Sample records for acute psychiatric department

  1. Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

    Linaker Olav M


    Full Text Available Abstract Background In psychiatric acute departments some patients present with brief depressive periods accompanied with fluctuating arrays of other psychiatric symptoms like psychosis, panic or mania. For the purpose of the present study we call this condition Acute Unstable Depressive Syndrome (AUDS. The aims of the present study were to compare clinical signs of organic brain dysfunctions and epilepsy in patients with AUDS and Major Depressive Episode (MDE. Methods Out of 1038 consecutive patients admitted to a psychiatric acute ward, 16 patients with AUDS and 16 age- and gender-matched MDE patients were included in the study. Using standardized instruments and methods we recorded clinical data, EEG and MRI. Results A history of epileptic seizures and pathologic EEG activity was more common in the AUDS group than in the MDE group (seizures, n = 6 vs. 0, p = 0.018; pathologic EEG activity, n = 8 vs. 1, p = 0.015. Five patients in the AUDS group were diagnosed as having epilepsy, whereas none of those with MDE had epilepsy (p = 0.043. There were no differences between the groups regarding pathological findings in neurological bedside examination and cerebral MRI investigation. Conclusion Compared to patients admitted with mood symptoms fulfilling DSM 4 criteria of a major depressive disorder, short-lasting atypical depressive symptoms seem to be associated with a high frequency of epileptic and pathologic EEG activity in patients admitted to psychiatric acute departments. Trial registration NCT00201474

  2. Quantitative EEG findings in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

    Linaker Olav M


    Full Text Available Abstract Background Patients with brief depressive episodes and concurrent rapidly fluctuating psychiatric symptoms do not fit current diagnostic criteria and they can be difficult to diagnose and treat in an acute psychiatric setting. We wanted to study whether these patients had signs of more epileptic or organic brain dysfunction than patients with depression without additional symptomatology. Methods Sixteen acutely admitted patients diagnosed with a brief depressive episode as well as another concurrent psychiatric diagnosis were included. Sixteen patients with major depression served as controls. Three electroencephalographic studies (EEG were visually interpreted and the background activity was also analysed with quantitative electroencephalography (QEEG. Results The group with brief depression and concurrent symptoms had multiple abnormal features in their standard EEG compared to patients with major depression, but they did not show significantly more epileptiform activity. They also had significantly higher temporal QEEG delta amplitude and interhemispheric temporal delta asymmetry. Conclusion Organic brain dysfunction may be involved in the pathogenesis of patients with brief depressive episodes mixed with rapidly fluctuating psychiatric symptoms. This subgroup of depressed patients should be investigated further in order to clarify the pathophysiology and to establish the optimal evaluation scheme and treatment in an acute psychiatric setting.

  3. Assessment of the Acute Psychiatric Patient in the Emergency Department: Legal Cases and Caveats


    1994; 24(4):672–677. 7. Dubin WR, Weiss KJ, Zeccardi JA. Organic brain syndrome: The psychiatric imposter. JAMA. 1993;249(1):60–62. 8. Tintinalli JE...16. Dubin WR, Weiss KJ. Emergency psychiatry. In: Michels R, Cavenar JD, Cooper AM, et al, ed: Psychiatry. Philadelphia: Lippincott-Raven; 1997:1–15

  4. Observed-predicted length of stay for an acute psychiatric department, as an indicator of inpatient care inefficiencies. Retrospective case-series study.

    Marot Milagros


    Full Text Available Abstract Background Length of stay (LOS is an important indicator of efficiency for inpatient care but it does not achieve an adequate performance if it is not adjusted for the case mix of the patients hospitalized during the period considered. After two similar studies for Internal Medicine and Surgery respectively, the aims of the present study were to search for Length of Stay (LOS predictors in an acute psychiatric department and to assess the performance of the difference: observed-predicted length of stay, as an indicator of inpatient care inefficiencies. Methods Retrospective case-series of patients discharged during 1999 from the Psychiatric Department from General Hospital "Hermanos Ameijeiras" in Havana, Cuba. The 374 eligible medical records were randomly split into two groups of 187 each. We derived the function for estimating the predicted LOS within the first group. Possible predictors were: age; sex; place of residence; diagnosis, use of electroconvulsive therapy; co morbidities; symptoms at admission, medications, marital status, and response to treatment. LOS was the dependent variable. A thorough exam of the patients' records was the basis to assess the capacity of the function for detecting inefficiency problems, within the second group. Results The function explained 37% of LOS variation. The strongest influence on LOS came from: age (p = 0.002, response to treatment (p Conclusions This study demonstrates the importance of possible predictors of LOS, in an acute care Psychiatric department. The proposed indicator can be readily used to detect inefficiencies.

  5. Children and adolescents in the Psychiatric Emergency Department: a 10-year survey in Copenhagen County

    Taastrøm, Annette; Klahn, Julie; Staal, Nina;


    Background: Knowledge on psychiatric emergencies in children and adolescents is limited. The Psychiatric Emergency Departments (PED) in Copenhagen enable the acute examination of children and adolescents 24 h a day, 7 days a week. However, very little is known about who presents to the PED...

  6. The Impact of Psychiatric Patient Boarding in Emergency Departments

    B. A. Nicks


    Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.

  7. Acute psychiatric beds: distribution and staffing in NSW and ACT.

    Rosenman, S


    This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. "Gazetted" acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990-1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured. Acute "gazetted" beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. "Non-gazetted" beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability. The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.

  8. Pediatric psychiatric emergency department visits during a full moon.

    Kamat, Shyama; Maniaci, Vincenzo; Linares, Marc Yves-Rene; Lozano, Juan M


    This study aimed to verify the hypothesis that the lunar cycle influences the number of pediatric psychiatric emergency department (ED) visits. Pediatric psychiatric ED visits between 2009 and 2011 were obtained retrospectively. Patients aged between 4 and 21 years presenting to Miami Children's Hospital ED with a primary psychiatric complaint were included in the study. Patients with a concomitant psychiatric problem and a secondary medical condition were excluded. The number of psychiatric visits was retrieved for the full moon dates, control dates as well as the day before and after the full moon when the moon appears full to the naked eye (full moon effect). A comparison was made using the 2-sample independent t test. Between 2009 and 2011, 36 dates were considered as the true full moon dates and 108 dates as the "full moon effect." A total of 559 patients were included in the study. The 2-sample independent t tests were performed between the actual full moon date and control dates, as well as between the "full moon effect" dates and control dates. Our results failed to show a statistical significance when comparing the number of pediatric psychiatric patients presenting to a children's hospital ED during a full moon and a non-full moon date. Our study's results are in agreement with those involving adult patients. The full moon does not affect psychiatric visits in a children's hospital.

  9. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    Bui, Quan M.


    Full Text Available We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. [West J Emerg Med. 2015;16(3:414–417.

  10. Medical clearance of the psychiatric patient in the emergency department.

    Janiak, Bruce D; Atteberry, Suzanne


    As part of the emergency department (ED) evaluation of patients with psychiatric complaints, emergency physicians are often asked to perform screening laboratory tests prior to admitting psychiatric patients, the value of which is questionable. To determine if routine screening laboratory studies performed in the ED on patients with a psychiatric chief complaint would alter ED medical clearance (evaluation, management or disposition) of such patients. In this retrospective chart review, the patient charts were reviewed for triage notes, history and physical examination, laboratory study results, and patient disposition. The study investigators subjectively determined if any of the laboratory abnormalities identified after admission would have changed ED management or disposition of the patient had they been identified in the ED. Subjects were 519 consecutive adult patients (18 years of age and older) admitted to the Medical College of Georgia's inpatient psychiatric ward through the ED. There were 502 patients who met inclusion criteria, and 50 of them had completely normal laboratory studies. Laboratory studies were performed in the ED for 148 patients. The most common abnormalities identified were positive urine drug screen (n = 221), anemia (n = 136), and hyperglycemia (n = 139). There was one case (0.19%) identified in which an abnormal laboratory value would have changed ED management or disposition of the patient had it been found during the patient's ED visit. Patients presenting to the ED with a psychiatric chief complaint can be medically cleared for admission to a psychiatric facility by qualified emergency physicians using an appropriate history and physical examination. There is no need for routine medical screening laboratory tests. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Psychiatric Disorders in Children and Adolescents Attending Pediatric Out Patient Departments of Tertiary Hospitals

    Akhter Jesmin


    Full Text Available Objectives: Psychiatric disorders are increasingly recognized among children and adolescents in Bangladesh. Psychiatric disorders are more common in children with chronic and acute pediatric disorders. Our study was designed to determine the psychiatric disorders among children and adolescents attending pediatric outpatient departments of tertiary care hospitals. Methods: This cross-sectional study was carried out from July 2012 to February 2013 in pediatric outpatient departments of three prime tertiary level hospitals of Dhaka, Bangladesh. A purposive sampling technique was used. A total of 240 male and female children aged 5 to 16 years old were included in the study. We used a semi-structured questionnaire to obtain sociodemographic and other relevant clinical information about the children and their families from their parents or caregivers and a validated parent version of the Bangla Development and Well-Being Assessment (DAWBA for measuring psychopathology. Results: The mean age of the children was 9.0± 2.6 years. The majority (71% of children were in the 5–10 year age group. The male/female ratio was 1.2:1. Among the respondents, 18% were found to have a psychiatric disorder. Behavioral disorders, emotional disorders, and developmental disorders were found in 9.0%, 15.0% and 0.4% respectively. Hyperkinetic disorder was the single most frequent (5.0% psychiatric disorder. Conclusions: A significant number of children were found to have psychiatric disorders. Our study indicates the importance of identification and subsequent management of psychiatric conditions among the pediatric population.

  12. Psychiatric service users, experiences of emergency departments: a CERQual review oaf qualitative studies

    Jensen, Lotte Groth; Carstensen, Kathrine; Lou, Stina


    Abstract Background: There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users’ experiences regarding general EDs is limited. Aim: To identify and summarize current, qualitative...

