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Treating Revolving-Door Patients Who Have "Hospitalphilia": Compassion, Coercion, and Common Sense
Jeffrey L. Geller
Psychiatric Services 1993; doi:
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University of Massachusetts Medical School; University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, Massachusetts 01655

1993 by the American Psychiatric Association

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Abstract

Treatments applicable to the frequently rehospitalized psychiatric patient-the so-called revolvingdoor patient-have been poorly delineated. One subgroup of these patients includes those for whom recidivism has become a way of life; they may be said to suffer from "hospitalpbilia". Neither refractoriness to treatment nor noncompliance with medications explains their frequent admissions. The author presents ten clinical principles to guide treatment planning for this subgroup of patients. The principles emphasize cooperation between the patient and the treatment agencies in creating a comprehensive, consistent, and enforceable plan to reduce unnecessary hospitalizations. Four treatment strategies based on the principles are outlined: unlimited access to hospitalization, a chit or voucher system, a rationing system, and an approach centered on the patient's expressed ability to avoid hospitalization.

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