title: Pathways to specialist care in an insomnia clinic at a psychiatric hospital: a comparative analysis of two periods.
abstract: BACKGROUND
  In this study, the pathways patients followed to treatment in an Insomnia Clinic in a psychiatric hospital were compared over 2 periods. The time interval to specialist referrals and patient clinical presentations were also studied. The aim was to better understand referrers' knowledge, needs and accessibility to services.
  
  
  METHODS
  A retrospective review of cases seen between 2002 and 2005 was compared with an earlier review of cases referred between 1997 and 2000. The information gathered from medical records was similar for the 2 periods.
  
  
  RESULTS
  There were no significant differences in the socio-demographic profiles of patients in the 2 periods. Primary Insomnia was diagnosed in 48.2% of the first period cohort and in 47.5% of the second period cohort. However, among the remaining patients there was a shift from more depressive disorders in the first period to neurosis in the second period. Significantly, there was no difference in alcohol or substance abuse or dependence between the 2 periods. More than three-quarters of the patients had received treatment prior to the referral and for 51.8% in both periods, the providers were family physicians. Treatment was mainly pharmacotherapy with an increase in the use of Sleep Hygiene measures in the second period.
  
  
  CONCLUSIONS
  There is a need for continuing medical education on insomnia as well as a need to highlight the risks of untreated insomnia and assessment for other psychiatric disorders in this common complaint.
authors.affiliation: Institute of Mental Health/Woodbridge Hospital, Singapore. rathi_mahendran@imh.com.sg
authors.forename: Rathi
authors.initials: R
authors.lastname: Mahendran
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D009497:Neurotic Disorders / Q000150:complications / Q000175:diagnosis; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012017:Referral and Consultation; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult