title: Open general medical wards versus specialist psychiatric units for acute psychoses.
abstract: BACKGROUND
  As international healthcare policy has moved away from treating people with severe mental illness in large inpatient psychiatric institutions, beds for people with acute psychiatric disorders are being established in specialised psychiatric units in general hospitals. In developing countries, however, limited resources mean that it is not always possible to provide discrete psychiatric units, either in general hospitals or in the community. An alternative model of admission, used in the Caribbean, is to treat the person with acute psychosis in a general hospital ward.
  
  
  OBJECTIVE
  To compare the outcomes for people with acute psychoses who have been admitted to open medical wards with those admitted to conventional psychiatric units.
  
  
  METHODS
  The Cochrane Schizophrenia Group's study-based register was searched (November 2001). This register is compiled from searches of BIOSIS, CINAHL, The Cochrane Library, EMBASE, LILACS, MEDLINE, PsycINFO, PSYNDEX, Sociofile, and many conference proceedings.
  
  
  METHODS
  All relevant randomised or quasi-randomised trials, allocating anyone thought to be suffering from an acute psychotic episode to either acute management on general medical wards, or acute management in a specialist psychiatric unit. The primary outcomes of interest were length of stay in hospital and relapse.
  
  
  METHODS
  Studies were reliably selected, assessed for quality, and their data would have been extracted. Homogeneous data were to have been synthesised. For binary data, the risk ratios (RR) and 95% confidence intervals (CI) were to have been calculated on an-intention-to-treat basis. If possible, the number needed to treat/harm statistic (NNT/H) was to have been calculated. For continuous data, weighted mean differences (WMD) were to have been calculated and only data from valid scales would have been reported in this review.
  
  
  RESULTS
  We identified no relevant randomised trials.
  
  
  CONCLUSIONS
  The Caribbean practice of treating people with severe mental illness on general medical wards has been influenced by socio-economic factors rather than evidence from randomised trials. This practice affords an opportunity for a well designed, well conducted and reported randomised trial, now impossible in many other settings.
authors.affiliation: Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica. fhicklng@uwimona.edu.jm
authors.forename: F W
authors.initials: FW
authors.lastname: Hickling
authors.forename: W
authors.initials: W
authors.lastname: Abel
authors.forename: P
authors.initials: P
authors.lastname: Garner
mesh_terms: D000208:Acute Disease; D006757:Hospital Units; D006778:Hospitals, Psychiatric; D006801:Humans; D010362:Patients' Rooms; D011618:Psychotic Disorders / Q000628:therapy*