  BULLET::::- Other specialist staff to provide specific evidence based interventions
  
  Section::::Reform of mental health services.:Australia and New Zealand.
   Treatments in psychiatric emergency service settings are typically transitory in nature and only exist to provide dispositional solutions and/or to stabilize life-threatening conditions. Once stabilized, patients suffering chronic conditions may be transferred to a setting which can provide long term psychiatric rehabilitation. Prescribed treatments within the emergency service setting vary dependent upon the patient's condition. Different forms of psychiatric medication, psychotherapy, or electroconvulsive therapy may be used in the emergency setting. The introduction and efficacy of psychiatric medication as a treatment option in psychiatry has reduced the utilization of physical restraints in emergency settings, by reducing dangerous symptoms resulting from acute exacerbation of mental illness or substance intoxication.
   One comparison study showed 34% of patients of a 'medical model' team were still being treated after two years, compared with only 9% of patients of a team using a 'non-diagnostic' approach (less medication, little diagnosis, individual treatment plans tailored to the person's unique needs). However the study comments that cases may have left the system in the 'non-diagnostic' approach, not because treatment had worked, but because (1) multi-agency involvement meant long-term work may have been continued by a different agency, (2) the starting question of ‘Do we think our service can make a positive difference to this young person’s life?’ rather than ‘What is wrong with this young person?’ may have led to treatment not being continued, and (3) the attitude of viewing a case as problematic when no improvement has occurred after five sessions may have led to treatment not being continued (rather than the case ‘drifting’ on in the system).
   Psychiatric treatments have changed over the past several decades. In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years. Today in most countries, people receiving psychiatric treatment are more likely to be seen as outpatients. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization.. However, in Japan psychiatric hospitals continue to keep patients for long periods, sometimes even keeping them in physical restraints, strapped to their beds for periods of weeks or months.
   The units, usually called locked units, focus on applying cognitive and mental activities to try to help keep the mind fresh. Since there is no cure for the disease, the goal is to work at prolonging or delaying the disease. If one is not engaged in activity, his or her memory will deteriorate more rapidly.
  
  Section::::United States.:Controversy.
  
  Section::::United States.:Controversy.:2011 "Miami Herald" investigation.
  
  A 2011 investigation by the "Miami Herald" into assisted living facilities in Florida won the Pulitzer Prize, and found that:
   In Ohio, AOT increased attendance at outpatient psychiatric appointments from 5.7 to 13.0 per year. It increased attendance at day treatment sessions from 23 to 60 per year. “During the first 12 months of outpatient commitment, patients experienced significant reductions in visits to the psychiatric emergency service, hospital admissions, and lengths of stay compared with the 12 months before commitment.”
  
  In Arizona, “71% [of AOT patients] … voluntarily maintained treatment contacts six months after their orders expired” compared with “almost no patients” who were not court-ordered to outpatient treatment.
   The treatment benefits of antidepressant medications are often not seen until 1–2 weeks into treatment, with maximum benefits being reached around 4–6 weeks. Most healthcare providers will monitor patients more closely during the acute phase of treatment and continue to monitor at longer intervals in the continuation and maintenance phases.
   People who are addicted to drugs or alcohol may be voluntarily or involuntarily admitted to a residential facility for treatment. Prescribed drugs are sometimes used to get people off illegal or addictive drugs, and to prevent the withdrawal symptoms of such drugs. The length of stay may be determined by the patient's needs or by external factors. In many cases the patient's insurance will cover such treatment in private facilities for only a limited period of time, and public rehabilitation facilities often have long waiting lists.
  
  Section::::Levels of care.
  
  Section::::Levels of care.:Total care.
   An evaluation of the Rapid Assessment, Interface and Discharge (RAID) model of liaison psychiatry — employed at City Hospital, Birmingham — estimated that the service saved between 43 and 64 beds per day through reduced lengths of stay and prevention of readmission. In 2011 the Centre for Mental Health published an economic evaluation of the service, estimating savings of around £3.5 million. This was followed in 2012 by the publication of a report recommending that every NHS hospital should have a liaison psychiatry service as standard.
  
  Section::::History.
   Section::::Products and software.:OnPatient.
   Chronotherapy (treatment scheduling)
  
  Chronotherapy, also called chronotherapeutics or chronotherapeutic drug delivery, refers to the use of circadian or other rhythmic cycles of a condition's symptoms and/or of the individual being treated in the application of therapy. Examples of this are treatments of psychiatric and somatic diseases that are administered according to a schedule that corresponds to these rhythms in order to maximize effectiveness and minimize side effects of the therapy.
  
  Chronotherapy is used in various clinical fields such as the treatments of asthma, hypertension, and bipolar disorder.
   Before starting DSPD treatment, patients are often asked to spend at least a week sleeping regularly, without napping, at the times when the patient is most comfortable. It is important for patients to start treatment well-rested.
  
  Section::::Management.:Non-pharmacologic.
   Long-term success rates of treatment have seldom been evaluated. However, experienced clinicians acknowledge that DSPD is extremely difficult to treat. One study of 61 DSPD patients, with average sleep onset at about 3:00 am and average waking time of about 11:30 am, was followed with questionnaires to the subjects after a year. Good effect was seen "during" the six-week treatment with a large daily dose of melatonin. Follow-up showed that over 90% had relapsed to pre-treatment sleeping patterns within the year, 29% reporting that the relapse occurred within one week. The mild cases retained changes significantly longer than the severe cases.
   In New Jersey, Kim Veith, director of clinical services at Ocean Mental Health Services, noted the AOT pilot program performed “beyond wildest dreams.” AOT reduced hospitalizations, shortened inpatient stays, reduced crime and incarceration, stabilized housing, and reduced homelessness. Of clients who were homeless, 20% are now in supportive housing, 40% are in boarding homes, and 20% are living successfully with family members.
  
  Writing in the "British Journal of Psychiatry" in 2013, Jorun Rugkåsa and John Dawson stated, "The current evidence from suggests that do not reduce readmission rates over 12 months."
   The primary treatment for bipolar disorder consists of medications called mood stabilizers, which are used to prevent or control episodes of mania or depression. Medications from several classes have mood stabilizing activity. Many individuals may require a combination of medication to achieve full remission of symptoms. As it is impossible to predict which medication will work best for a particular individual, it may take some trial and error to find the best medication or combination for a specific patient. Psychotherapy also has a role in the treatment of bipolar disorder. The goal of treatment is not to cure the disorder but rather to control the symptoms and the course of the disorder. Generally speaking, maintenance treatment of bipolar disorder continues long after symptom control has been achieved.
   In many developed countries there has been a massive reduction in psychiatric beds since the mid 20th century, with the growth of community care. Standards of inpatient care remain a challenge in some public and private facilities, due to levels of funding, and facilities in developing countries are typically grossly inadequate for the same reason. Even in developed countries, programs in public hospitals vary widely. Some may offer structured activities and therapies offered from many perspectives while others may only have the funding for medicating and monitoring patients. This may be problematic in that the maximum amount of therapeutic work might not actually take place in the hospital setting. This is why hospitals are increasingly used in limited situations and moments of crisis where patients are a direct threat to themselves or others. Alternatives to psychiatric hospitals that may actively offer more therapeutic approaches include rehabilitation centers or "rehab" as popularly termed. 
   Psychiatric medications carry risk for adverse effects. The occurrence of adverse effects can potentially reduce drug compliance. Some adverse effects can be treated symptomatically by using adjunct medications such as anticholinergics (antimuscarinics). Some rebound or withdrawal adverse effects, such as the possibility of a sudden or severe emergence or re-emergence of psychosis in antipsychotic withdrawal, may appear when the drugs are discontinued, or discontinued too rapidly.
  
  Section::::Adverse and withdrawal effects.:Medicine combinations with clinically untried risks.
  