  13. Hostility and violence of acute psychiatric inpatients

    Azzoni Antonella


    Full Text Available Abstract Objective The aim of the present study was to find out the extent of hostility and violence and the factors that are associated with such hostility and violence in a psychiatric intensive care unit. Methods Retrospective analysis of data prospectively collected in a 6-year period. Results No hostility was observed in 56.1%, hostility in 40.9%, and violence in 3.0% of the admitted cases. Seclusion was never used. Six cases (2,5‰ required physical restraint. Risk factors associated with violence were younger age, suicidal risk, and diagnosis of schizophrenia. Risk factors associated with hostile and violent behavior were younger age at the onset of the disorder, being single, having no children, lower GAF scores, higher BPRS hostility, SAPS, and CGI scores, lower BPRS anxiety-depression score, higher doses of psychoactive drugs, more frequent use of neuroleptics, diagnosis of mania, personality disorder, substance and alcohol related disorders, no diagnosis of depression. Conclusion The study confirms the low rate of violence among Italian psychiatric in-patients, the major relevance of clinical rather than socio-demographic factors in respect of aggressive behavior, the possibility of a no seclusion-no physical restraint policy, not associated either with higher rates of hostility or violence or with more severe drug side effects.

  14. Effects of a Dedicated Regional Psychiatric Emergency Service on Boarding of Psychiatric Patients in Area Emergency Departments

    Scott Zeller


    Full Text Available Introduction: Mental health patients boarding for long hours, even days, in United States emergency departments (EDs awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the “regional dedicated emergency psychiatric facility,” which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the “Alameda Model” on boarding times and hospitalization rates for psychiatric patients in area EDs. Methods: Over a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service.Results: In a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service. Conclusion: The results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding

  15. Factors predicting adherence with psychiatric follow-up appointments for patients assessed by the liaison psychiatric team in the emergency department.

    Agyapong, Vincent I O


    Several factors may predict adherence with psychiatric follow-up appointment for patients seen in the emergency department (ED) by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups.

  16. Screening for Sexual Orientation in Psychiatric Emergency Departments

    Currier, Glenn W.


    Full Text Available Introduction: Our goal was to explore whether emergency department (ED patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177 presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants’ willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results: No participants (0/177 refused to respond to the categorical question about sexual orientation, 168/177 (94.9% agreed to provide information about prior sexual partners, and 100/109 (91.7% provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0% self-identified as heterosexual, 11 (6.2% as bisexual, 10 (5.6% as gay or lesbian, and 2 (1.1% indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89 reported sexual attraction as other than ‘only opposite sex,’ and 10.3% (15/142 of sexually active ‘heterosexual’ participants reported previous same-gender sexual partners. Conclusion

  17. An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy

    Margari Francesco


    Full Text Available Abstract Objectives this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs. Information was focused on diagnosis (DSM-IV, reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. Methods assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS, the Modified Overt Aggression Scale (MOAS and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30. Results 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs completed both admission and discharge visits. A severe psychotic episode with (19.1% or without (47.7% aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge and depression (12.9% at admission and 14.7% at discharge were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0% patients had episodes of aggressiveness at admission and 8 (1.7% at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%, 686 (94.2% and 676 (92.9%. The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%, typical anti-psychotics (48.3%, 57.0%, 49.6%, atypical anti-psychotics (35.6%, 41.8%, 39.8% and antidepressants (40.9%, 48.8%, 43.2%. Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20

  18. Dissociative disorders in acute psychiatric inpatients in Taiwan.

    Chiu, Chui-De; Meg Tseng, Mei-Chih; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo; Ross, Colin A


    Dissociative disorders have been documented to be common psychiatric disorders which can be detected reliably with standardized diagnostic instruments in North American and European psychiatric inpatients and outpatients (20.6% and 18.4%, respectively). However, there are concerns about their cross-cultural manifestations as an apparently low prevalence rate has been reported in East Asian inpatients and outpatients (1.7% and 4.9%, respectively). It is unknown whether the clinical profile of dissociative disorders in terms of their core symptomatic clusters, associated comorbid disorders, and environmental risk factors that has emerged in western clinical populations can also be found in non-western clinical populations. A standardized structured interview for DSM-IV dissociative disorders, post-traumatic stress disorder, and a history of interpersonal victimization was administered in a sample of Taiwanese acute psychiatric inpatients. Our results showed that 19.5% of our participants met criteria for a DSM-IV dissociative disorder, mostly dissociative disorder not otherwise specified. More importantly, the western clinical profile of dissociative disorders also characterized our patients, including a poly-symptomatic presentation and a history of interpersonal trauma in both childhood and adulthood. Our results lend support to the conclusion that cross-cultural manifestations of dissociative pathology in East Asia are similar to those in North America and Europe. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  19. Specific psychiatric correlates of acute care utilization among unstably housed HIV-positive adults.

    Chartier, Maggie; Carrico, Adam W; Weiser, Sheri D; Kushel, Margot B; Riley, Elise D


    The role of specific psychiatric diagnoses in emergency department use and/or inpatient hospitalizations (acute care) has not been extensively examined among HIV-infected, unstably housed persons. A community-recruited sample of 284 HIV-infected, unstably housed adults completed the Diagnostic Interview Schedule for DSM-IV. One-third of participants screened positive for major depression and stimulant use disorders. Sleeping on the street [adjusted odds ratio (AOR) = 4.21], major depression (AOR = 2.88) and stimulant use disorders (AOR = 4.45) were associated with greater odds of acute care use. Housing and effective treatment of depression and stimulant use disorders may decrease use of acute care services in this population.

  20. Acute psychiatric inpatient care: A cross-cultural comparison between two hospitals in Germany and Japan


    Background: Intercultural differences influence acute inpatient psychiatric care systems. Aims: To evaluate characteristics of acute inpatient care in a German and a Japanese hospital. Method: Based on a sample of 465 admissions to the Psychiatric State Hospital Regensburg (BKR) and 91 admissions to the Hirakawa Hospital (HH) over a six-month period in 2008, data from the psychiatric basic documentation system (BADO) were analysed with regard to socio-demographic characteristics, treatm...

  1. A screening tool to medically clear psychiatric patients in the emergency department.

    Shah, Sachin J; Fiorito, Michael; McNamara, Robert M


    Emergency physicians are frequently called on to medically clear patients presenting with a psychiatric complaint. There is limited guidance on how to conduct this clearance. This study evaluated the usefulness of a screening tool in ruling out serious organic disease in emergency department (ED) patients with psychiatric complaints. A retrospective chart review was performed on 500 consecutive adult ED patients with primarily psychiatric complaints who were evaluated using the tool, and then subsequently transferred to a psychiatric crisis center. The screening tool consists of a series of historical and physical examination criteria derived from the literature intended to identify patients who have a psychiatric manifestation of an organic disease. The physician filled out the screening form and if the proper conditions were met, the patient was transferred to Psychiatry without further laboratory or imaging studies. We reviewed the charts of both the ED visit and the psychiatric crisis center visit to determine if any of the patients required further medical treatment or a medical admission rather than a psychiatric admission. Five hundred consecutive ED patient charts were reviewed. Fifteen of the corresponding charts from the psychiatric center could not be found. Of the remaining 485 patients, 6 patients were sent back to the ED for further evaluation. After laboratory work and imaging, none of these 6 patients required more than an outpatient prescription. The screening tool proved useful in determining if a psychiatric patient needed further medical evaluation beyond a history and physical examination before transfer for a psychiatric evaluation. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Treatment profiles in a Danish psychiatric university hospital department

    Okkels, Niels; Mogensen, Rasmus Beyer; Crean, Lea Catherine


    -eight patients (94%) used psychotropic medication, 37 (19%) as monotherapy, and 148 (74%) in combination with non-pharmacological therapy. Ninety-seven (49%) had psychotherapy and 104 (52%) social support. Among inpatients, 21 (64%) had physical therapy, and 10 (30%) electroconvulsive therapy. In total, 163 (82......%) had non-pharmacological therapy. Fifty-two (26%) patients had monotherapy, and 148 (74%) polytherapy. Mean number of treatment modalities used per patient was 2.07 for all patients and 3.23 for inpatients. CONCLUSIONS: In this department, polytherapy including non-pharmacological modalities is applied...

  3. Switch Function and Pathological Dissociation in Acute Psychiatric Inpatients.

    Chui-De Chiu

    Full Text Available Swift switching, along with atypical ability on updating and inhibition, has been found in non-clinical dissociators. However, whether swift switching is a cognitive endophenotype that intertwines with traumatisation and pathological dissociation remains unknown. Unspecified acute psychiatric patients were recruited to verify a hypothesis that pathological dissociation is associated with swift switching and traumatisation may explain this relationship. Behavioural measures of intellectual function and three executive functions including updating, switching and inhibition were administered, together with standardised scales to evaluate pathological dissociation and traumatisation. Our results showed superior control ability on switching and updating in inpatients who displayed more symptoms of pathological dissociation. When all three executive functions were entered as predictors, in addition to intellectual quotient and demographic variables to regress upon pathological dissociation, switching rather than updating remained the significant predictor. Importantly, the relationship between pathological dissociation and switching became non-significant when the effect of childhood trauma were controlled. The results support a trauma-related switching hypothesis which postulates swift switching as a cognitive endophenotype of pathological dissociation; traumatisation in childhood may explain the importance of swift switching.

  4. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial

    Abderhalden, Christoph; Needham, Ian; Dassen, Theo; Halfens, Ruud; Haug, Hans-Joachim; Fischer, Joachim E


    .... To assess whether such risk assessments decrease the incidence of violence and coercion. A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm...

  5. Drug Screens for Psychiatric Patients in the Emergency Department: Evaluation and Recommendations

    Kroll, David S.; Smallwood, Jennifer; Chang, Grace


    Objective To better understand how toxicology screening for psychiatric patients in the emergency department (ED) setting affects diagnostic decisions. Methods Retrospective chart review of 439 ED visits of adult patients receiving psychiatry consultations at two hospitals, one an academic medical center (n = 224) and the other a community hospital (n = 220), between July 2008 and February 2009. Clinical, demographic, and ED length of stay (LOS) information was abstracted from the psychiatry consultation notes and the medical records. Results Positive urine toxicology results, when combined with a basic substance abuse history, were not associated independently with a patient’s receiving a substance-related diagnosis as part of the psychiatric assessment. By contrast, a positive blood alcohol level was associated independently with a patient’s receiving one of these diagnoses while a positive alcohol use history was not. Conclusions Urine toxicology screens do not add significant diagnostic value to all ED psychiatric evaluations when combined with standard substance use histories. PMID:23194932

  6. Acute and long-term psychiatric side effects of mefloquine

    Ringqvist, Asa; Bech, Per; Glenthøj, Birte


    psychiatric side effects were retrospectively assessed using the SCL-90-R and questions based on Present State Examination (PSE). Subjects reporting suspected psychotic states were contacted for a personal PSE interview. Electronic records of psychiatric hospitalizations and diagnoses were cross-checked. Long...

