The manic readmissions explosion in Edinburgh

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Abstract
Between 1975 and 1985 there was a significant increase in the total number of admissions for mania and schizophrenia and a significant decrease for personality disorder to the Royal Edinburgh Hospital. All admissions for 1975 and 1985 in these three groups were subsequently examined retrospectively. The number of first admissions for personality disorder dropped significantly and the number of readmissions for mania increased significantly. Patients with schizophrenia and personality disorder had shorter admissions and a shorter relapse-free interval in 1985 but the overall effect of these changes was to reduce the total number of bed days used by these groups. For mania there was no change in admission length but significant shortening of the relapse-free interval leading to a substantial increase in total bed days used. There was no evidence that a change of diagnostic practice had occurred or that patients admitted with mania in 1985 were less ill. Although there were changes in referral and after-care arrangements, these were not specific to mania. Further work should specifically address the issue of aftercare arrangements and their influence on prognosis in mania, and the resource implications of the continuing rise in admissions.