  7. Psychiatric emergency services in Amsterdam: Experiences with acute admissions in a metropolitan area

    Mulder, W.; Dekker, J.J.M.; Gijsbers van WIjk, C.


    Problems in the acute sector of psychiatric care are not unique to the Netherlands and at an international level appear to be linked to problems that are significant for big cities. The search for an “acute bed” had become more difficult and patients were being placed and transported through the who

  8. Psychiatric emergency services in Amsterdam: Experiences with acute admissions in a metropolitan area

    Mulder, W.; Dekker, J.J.M.; Gijsbers van WIjk, C.


    Problems in the acute sector of psychiatric care are not unique to the Netherlands and at an international level appear to be linked to problems that are significant for big cities. The search for an “acute bed” had become more difficult and patients were being placed and transported through the

  9. Psychiatric context of acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: IV.

    Atkinson, J Hampton; Higgins, Jenny A; Vigil, Ofilio; Dubrow, Robert; Remien, Robert H; Steward, Wayne T; Casey, Corinna Young; Sikkema, Kathleen J; Correale, Jackie; Ake, Chris; McCutchan, J Allen; Kerndt, Peter R; Morin, Stephen F; Grant, Igor


    Acute/early HIV infection is a period of high risk for HIV transmission. Better understanding of behavioral aspects during this period could improve interventions to limit further transmission. Thirty-four participants with acute/early HIV infection from six US cities were assessed with the Mini International Diagnostic Interview, Beck Depression Inventory II, State-Trait Anxiety Inventory, Brief COPE, and an in-depth interview. Most had a pre-HIV history of alcohol or substance use disorder (85%); a majority (53%) had a history of major depressive or bipolar disorder. However, post-diagnosis coping was predominantly adaptive, with only mild to moderate elevations of anxious or depressive mood. Respondents described challenges managing HIV in tandem with pre-existing substance abuse problems, depression, and anxiety. Integration into medical and community services was associated with adaptive coping. The psychiatric context of acute/early HIV infection may be a precursor to infection, but not necessarily a barrier to intervention to reduce forward transmission of HIV among persons newly infected.

  10. [Enrichment of the functions of the psychiatric department in a general hospital and collaboration within the area].

    Koishikawa, Hiraki; Ookami, Toshihiko


    Psychiatric disease has been included in the five main diseases, and a medical care plan is required. In it, there are many problems, for example, physical complications and which general hospital should chiefly deal with it. Here, we present a way to cope with these problems on the basis of achievements in the psychiatric department of Kameda General Hospital. Specifically, we would like to assert that creating a consultation-liaison team and enriching the section of clinical psychiatry are very important and effective. The activities of the consultation-liaison team, created to address various issues after establishing a psychiatric ward, have led to the possibility of a psychiatric department in a general hospital. Experience to date indicates that, in the context of a general hospital with a psychiatric inpatient unit, the existence of a multidisciplinary liaison team working across departmental boundaries is crucial to determining and managing the treatment of patients with psychiatric emergencies, as well as patients with psychiatric issues and physical complications. Additionally, in order to increase the effectiveness of the hospital liaison team, it is critical to realize seamless, prompt collaboration with facilities outside the hospital. In this respect, the role of a patient care coordinator is expected to become increasingly important. Additionally, enriching and guarding activities of clinical psychologists have contributed to the growth of psychiatric departments in general hospitals and proved to be effective in combination with activities of the consultation-liaison team.

  11. Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study

    Bowers, L.; Allan, T.; Simpson, A.; Nijman, H; Warren, J.


    Background: Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice.\\ud \\ud Aims: To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables.\\ud \\ud Methods: A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. Thi...

  12. Nurse-police coalition: improves safety in acute psychiatric hospital.

    Allen, Diane E; Harris, Frank N; de Nesnera, Alexander


    Although police officers protect and secure the safety of citizens everywhere, nurses are the primary guardians of patient safety within the treatment milieu. At New Hampshire Hospital, both nurses and police officers share ownership of this responsibility, depending on the needs that arise specific to each profession. Psychiatric nurses take pride in their ability to de-escalate agitated and potentially aggressive patients; however, times arise when the best efforts of nurses fail, or when a situation requires intervention from police officers. Nurses and police officers at New Hampshire Hospital have worked together for many years to develop a trusting, respectful alliance. This coalition has resulted in a safe, clear, orderly process for transfer of authority from nurses to police during violent, clinically unmanageable psychiatric emergencies. Nurses and police officers work collaboratively toward the common goal of ensuring safety for patients and staff, while also acknowledging the unique strengths of each profession.

  13. Depression in patients with schizophrenia admitted to the acute services of the Psychiatric Hospital of Havana

    Llanes Basulto, Yasmani; Barrios Hernández, Yanquiel; Oliva Hernández, Ignacio; Pimentel Noda, Susel de la Caridad; Calvo Guerra, Esvieta


    The presence of depression in the acute phase of schizophrenia is evaluated, and the clinical and psychosocial characteristics that can be associated with depression are identified. Participants included 73 patients that were admitted to the acute services of the Psychiatric Hospital of Havana, given that depression is a symptom in a significant amount of the patients with schizophrenia, 35.6% of the patients presented clinically significant symp- toms, and these were related significantly wi...

  14. Emergency Department Management Of Acute Infective Endocarditis.

    Schauer, Steven G; Pfaff, James A; Cuenca, Peter John


    Infective endocarditis has a high rate of mortality, and most patients suspected of having the disease will require hospital admission. This review examines the literature as it pertains specifically to emergency clinicians who must maintain vigilance for risk factors and obtain a thorough history, including use of intravenous drugs, in order to guide the workup and treatment. Properly obtained cultures are critical during the evaluation, as they direct the course of antibiotic therapy. Although transthoracic echocardiography is widely available in United States emergency departments, it is not sensitive or specific enough to rule out a diagnosis of infective endocarditis. In high-risk patients, transesophageal echocardiography should be considered.

  15. Investigation into the acceptability of door locking to staff, patients, and visitors on acute psychiatric wards.

    Muir-Cochrane, Eimear; van der Merwe, Marie; Nijman, Henk; Haglund, Kristina; Simpson, Alan; Bowers, Len


    There is disagreement among psychiatric professionals about whether the doors of acute psychiatric wards should be kept locked to prevent patients from leaving and harming themselves or others. This study explored patient, staff, and visitor perceptions about the acceptability of locking the ward door on acute psychiatric inpatient wards. Interviews were conducted with 14 registered nurses, 15 patients, and six visitors from three different acute wards. Findings revealed commonalities across all groups, with general agreement that locking the door reduced absconding. Staff expressed feelings of guilt, embarrassment, and fear of being blamed when a patient absconded. Staff also reported that open wards created anxious vigilance to prevent an abscond and increased workload in allocating staff to watch the door, whereas staff on partially-locked doors also perceived an increased workload in letting people in and out of the ward. Patients had mixed feelings about the status of the door, expressing depression, a sense of stigma, and low self-esteem when the door was locked. The issue of balancing safety and security on acute psychiatric wards against the autonomy of patients is not easily resolved, and requires focused research to develop innovative nursing practices. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  16. A Comparative Study of Pituitary Volume Variations in MRI in Acute Onset of Psychiatric Conditions.

    Soni, Brijesh Kumar; Joish, Upendra Kumar; Sahni, Hirdesh; George, Raju A; Sivasankar, Rajeev; Aggarwal, Rohit


    The growing belief that endocrine abnormalities may underlie many mental conditions has led to increased use of imaging and hormonal assays in patients attending to psychiatric OPDs. People who are in an acute phase of a psychiatric disorder show Hypothalamic Pituitary Adrenal (HPA) axis hyperactivity, but the precise underlying central mechanisms are unclear. To assess the pituitary gland volume variations in patients presenting with new onset acute psychiatric illness in comparison with age and gender matched controls by using MRI. The study included 50 patients, with symptoms of acute psychiatric illness presenting within one month of onset of illness and 50 age and gender matched healthy controls. Both patients and controls were made to undergo MRI of the Brain. A 0.9 mm slices of entire brain were obtained by 3 dimensional T1 weighted sequence. Pituitary gland was traced in all sagittal slices. Anterior pituitary and posterior pituitary bright spot were measured separately in each slice. Volume of the pituitary (in cubic centimetre- cm(3)) was calculated by summing areas. Significance of variations in pituitary gland volumes was compared between the cases and controls using Analysis of Covariance (ANOVA). There were significantly larger pituitary gland volumes in the cases than the controls, irrespective of psychiatric diagnosis (ANOVA, f=15.56; p=0.0002). Pituitary volumes in cases were 15.36% (0.73 cm(3)) higher than in controls. There is a strong likelihood of HPA axis overactivity during initial phase of all mental disorders along with increased pituitary gland volumes. Further studies including hormonal assays and correlation with imaging are likely to provide further insight into neuroanatomical and pathological basis of psychiatric disorders.

  17. Prevention and management of aggression training and violent incidents on U.K. Acute psychiatric wards.

    Bowers, Len; Nijman, Henk; Allan, Teresa; Simpson, Alan; Warren, Jonathan; Turner, Lynny


    Reports of violence and injuries to staff and patients in acute psychiatric inpatient settings have led to the development and implementation of training courses in the Prevention and Management of Violence and Aggression (PMVA). The purpose of this study was to explore the relationship between PMVA training of acute psychiatric ward nursing staff and officially reported violent incident rates. A retrospective analysis was conducted of training records (312 course attendances) and violent incident rates (684 incidents) over two-and-a-half years on 14 acute admission psychiatric wards (5,384 admissions) at three inner-city hospitals in the United Kingdom as part of the Tompkins Acute Ward Study. A positive association was found between training and rates of violent incidents. There was weak evidence that increased rates of aggressive incidents prompted course attendance, no evidence that course attendance reduced violence, and some evidence that attendance of briefer update courses triggered small short-term rises in rates of physical aggression. Course attendance was associated with a rise in physical and verbal aggression while staff were away from the ward. The failure to find a drop in incident rates after training, coupled with the small increases in incidents detected, raises concerns about the training course's efficacy as a preventive strategy. Alternatively, the results are consistent with a threshold effect, indicating that once adequate numbers of staff have been trained, further training keeps incidents at a low rate.

  18. Risk factors leading to increased rehospitalization rates among adolescents admitted to an acute care child and adolescent psychiatric hospital.

    McCarthy, Logan; Pullen, Lisa M; Savage, Jennifer; Cayce, Jonathan


    Suicide is the third leading cause of death in adolescents in the United States, with suicidal behavior peaking in adolescence. Suicidal and self-harming behavior is often chronic, with an estimated 15-30% of adolescents who attempt suicide having a second suicide attempt within a year. The focus of acute psychiatric hospitalization is on stabilization of these psychiatric symptoms resulting at times in premature discharge. Finding from studies based on high rehospitalization rates among adolescents admitted to an acute psychiatric hospital indicates that adolescents continue to experience crisis upon discharge from an acute psychiatric hospital, leading to the question of whether or not these adolescents are being discharged prematurely. A chart review was performed on 98 adolescent clients admitted to an acute psychiatric hospital to identify risk factors that may increase rehospitalization among adolescents admitted to an acute psychiatric hospital. Clients admitted to the hospital within a 12-month time frame were compared to clients who were not readmitted during that 12-month period. History of self-harming behavior and length of stay greater than 5 days were found to be risk factors for rehospitalization. Adolescent clients who are admitted to an acute psychiatric hospital with a history of self-harming behavior and extended length of stay need to be identified and individualized treatment plans implemented for preventing repeat hospitalizations. © 2017 Wiley Periodicals, Inc.

  19. Imaging strategies for acute chest pain in the emergency department

    A. Dedic (Admir); T.S.S. Genders (Tessa); K. Nieman (Koen); M.G.M. Hunink (Myriam)


    textabstractOBJECTIVE. Echocardiography, radionuclide myocardial perfusion imaging (MPI), and coronary CT angiography (CTA) are the three main imaging techniques used in the emergency department for the diagnosis of acute coronary syndrome (ACS). The purpose of this article is to quantitatively

  20. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology.

    Svindseth, Marit F; Nøttestad, Jim Aage; Wallin, Juliska; Roaldset, John Olav; Dahl, Alv A


    The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM). Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations >/=0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

  1. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Svindseth, Marit F; Nøttestad, Jim Aage; Wallin, Juliska; Roaldset, John Olav; Dahl, Alv A


    Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM). Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM). Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination. PMID:18304339

  2. Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

    Wallin Juliska


    Full Text Available Abstract Background The objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM. Methods This cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS and the Global Assessment of Functioning (GAF. The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21, The Hospital Anxiety and Depression Scale (HADS and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM. Results Being male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales. Conclusion Narcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

  3. Effectiveness of a Multimodal Intervention Program for Restraint Prevention in an Acute Spanish Psychiatric Ward.

    Guzman-Parra, Jose; Aguilera Serrano, Carlos; García-Sánchez, Juan A; Pino-Benítez, Isabel; Alba-Vallejo, Mercedes; Moreno-Küstner, Berta; Mayoral-Cleries, Fermin


    International recommendations have called to implement strategies to reduce the use of coercion in psychiatric settings. However, in Spain there is a lack of research about intervention programs to reduce mechanical restraint in acute psychiatric units. The aim of this study was to evaluate the effectiveness of a multimodal intervention program based on the principles of six core strategies to reduce the frequency of use of mechanical restraint in an acute psychiatric ward. The design was a retrospective analysis of the frequency and duration of episodes of mechanical restraint prior to the intervention program (2012) and during the intervention program (2013) in one acute psychiatric ward. The intervention was governed by four strategies: (1) leadership and organizational changes, (2) registration and monitoring of risk patients, (3) staff training, and (4) involving patients in the treatment program. There was a significant difference between the mean number of monthly episodes of mechanical restraint per 1,000 patient days, pre-intervention (18.54 ± 8.78) compared with postintervention (8.53 ± 7.00; p = .005). We found the probability that mechanical restraint would occur in a hospital admission decreased after performing the intervention (odds ratio = .587; confidence interval = 0.411-0.838; p = .003) after adjusting for confounding variables. The total percentage of restrained patients fell from 15.07% to 9.74%. The main implication of the study is to support the effectiveness of specific intervention programs based on different measures to reduce mechanical restraint and without contemplating all the strategies that are considered effective. © The Author(s) 2016.

  4. Mobile Mindfulness Intervention on an Acute Psychiatric Unit: Feasibility and Acceptability Study.

    Mistler, Lisa A; Ben-Zeev, Dror; Carpenter-Song, Elizabeth; Brunette, Mary F; Friedman, Matthew J


    Aggression and violence on acute psychiatric inpatient units is extensive and leads to negative sequelae for staff and patients. With increasingly acute inpatient milieus due to shorter lengths of stay, inpatient staff is limited in training and time to be able to provide treatments. Mobile technology provides a new platform for offering treatment on such units, but it has not been tested for feasibility or usability in this particular setting. The aim of this study was to examine the feasibility, usability, and acceptability of a brief mindfulness meditation mobile phone app intended to reduce anger and aggression in acute psychiatric inpatients with schizophrenia, schizoaffective disorder, or bipolar disorder, and a history of violence. Participants were recruited between November 1, 2015 and June 1, 2016. A total of 13 inpatients at an acute care state hospital carried mobile phones for 1 week and were asked to try a commercially available mindfulness app called Headspace. The participants completed a usability questionnaire and engaged in a qualitative interview upon completion of the 7 days. In addition, measures of mindfulness, state and trait anger, and cognitive ability were administered before and after the intervention. Of the 13 enrolled participants, 10 used the app for the 7 days of the study and completed all measures. Two additional participants used the app for fewer than 7 days and completed all measures. All participants found the app to be engaging and easy to use. Most (10/12, 83%) felt comfortable using Headspace and 83% (10/12) would recommend it to others. All participants made some effort to try the app, with 6 participants (6/12, 50%) completing the first 10 10-minute "foundation" guided meditations. This is the first known study of the use of a commercially available app as an intervention on acute psychiatric inpatient units. Acutely ill psychiatric inpatients at a state hospital found the Headspace app easy to use, were able to complete

  5. A systematic review of music therapy practice and outcomes with acute adult psychiatric in-patients.

    Catherine Carr

    Full Text Available There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported.A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis.98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions.No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to develop specific music therapy models for this

  6. Acute atropine intoxication with psychiatric symptoms by herbal infusion of Pulmonaria officinalis (Lungwort

    Enrique Baca-García


    Full Text Available Background and objectives: Lungwort infusion is a preparation extracted from Pulmonaria officinalis which is occasionally used as a folk remedy for the common cold. The current report aims to describe acute atropine intoxications with delirium caused by Lungwort infusion in several members of the same family. Methods: Description of three case reports. Search of literature through Medline. Results: Three generations of a same family presented acute and moderately severe atropine intoxications after drinking an infusion prepared with Pulmonaria officinalis. Conclusions: Despite the lack of scientific evidence for its clinical use, medicinal plants continue being widely used. In spite of severe adverse effects reported, the general thought is that herbal remedies are harmless. To our knowledge, this is the first report of acute atropine intoxications with psychiatric symptoms secondary to Pulmonaria officinalis in several members of a family. We suspect that the lungwort infusion may have been contaminated with some other substance with atropinic properties.

  7. Predictors of inpatient psychiatric admission in patients presenting to the emergency department: the role of dimensional assessment.

    Dazzi, Federico; Picardi, Angelo; Orso, Luigi; Biondi, Massimo


    To identify which patient factors predict psychiatric hospitalization in patients presenting to the emergency department and to examine the role of the dimensional approach to psychopathology in predicting hospitalization. We consecutively recruited 312 patients undergoing psychiatric evaluation in the emergency room of a hospital in Rome over a 6-month period. Patients were rated on the SVARAD (Scala per la Valutazione Rapida Dimensionale), a scale designed for the rapid assessment of the main psychopathological dimensions. Information about patient history, as well as sociodemographic and clinical variables, was also collected. Univariate analysis was performed to detect the variables associated with recommendation of psychiatric hospitalization. Multiple logistic regression analysis was used to identify independent predictors of hospitalization and compare their strength. A replication study was performed in another hospital on a random sample of 118 patients. In both studies, patients who were recommended for psychiatric hospitalization showed significantly higher levels of anger/aggressiveness, apathy, impulsivity, reality distortion, thought disorganization and activation. Multivariate analysis identified psychopathological dimensions (reality distortion, impulsivity, apathy), diagnosis of psychotic or mood disorders and proposal for compulsory admission as independent predictors of psychiatric hospitalization. Hierarchical regression analysis revealed that the dimensional evaluation was the strongest predictor. Our findings suggest that, in emergency setting, a systematic dimensional assessment may usefully complement the categorical assessment. Future research should aim at developing an operational assessment model, including both categorical and dimensional approaches to psychopathology. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Down the Rabbit Hole: Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies.

    Tucci, Veronica; Siever, Kaylin; Matorin, Anu; Moukaddam, Nidal


    Patients presenting with behavior or psychiatric complaints may have an underlying medical disorder causing or worsening their symptoms. Misdiagnosing a medical illness as psychiatric can lead to increased morbidity and mortality. A thorough history and physical examination, including mental status, are important to identify these causes and guide further testing. Laboratory and ancillary testing should be guided by what is indicated based on clinical assessment. Certain patient populations and signs and symptoms have a higher association with organic causes of behavioral complaints. Many medical problems can present with or exacerbate psychiatric symptoms, and a thorough medical assessment is imperative.

  9. READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units.

    Vigod, Simone N; Kurdyak, Paul A; Seitz, Dallas; Herrmann, Nathan; Fung, Kinwah; Lin, Elizabeth; Perlman, Christopher; Taylor, Valerie H; Rochon, Paula A; Gruneir, Andrea


    Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.

  10. Acute fatal chest pain: optimized procedure in emergency department.

    Yang, Yang; Zhang, Wei; Peng, Ming; Tong, Lianying; Lin, Shouyu


    To explore the diagnostic procedure of acute fatal chest pain in emergency department (ED) in order to decrease the misdiagnosis rate and shorten the definite time to diagnosis. The ultimate aim is to rescue the patients timely and effectively. Three hundreds and two patients (56.9 ± 11.8 Years, 72% men) complained with acute chest pain and chest distress presenting to our ED were recruited. They were divided into two groups according to visiting time (Group I: from October 2010 to March 2011, Group II: from October 2011 to March 2012). The misdiagnosis rate, definite time for diagnosis and medical expense were analyzed. Patients of Group I were diagnosed by initial doctors who made their diagnosis according to personal experience in outpatient service or rescue room in ED. While patients of Group II were all admitted to rescue room and were diagnosed and rescued according to the acute chest pain screening flow-process diagram. Differences inter-group was compared. The misdiagnosis rate of fatal chest pain in Group I and Group II was 6.8% and 0% respectively, and there was statistic difference (P=0.000). The definite time to diagnosis was 65.3 min and 40.1 min in control and Group II respectively, the difference had statistic significance (P=0.000). And the mean cost for treatment was 787.5/124.5 ¥/$ and 905.5/143.2 ¥/$ respectively, and there was statistic difference too (P=0.012). Treating emergency patients with acute chest pain according to the acute chest pain screening flow-process diagram in rescue room will decrease misdiagnosis apparently, and it can also shorten the definite time to correct diagnosis. It has a remarkable positive role in rescuing patients with acute chest pain timely and effectively.

  11. Risk Factors of Acute Behavioral Regression in Psychiatrically Hospitalized Adolescents with Autism

    Périsse, Didier; Amiet, Claire; Consoli, Angèle; Thorel, Marie-Vincente; Gourfinkel-An, Isabelle; Bodeau, Nicolas; Guinchat, Vincent; Barthélémy, Catherine; Cohen, David


    Aim: During adolescence, some individuals with autism engage in severe disruptive behaviors, such as violence, agitation, tantrums, or self-injurious behaviors. We aimed to assess risk factors associated with very acute states and regression in adolescents with autism in an inpatient population. Method: Between 2001 and 2005, we reviewed the charts of all adolescents with autism (N=29, mean age=14.8 years, 79% male) hospitalized for severe disruptive behaviors in a psychiatric intensive care unit. We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), associated organic conditions, etiologic diagnosis of the episode, and treatments. Results: All patients exhibited severe autistic symptoms and intellectual disability, and two-thirds had no functional verbal language. Fifteen subjects exhibited epilepsy, including three cases in which epilepsy was unknown before the acute episode. For six (21%) of the subjects, uncontrolled seizures were considered the main cause of the disruptive behaviors. Other suspected risk factors associated with disruptive behavior disorders included adjustment disorder (N=7), lack of adequate therapeutic or educational management (N=6), depression (N=2), catatonia (N=2), and painful comorbid organic conditions (N=3). Conclusion: Disruptive behaviors among adolescents with autism may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic diseases such as epilepsy. The management of these behavioral changes requires a multidisciplinary functional approach. PMID:20467546

  12. Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis.

    Iozzino, Laura; Ferrari, Clarissa; Large, Matthew; Nielssen, Olav; de Girolamo, Giovanni


    Violence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards. To use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators). Systematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries. Of the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14-20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence. The findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence).

  13. Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study.

    Stevenson, Kelly N; Jack, Susan M; O'Mara, Linda; LeGris, Jeannette


    Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses' experiences of patient violence in acute care inpatient psychiatric settings. An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation. Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered "part of the job." Nurses often struggled with role conflict between one's duty to care and one's duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace. Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

  14. Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study.

    Bowers, Len; Allan, Teresa; Simpson, Alan; Nijman, Henk; Warren, Jonathan


    Adverse incidents (violence, self-harm and absconding) can cause significant harm to patients and staff, are difficult to predict, and are driving an increase in security measures and defensive practice. To explore the relationship between adverse incidents on acute psychiatric wards, admissions and nursing workforce variables. A retrospective analysis of officially collected data covering a period of 30 months on 14 acute wards at three hospitals. This data included 69 serious untoward incidents. Adverse incidents were more likely during and after weeks of high numbers of male admissions, during weeks when other incidents also occurred, and during weeks of high regular staff absence through leave and vacancy. It may be possible to predict adverse incidents. Careful staff management and deployment may reduce the risks.

  15. Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland

    Fischer Joachim E


    Full Text Available Abstract Background Aggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult. Objective To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland. Methods We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days. Results A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10–1.78 for physical attacks and 1.83 (1.70–1.97 for all aggressive incidents (including purely verbal aggression. The mean severity was 8.80 ± 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (≥ 9 pts.. 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6–2.9, longer length of stay (OR 2.7; 2.0–3.8, and a diagnosis of schizophrenia (ICH-10 F2 (OR 2.1; 1.5–2.9 was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission. Conclusion Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the

  16. Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards.

    Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta


    Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

  17. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

    Di Lorenzo R


    Full Text Available Rosaria Di Lorenzo,1 Giulio Cabri,2 Eleonora Carretti,3 Giacomo Galli,4 Nina Giambalvo,4 Giulia Rioli,4 Serena Saraceni,4 Giulia Spiga,4 Cinzia Del Giovane,5 Paola Ferri6 1Mental Health Department, Service of Psychiatric Diagnosis and Treatment in NOCSAE General Hospital, 2Private Accredited Psychiatric Hospital villa Igea, Modena, 3Nursing Home of Rubiera, Reggio Emilia, 4Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, 5PhD Statistics Unit, Department of Diagnostic, Clinical and Public Health Medicine, 6Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy Purpose: To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI, which had been first validated in oncologic field among terminally ill patients. Patients and methods: After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town, who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for <72 hours. We collected the demographic and clinical variables of our sample (n=135. We statistically analyzed PDI scores, performing Cronbach’s alpha coefficient and principal factor analysis, followed by orthogonal and oblique rotation. We concomitantly administered to our sample other scales (Hamilton Rating Scales for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales to analyze the PDI concurrent validity. Results: With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD with

  18. Erectile dysfunction in a sample of patients attending a psychiatric outpatient department.

    Mosaku, K S; Ukpong, D I


    To assess the prevalence of erectile dysfunction among a sample of patients attending a psychiatric clinic, we administered the International Index of Erectile Function on 108 male patients attending the clinic. We also obtained sociodemographic and clinical variables from the patients. The mean age of the patients studied was 39.6 (s.d.=11.6), with a mean duration of illness of 10.24 (s.d.=8.2) years. There were 46.8% schizophrenics; other diagnoses include bipolar affective disorder, recurrent depressive disorder and substance use disorder. The prevalence of erectile dysfunction was 83%. Age, marital status, current medications and the presence of comorbid medical conditions were significantly associated with erectile dysfunction; however, only age and marital status significantly predicted erectile dysfunction. We concluded that erectile dysfunction is highly prevalent among patients attending the psychiatric clinic, as such inquiries about sexual function should be routinely carried out by clinicians.

  19. Associations of homelessness and residential mobility with length of stay after acute psychiatric admission

    Tulloch Alex D


    Full Text Available Abstract Background A small number of patient-level variables have replicated associations with the length of stay (LOS of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home, or the magnitude of these associations compared to other exposures. Methods Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression. Results Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS, especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor. Conclusions Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.

  20. [Psychosocial functioning in non-psychiatric acute and chronic inpatients: depression, alexithymia and lack of assertiveness].

    Arancibia, Marcelo; Behar, Rosa; Marín, Sofía; Inzunza, Nicolás; Madrid, Eva


    Depression, alexithymia, and lack of assertiveness interfere with individual psychosocial functioning and may result in longer hospitalization stay and poorer therapeutic results. To analyze the psychosocial functioning in acute and chronic patients and its association with psychological, clinical and sociodemographic variables. We performed a cross-sectional study that included 80 inpatients of both sexes with organic pathology, aged between 18 to 70 years old, without any current psychiatric disorder. Clinical and sociodemographic data were collected from a semi-structured interview and hospital records. Beck Depression Inventory-IA, Toronto Alexithymia Scale-20 and Rathus Assertiveness Scale were administered. Fifty five percent of patients had some degree of depression, 33% alexithymia and 34% lack of assertiveness. The levels of depression, alexithymia and lack of assertiveness in chronic patients were significantly higher than those observed in acute patients. Women and participants older than 60 years exhibited the highest degrees of depression. Alexithymia and lack of assertiveness were associated with a lower educational level. A negative significant correlation between alexithymia and assertiveness scores was observed among acute patients. Participants with chronic diseases had a lower psychosocial functioning. Less educated patients showed more alexithymic and less assertive features. We emphasized the need of a better management of these aspects by the health team, since social functioning might interfere with the outcome of physical illnesses.

  1. 'Shared-rhythm cooperation' in cooperative team meetings in acute psychiatric inpatient care.

    Vuokila-Oikkonen, P; Janhonen, S; Vaisanen, L


    The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared-rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed.

  2. The Role of Research in Academic Psychiatric Departments: A Case Study

    Pato, Carlos; Abulseoud, Osama; Pato, Michelle


    Objective: The authors demonstrate the role that research can play in the development of an academic department of psychiatry. Method: The authors explore the challenges and achievements in the transition of one department from a strong clinically- and educationally-centered department to one with an equally strong research focus. Results: The…

  3. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

    Jensen Gunnar


    Full Text Available Abstract Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA, which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score were analysed with a regression model. Results The sample comprised 192 adolescents admitted during one year (response rate 87%. Mean age was 15.7 years (range 10-18 and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4. The largest groups of main diagnostic conditions were affective (28% and externalizing (26% disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement in the HoNOSCA total score was 5.1 (SD 6.2, with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission

  4. 精神专科医院外科住院患者精神病共病现状分析%Status analysis on psychiatric comorbidity of inpatients from surgery department of psychiatric hospitals

    沈萍; 沈仲夏; 徐美英; 陈海勤; 金莉; 陈海支


    目的 分析精神专科医院外科住院患者精神病共病的流行病学情况及特征.方法外科住院患者791例,对其中共患精神病者进行统计学分析.结果 791例患者中共患精神病59例,精神病前3位分别为精神分裂症、抑郁症、神经症;外科疾病前3位分别为骨折、脑外伤、肠梗阻.结论 精神专科医院外科住院患者精神病共病比例高,共患疾病有相关性.%Objective To study the cpidcmiological status and characteristics on psychiatric comorbidity of inpatients from surgery department of psychiatric hospitals. Method Take statistic analysis on patients with psychiatric comorbidity from 791 inpatients from surgery department. Result There arc 59 psychiatric comorbidity patients from 791 patients. The first three of psychosis arc schizophrenia, depression and neurosis and the first three surgical diseases arc fracture, brain injury and intestinal obstruction. Conclusion There is a high level of psychiatric comorbidity among inpatients from surgery department of psychiatric hospitals. There is correlation between comorbidity diseases.

  5. Mechanical and pharmacological restraints in acute psychiatric wards--why and how are they used?

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Helen Mjøsund, Nina; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein


    Restraint use has been reported to be common in acute psychiatry, but empirical research is scarce concerning why and how restraints are used. This study analysed data from patients' first episodes of restraint in three acute psychiatric wards during a 2-year study period. Logistic regression analyses were used to identify predictors for type and duration of restraint. The distribution of restraint categories for the 371 restrained patients was as follows: mechanical restraint, 47.2%; mechanical and pharmacological restraint together, 35.3%; and pharmacological restraint, 17.5%. The most commonly reported reason for restraint was assault (occurred or imminent). It increased the likelihood of resulting in concomitant pharmacological restraint. Female patients had shorter duration of mechanical restraint than men. Age above 49 and female gender increased the likelihood of pharmacological versus mechanical restraint, whereas being restrained due to assault weakened this association. Episodes with mechanical restraint and coinciding pharmacological restraint lasted longer than mechanical restraint used separately, and were less common among patients with a personality disorder. Diagnoses, age and reason for restraint independently increased the likelihood for being subjected to specific types of restraint. Female gender predicted type of restraint and duration of episodes.

  6. Psychiatric nurse practitioners’ experiences of working with mental health care users presenting with acute symptoms

    Kgalabi J. Ngako


    Full Text Available Psychiatric nurse practitioners (PNPs working with mental health care users presenting with acute symptoms work in a complex environment. This environment is characterised by mental health care users who may present with a history of violence, sexual assault and substance misuse.The objectives of this study were twofold: firstly, to explore and describe the experiences of PNPs working with mental health care users (MHCUs presenting with acute symptoms; and secondly, to make recommendations for the advanced PNPs to facilitate promotion of the mental health of PNPs with reference to nursing practice, research and education.A qualitative, explorative, descriptive and contextual design was used. The target population was PNPs working with MHCUs presenting with acute symptoms in a public mental health care institution in Gauteng. Data were collected by means of four focus group interviews involving 21 PNPs. The researcher made use of drawings, naïve sketches and field notes for the purpose of data triangulation. Data were analysed in accordance with Tesch’s method of open coding.The three themes that emerged were: PNPs experienced working with these MHCUs as entering an unsafe world where care became a burden; they experienced negative emotional reactions and attitudes towards these MHCUs that compromised quality nursing care; and they made a plea for a nurturing environment that would enhance quality nursing care.The PNPs suggest skills and competency development, organisational support, and a need for external resources. Creation of a positive environment and mobilisation of resources as well as the identification and bridging of obstacles are essential in the promotion of the overall wellbeing and mental health of PNPs. 

  7. Relationship between psychiatric nurse work environments and nurse burnout in acute care general hospitals.

    Hanrahan, Nancy P; Aiken, Linda H; McClaine, Lakeetra; Hanlon, Alexandra L


    Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments.

  8. Clinical experience and institutional in a Department of Mental Health: The multifamily groups for parents and children with psychiatric illness in the time of post-modernity

    Luisella Ferraris


    Full Text Available The following work shows the beginning and development of a multifamily group, involving mental health professionals, parents and psychiatric patients, in a mental health center. The group goals and the main functions of this setting, will be described, observing also the social and community changes, occurring in recent years. Finally, starting from the analysis of the major psychoanalysis research findings, the concepts of inter-subjectivity, therapeutic alliance and institution's role regarding the psychiatric patients’ treatment, will be deepened. Keywords: Department of Mental Health; Multifamily group; Community changes; Therapeutic alliance; Psychiatric patients

  9. Psychological impact of verbal abuse and violence by patients on nurses working in psychiatric departments



    Abstract  The aim of this study was to assess the psychological impact of verbal abuse or violence by patients on nurses working in psychiatry departments and to identify factors related to their impact...

  10. What happens when 55% of acute psychiatric beds are closed in six days: an unexpected naturalistic observational study

    Branch, Matt; Mitchell, Anji; Parkin, Lindsay; Confue, Phil; Shankar, Rohit; Wilson-James, Diane; Marshall, Mike; Edgecombe, Maria; Keaney, Bernie; Gill, Kiran; Harrison, Juliet


    Objective The sudden closure of 30 out of 54 acute psychiatric beds in Cornwall presented a stressful challenge to staff but also a natural experiment on how a service dealt with this situation. We aimed to evaluate the outcomes of patients needing to leave the closed ward, how bed occupancy rates were affected and the impact on admission rates. Design A service evaluation of the impact of the ward closure. Setting A comprehensive secondary NHS mental health service in Cornwall serving 550,000 population. Main outcome measures The destination of the patients needing to leave the acute unit, the effect of the closure on bed occupancy, admission rates and serious untoward incidents. Results Of 26 patients needing to be moved from the acute ward, only 10 needed an acute psychiatric bed. None of the seven patients who had been on the ward longer than nine weeks needed an acute unit. Admission rates fell over the subsequent three months. There was no increase in serious incidents due to the closure. Conclusions This naturalistic event suggests that many patients on acute units could be cared for elsewhere, especially recovery/rehabilitation care environments, if political and financial urgency is present. Admission rates are responsive to the pressure on beds. PMID:27757241

  11. Acute chest pain fast track at the emergency department: who was misdiagnosed for acute coronary syndrome?

    Prachanukool T


    Full Text Available Thidathit Prachanukool,1 Kasamon Aramvanitch,1 Kittisak Sawanyawisuth,2–4 Yuwares Sitthichanbuncha1 1Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 2Department of Medicine, Faculty of Medicine, 3Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, 4Internal medicine research group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand Background: Acute coronary syndrome (ACS is a commonly treated disease in the emergency department (ED. Acute chest pain is a common presenting symptom of ACS. Acute chest pain fast track (ACPFT is a triage to cover patients presenting with chest pain with the aims of early detection and treatment for ACS. This study aimed to assess the quality of the ACPFT with the aim of improving the quality of care for ACS patients. Methods: This study was conducted at the ED in Mahidol University, Bangkok, Thailand. The inclusion criterion was patients presenting with acute chest pain at the ED. We retrospectively reviewed the medical records of all eligible patients. The primary outcomes of this study were to determine time from door to electrocardiogram and time from door to treatment (coronary angiogram with percutaneous coronary intervention or thrombolytic therapy in the case of ST elevation myocardial infarction. The outcome was compared between those who were in and not in the ACPFT. Results: During the study period, there were 616 eligible patients who were divided into ACPFT (n=352 patients; 57.1% and non-ACPFT (n=264 patients; 42.9% groups. In the ACPFT group (n=352, 315 patients (89.5% received an electrocardiogram within 10 minutes. The final diagnosis of ACS was made in 80 patients (22.7% in the ACPFT group and 13 patients (4.9% in the non-ACPFT group (P-value <0.01. After adjustment using multivariate logistic regression analysis, only epigastric pain was independently associated with being in the ACPFT group (adjusted

  12. Psychological impact of verbal abuse and violence by patients on nurses working in psychiatric departments.

    Inoue, Makoto; Tsukano, Ken; Muraoka, Mitsutaro; Kaneko, Fumiko; Okamura, Hitoshi


    The aim of this study was to assess the psychological impact of verbal abuse or violence by patients on nurses working in psychiatry departments and to identify factors related to their impact. Survey sheets were distributed to a total of 266 nurses working at two hospitals, and replies were obtained from 232 of them. Because three of them had less than 1 month of experience working in the psychiatry department and four of them failed to answer all the questions, valid replies were obtained from 225 nurses. Among the 225 whose replies were valid, 141 nurses who replied that they had experienced verbal abuse or violence that left an impression on them remained as the subjects of the final analysis. The Impact of Event Scale-Revised (IES-R) was used to evaluate psychological impact. Of the nurses who had been exposed to verbal abuse or violence that left an impression, 21% had scores that exceeded the IES-R cut-off point (24/25), and low satisfaction with family support, and neuroticism on the Eysenck Personality Questionnaire-Revised were shown to have contributed to the psychological impact. Nurses working in psychiatry departments were shown to experience a severe psychological impact when exposed to verbal abuse or violence. These results suggest the need for mental care approaches for nurses working in psychiatry departments.

  13. Young people's risk of suicide attempts after contact with a psychiatric department - a nested case-control design using Danish register data

    Christiansen, Erik; Juul Larsen, Kim


    Background:  There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk...... discharge from last contact with a psychiatric department. The risk of suicide attempt is highest for children and adolescents suffering from personality disorders, depression and substance use disorders. Children and adolescents with previous contact with a psychiatric department and parental income....... Methods:  A complete extraction of Danish register data for every individual born in the period 1983-1989 was made. Of these 403,431 individuals, 3,465 had attempted suicide. In order to control for confounder effects from gender, age and calendar-time, a nested case-control study was designed. A total...

  14. Acute chest pain fast track at the emergency department: who was misdiagnosed for acute coronary syndrome?

    Prachanukool, Thidathit; Aramvanitch, Kasamon; Sawanyawisuth, Kittisak; Sitthichanbuncha, Yuwares


    Background Acute coronary syndrome (ACS) is a commonly treated disease in the emergency department (ED). Acute chest pain is a common presenting symptom of ACS. Acute chest pain fast track (ACPFT) is a triage to cover patients presenting with chest pain with the aims of early detection and treatment for ACS. This study aimed to assess the quality of the ACPFT with the aim of improving the quality of care for ACS patients. Methods This study was conducted at the ED in Mahidol University, Bangkok, Thailand. The inclusion criterion was patients presenting with acute chest pain at the ED. We retrospectively reviewed the medical records of all eligible patients. The primary outcomes of this study were to determine time from door to electrocardiogram and time from door to treatment (coronary angiogram with percutaneous coronary intervention or thrombolytic therapy in the case of ST elevation myocardial infarction). The outcome was compared between those who were in and not in the ACPFT. Results During the study period, there were 616 eligible patients who were divided into ACPFT (n=352 patients; 57.1%) and non-ACPFT (n=264 patients; 42.9%) groups. In the ACPFT group (n=352), 315 patients (89.5%) received an electrocardiogram within 10 minutes. The final diagnosis of ACS was made in 80 patients (22.7%) in the ACPFT group and 13 patients (4.9%) in the non-ACPFT group (P-value <0.01). After adjustment using multivariate logistic regression analysis, only epigastric pain was independently associated with being in the ACPFT group (adjusted odds ratio of 0.11; 95% confidence interval of 0.02, 0.56). Conclusion The ACPFT at the ED facilitated the prompt work-ups and intervention for ACS. PMID:27980438

  15. Acute effects of electroconvulsive therapy on regional cerebral blood flow (rCBF) in psychiatric disorders

    Prohovnik, I.; Alderson, P.O.; Sackheim, H.A.; Decina, P.; Kahn, D.


    Electroconvulsive therapy (ECT) is frequently used in the treatment of major depression and other psychiatric disorders; its mechanism of action is not established, but previous evidence suggests that it is associated with postictal metabolic suppression. The authors have used measurements of rCBF as an index of cortical metabolic activity to study the acute effects of ECT. Measurements of rCBF were made in 32 cortical regions in 10 patients (pts) following one minute breathing of Xe-133 (5mCi/L); the measurements were performed 30min before and 50min after ECT. Bilateral ECT was administered to six pts (five diagnosed as major depressives and one schizophrenic) and unilateral ECT to four (all diagnosed as unipolar or bipolar affective disorder). The total rCBF material consists of 52 measurements in these pts, made before and after 16 bilateral and 10 unilateral treatments. ECT was found to cause significant reduction of rCBF. Mean hemispheric flows (using the Initial Slope Index to measure grey-matter flow) were reduced by about 5% in both hemispheres following bilateral treatment. Unilateral treatment caused a 9% reduction of flow in the treated hemisphere, but only 2% contralaterally. Regional patterns of flow decreases also differed between the two treatment modes: bilateral frontal reductions were found after bilateral treatment, whereas unilateral ECT caused a widespread flow reduction in the treated hemisphere, and almost no effect contralaterally. These results suggest that rCBF studies are useful for assessing ECT, and indicate that the acute cerebral effects of ECT vary with the mode of treatment.

  16. Young People's Risk of Suicide Attempts after Contact with a Psychiatric Department--A Nested Case-Control Design Using Danish Register Data

    Christiansen, Erik; Larsen, Kim Juul


    Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…

  17. The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards

    Bowers, L.; Nijman, H.L.I.; Simpson, A.; Jones, J.


    Background: Conflict (aggression, substance use, absconding, etc.) and containment (coerced medication, manual restraint, etc.) threaten the safety of patients and staff on psychiatric wards. Previous work has suggested that staff variables may be significant in explaining differences between wards

  18. Short-term diagnostic stability of acute psychosis: Data from a tertiary care psychiatric center in South India

    Janardhanan C Narayanaswamy


    Full Text Available Context: Studies on acute psychosis in patients from India report good outcome. A small proportion of these patients may suffer relapses or other develop major psychiatric disorders later. Aim: The aim of this study was to examine the diagnostic stability of acute psychosis in patients from India. Materials and Methods: The records of patients who presented with the first episode of acute and transient psychotic disorder (n=57 over 1 year (2004 were analyzed, and the follow-up data at the end of 1 and 2 years were recorded. Results: The mean age of the sample was 30.72 years. The mean duration of illness episode was 18.15±17.10 days. The follow-up data were available for 77.2% (n=44 and 75.4% (n=43 of the sample at the end of first and second years. Relapse was recorded in 47.4 and 54.4% at the end of first and second years, respectively. Conclusion: The diagnosis changed into other disorders such as bipolar disorder, schizophrenia, and unspecified psychosis, while a majority retained the initial diagnosis of acute psychosis. The findings suggest that acute psychosis is a relatively stable condition. A small percentage of these patients may go on to develop schizophrenia or bipolar disorder.

  19. The Norwegian version of Mini-International Neuropsychiatric Interview (M.I.N.I.): Feasibility, patient acceptability and test-retest reliability in an acute psychiatric ward.

    Gundersen, Øystein


    ABSTRACT Background: Mini-International Neuropsychiatric Interview (MINI) is a structured psychiatric diagnostic interview. Feasibility, patient acceptability, reliability and validity of MINI have been tested in other countries, but not yet in Norway. Objective: The aim of the present study was to test the feasibility, patient acceptability and test-retest reliability of the Norwegian MINI version in an acute psychiatric ward. Methods: From August 2006 to February 2007 3...

  20. Chloramphenicol and acute esophagitis in the emergency department

    Chad T Andicochea


    Full Text Available Even with its broad spectrum and low cost, concern over chloramphenicol′s adverse effects limited its use in the United States during the 1980s. Reports from United Kingdom and China in the 1990s demonstrated a low incidence of blood dyscrasias with the topical preparation of chloramphenicol, and showed continued good efficacy and low cost. Today, topical chloramphenicol is being used by some groups within otolaryngology and ophthalmology in the United States. As a result, emergency physicians are once again considering chloramphenicol-induced side effects in patients presenting to the emergency department. To date, there have been no published reports associating chest pain, dyspnea with chloramphenicol use, and there has only been one report of fungal esophagitis associated with topical chloramphenicol. We present a 31-year-old woman, 4 months status post tympanoplasty with a modified radical canal wall down mastoidectomy due to a cholesteatoma involving the epitympanum who had a residual tympanic membrane defect. She presented to the emergency department with chest "burning", with no other symptoms shortly after starting treatment with an insufflated combination antibiotic containing chloramphenicol. After ruling out cardiopulmonary or vascular etiology, she was treated successfully with a gastrointestinal cocktail cocktail for presumed esophagitis secondary to newly prescribed chloramphenicol.

  1. Treatments for common psychiatric conditions among adults during acute, rehabilitation, and reintegration phases.

    Difede, Joann; Cukor, Judith; Lee, Francis; Yurt, Roger


    Common and pernicious adult psychiatric disorders consequent to burn injury include post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and new-onset substance abuse disorder. Diagnosing and treating these disorders is complicated by the complex psychosocial issues associated with burns including grief, pain, role impairment, disfigurement, dysfunction, stigma, as well as financial and legal issues. Additionally, pre-morbid psychiatric and neurological illnesses are risk factors for burns, adding to the challenge of diagnosis and treatment. This article will focus on the diagnosis and treatment of PTSD and MDD consequent to burn trauma, as these are the major psychiatric outcomes, addressing the attendant psychosocial problems as threads in this post-trauma tapestry.

  2. Identifying Patients in the Acute Psychiatric Hospital Who May Benefit From a Palliative Care Approach.

    Burton, M Caroline; Warren, Mark; Cha, Stephen S; Stevens, Maria; Blommer, Megan; Kung, Simon; Lapid, Maria I


    Identifying patients who will benefit from a palliative care approach is the first critical step in integrating palliative with curative therapy. Criteria are established that identify hospitalized medical patients who are near end of life, yet there are no criteria with respect to hospitalized patients with psychiatric disorders. The records of 276 consecutive patients admitted to a dedicated inpatient psychiatric unit were reviewed to identify prognostic criteria predictive of mortality. Mortality predictors were 2 or more admissions in the past year (P = .0114) and older age (P = .0006). Twenty-two percent of patients met National Hospice and Palliative Care Organization noncancer criteria for dementia. Palliative care intervention should be considered when treating inpatients with psychiatric disorders, especially older patients who have a previous hospitalization or history of dementia.

  3. Acute Hemolysis in the Emergency Department: Think about Clostridium perfringens!

    Roustit Cécilia


    Full Text Available Clostridium perfringens (CP gives several clinical settings, from an asymptomatic to a massive intravascular hemolysis. We report a case of fatal intravascular hemolysis due to CP septicemia having a hepatic supposed starting point in the emergency department. Like in many cases, the diagnosis was made when patient had already gone into shock and died. The CP septicemia often complicated the course of the digestive or genital pathologies. The alpha toxin can damage the structural integrity of the red cell membrane by means of a phospholipase activity. Nevertheless, a massive intravascular hemolysis arises only rarely in this septicemia, only from 7 to 15% of the cases. The emergency physician has to think about this complication in case of hemoglobinuria and/or signs of hemolysis associated with a septic syndrome. An immediate antibiotic treatment adapted as well as the symptomatic treatment of the spread intravascular coagulation could improve the survival of these patients.

  4. Etiological characterization of acute poisonings in the emergency department

    Khlifi Malek


    Full Text Available Introduction: An investigation of emergency department (ED poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities. Methods: The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department. Results: Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9% between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4% ( n = 230 of cases, followed by cocaine overdose at 31.7% ( n = 206, concomitant heroin and cocaine overdose at 4.3% ( n = 28, multiple drug poisoning at 5.5% ( n = 36, and antidepressant/antipsychotic poisoning at 6% ( n = 39. Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, P = 0.0001, cocaine poisoning and hypertension (F = 33.34, DF = 1, P = 0.0001, and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, P = 0.0001. A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma. Conclusions: These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay.

  5. Characteristics of Adolescent Suicide Attempters Admitted to an Acute Psychiatric Ward in Taiwan

    Pei-Ning Chiou


    Conclusion: Our study confirms some previous Western reports that adolescents with depressive disorders commonly manifest suicide attempts. There are, however, some cultural differences in risk factors. School-related problems play an important role in Taiwan among the adolescent suicides, and prior suicide attempts predict future suicidal behavior. Enhancing school-based screening for adolescents with suicide risk and transferring them to psychiatric professionals for intervention is important. We should focus suicide prevention resources mainly on the adolescent population with psychiatric illness, prior suicide attempts, and with high risk factors.

  6. Factors Affecting Non-Adherence among Patients Diagnosed with Unipolar Depression in a Psychiatric Department of a Tertiary Hospital in Kolkata, India

    Sohini Banerjee; Ravi Prasad Varma


    Non-adherence to depression treatment is a common clinical problem globally. However, limited research is available from India. This cross-sectional study aimed to assess non-adherence to prescribed treatment among patients with unipolar depression at a psychiatric out-patient department (OPD) of a tertiary hospital in Kolkata, India. The Morisky Medication Adherence Scale (MMAS) was used and a questionnaire designed by the Principal Investigator (PI) was administered. A total of 239 patients...

  7. Prevalence of nosocomial infections in psychiatric department and nursing countermeasures%精神科医院感染现患率调查与护理对策



    目的 了解精神科医院感染基本情况,发现医院感染管理中存在的问题,调整控制医院感染措施.方法 采取横断面调查方法,以床旁调查与病案调查相结合,填写统一的个案调查表.结果 调查住院精神科患者750例,医院感染现患率为1.87%,感染主要科室为老年精神科;主要部位为呼吸道50.00%、泌尿道42.86%.结论 加强老年精神科医院感染管理,特别是基础护理,能有效降低医院感染发生率.%OBJECTIVE To explore the status of nosocomial infections in the psychiatric department and find out the problems existing in the nosocomial infection management so as to adjust the control of nosocomial infections. METHODS By means of the cross-sectional investigation and the bedside investigation combined with the medical records investigation, the uniform questionnaire was filled out. RESULTS Totally 750 hospitalized patients in psychiatric department were investigated,the prevalence rate of nosocomial infections was 1. 86%, the infections mainly distributed in the geriatric department of psychiatrics; the respiratory tract and the urinary tract were the predominant infection sites, accounting for 50. 00% and 42. 86%, respectively. CONCLUSION It can effectively reduce the incidence of nosocomial infections that the control of nosocomial infections in the geriatric department of psychiatrics ,especially the primary nursing,is intensified.

  8. Door locking and exit security measures on acute psychiatric admission wards

    Nijman, H.L.I.; Bowers, L.; Haglund, K.; Muir-Cochrane, E.; Simpson, A.; Merwe, M. van der


    Locking the exit doors of psychiatric wards is believed to reduce the risk of patients absconding. The aims of the study were to investigate both the prevalence of door locking and other exit security measures on UK admission wards, as well as whether door locking appears to be effective in keeping

  9. A pilot randomized control trial: testing a transitional care model for acute psychiatric conditions.

    Hanrahan, Nancy P; Solomon, Phyllis; Hurford, Matthew O


    People with multiple and persistent mental and physical health problems have high rates of transition failures when transferring from a hospital level of care to home. The transitional care model (TCM) is evidence-based and demonstrated to improve posthospital outcomes for elderly with physical health conditions, but it has not been studied in the population with serious mental illness. Using a randomized controlled design, 40 inpatients from two general hospital psychiatric units were recruited and randomly assigned to an intervention group (n = 20) that received the TCM intervention that was delivered by a psychiatric nurse practitioner for 90 days posthospitalization, or a control group (n = 20) that received usual care. Outcomes were as follows: service utilization, health-related quality of life, and continuity of care. The intervention group showed higher medical and psychiatric rehospitalization than the control group (p = .054). Emergency room use was lower for intervention group but not statistically significant. Continuity of care with primary care appointments were significantly higher for the intervention group (p = .023). The intervention group's general health improved but was not statistically significant compared with controls. A transitional care intervention is recommended; however, the model needs to be modified from a single nurse to a multidisciplinary team with expertise from a psychiatric nurse practitioner, a social worker, and a peer support specialist. A team approach can best manage the complex physical/mental health conditions and complicated social needs of the population with serious mental illness. © The Author(s) 2014.

  10. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    Madsen, Tracy E.; Choo, Esther K.; Seigel, Todd A.; Palms, Danielle; Silver, Brian


    Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV) tissue plasminogen activator (tPA). Emergency department (ED) triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to d...

  11. Analgesia and Addiction in Emergency Department Patients with Acute Pain Exacerbations

    Gorchynski, Julie; KELLY, Kevin


    Introduction: There is ongoing controversy regarding the appropriate use of narcotic analgesia for patients presenting frequently to the emergency department (ED) with subjective acute exacerbations of pain. "Are we treating pain or enabling addiction?” Objectives: To determine whether the presence o f specific factors could be used to identify adults complaining of acute exacerbations of pain for suspected drug addiction, to estimate the percentage of drug addicted patients, to asse...

  12. 精神科护理安全管理浅析%The analysis of management on nursing safety in psychiatric department



    To explore the management on nursing safety in psychiatric department,ful play the management ability of charge nurse,meanwhile emphasis on staff training and strengthen their ideological education, and improve their risk prevention capacity ,thus to ensure the personal safety of patients during their hospitalization.%探讨精神科护理安全管理,充分发挥护士长管理能力,重视培训、强化思想教育,加强责任心,提高风险识别能力。保证患者住院期间人身安全。

  13. Acute Cholecystitis Detected by Serial Emergency Department Focused Right Upper Quadrant Ultrasound

    David Bosch


    Full Text Available Acute cholecystitis is a common etiology of acute right upper quadrant pain in patients presenting to the emergency department (ED. The use of ED-focused right upper quadrant ultrasound (RUQ US is becoming more widely utilized to evaluate abdominal pain thought to be hepatobiliary in nature. We describe a case series of two patients with acute cholecystitis detected by serial ED-focused RUQ US. Case 1: A woman presented to the ED with epigastric pain of acute onset. She was initially found to have a mild leukocytosis and cholelithiasis detected by ED-focused RUQ US. Seventy-five minutes later, the patient had a repeat bedside ultrasound by the same sonographer that showed visual evidence of acute cholecystitis that was later confirmed by surgical pathology. She was treated operatively. Case 2: A man with known cholelithiasis presents to the ED with acute-onset RUQ pain. Initial RUQ ultrasound performed by the Department of Radiology (University of Colorado Hospital was equivocal, showing cholelithiasis with a mildly thickened wall and no pericholecystic fluid. A repeat ED-focused RUQ ultrasound 5 hours later showed increased wall thickness and pericholecystic fluid. The patient was subsequently taken for same-day cholecystectomy. This case series demonstrates the dynamic and progressive nature of acute cholecystitis detected by ED-focused RUQ US. It also highlights how serial bedside ultrasonography can reduce harm, appropriately triage patients with hepatobiliary disease and lead to reductions in overall morbidity.

  14. Acute health problems in African refugees: ten years' experience in a Swiss emergency department.

    Pfortmueller, Carmen A; Graf, Fabienne; Tabbara, Malek; Tabarra, Malek; Lindner, Gregor; Zimmermann, Heinz; Exadaktylos, Aristomenis K


    Over the last two decades, the total number of applications from Africans for asylum in the countries of the European Union has increased from 578,000 to more than 2.9 million. About 20 % (7,196/36,100) of the asylum seekers in Switzerland originate from Africa. The disease profile of African asylum seekers is remarkably different from that of the native population in the country of application. We have therefore conducted an analysis of African asylum seekers presenting themselves to our emergency department. In a retrospective analysis, the central patient registry database was searched for patients originating from Africa admitted from 1 January 2000 to 30 November 2011 and labelled as "Asylbewerber" (asylum seeker) or "Flüchtling" (refugee). Three thousand six hundred and seventy-five African asylum seekers were admitted to our emergency department between 2000 and 2010. Thirty-four percent (n = 1,247) were female and 66 % (n = 2,426) male. Eighty percent (n = 1,940) of the men and 70 % (n = 823) of the women were younger than 40 years. Most of our patients originated from Algeria (n = 612). Forty-five percent (n = 1,628) of all patients presented with internal medical problems, 40 % (n = 1,487) with injuries. 3.5 % (n = 130) of all patients presented with psychiatric problems. Admission for psychiatric problems increased steadily from 2 % (n = 4) in 2001 to 10 % (n = 35) in 2011. The causes of presentation are manifold, including internal medical problems and injuries. Admissions for psychiatric problems are increasing. Establishing simple screening scores for somatization should be a key priority in providing more focused treatment in emergency departments.

  15. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

    Di Lorenzo, Rosaria; Cabri, Giulio; Carretti, Eleonora; Galli, Giacomo; Giambalvo, Nina; Rioli, Giulia; Saraceni, Serena; Spiga, Giulia; Del Giovane, Cinzia; Ferri, Paola


    Purpose To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. Patients and methods After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity. Results With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach’s alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser’s criterion), which explained >80% of total variance with good internal consistency: 1) “Loss of self-identity and social role”, 2) “Anxiety and uncertainty for future” and 3) “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments. PMID:28182110

  16. Department



    Sep 20, 2016 ... Department of Mathematics, Faculty of Science, Kibabii University. 2. Department .... be seen that average rainfall exhibited a cyclic pattern with a reducing trend under both scenarios .... Department of Meteorology, University.

  17. The permeable institution: an ethnographic study of three acute psychiatric wards in London.

    Quirk, Alan; Lelliott, Paul; Seale, Clive


    In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme.

  18. 护理警示标识在精神科的应用%Introduction of a psychiatric nursing warning logo application in the psychiatric department

    侯明如; 蔡燕; 徐慧鸣; 王静; 高秋寅


    Objective To explore the application nursing warning mark in psychiatric.Methods Photos of psychiatric patients when they admitted to hospital were collected,and their nursing warning logo were made which including their photos,basic information and colored wax light strips.And patients identification and nursing care providing by nurses were accorded to patients' warning logo.The errors due to adverse event occurded on in-hospital patients and mistaken identification during nursing checkup were compared between before and after the application of warning logo.Results After the application of nursing warming logo,the accident rate of hospitalized patients was significantly dropped from 15.7% to 6.7% (x2 =64.39,P < 0.01),the incidence of medication error for identification error was decreased to 0.2%,and no infusion error happened.Conclusions Warning sign can be used as a fast,safe,effective clinical nursing identification tool.%目的 探讨护理警示标识在精神科的应用效果.方法 对确诊的精神病患者入院时即拍照,将照片、基本信息与彩色蜡光纸条合成护理警示标识,护士结合警示标识对患者进行身份识别与护理.比较护理警示标识使用前(2010年12月至201 1年11月)和使用后(2011年12月至2012年11月)住院患者意外事件和身份识别错误所致的护理工作差错的发生情况.结果 应用护理警示标识后住院患者意外事件发生率从15.7%下降到6.7%,差异有统计学意义(x2=64.39,P<0.01),因身份识别错误所致给药错误发生率下降至0.2%,未再发生输液错误,与实施前比较差异有统计学意义(x2值分别为56.65,44.59;P <0.01).结论 警示标识可作为一种快捷、安全、有效的临床护理识别工具.

  19. The Revolving Door Phenomenon in an Italian Acute Psychiatric Ward: A 5-Year Retrospective Analysis of the Potential Risk Factors.

    Di Lorenzo, Rosaria; Sagona, Marco; Landi, Giulia; Martire, Lisa; Piemonte, Chiara; Del Giovane, Cinzia


    To highlight the revolving door (RD) phenomenon in an acute psychiatric ward, we retrospectively identified the patients hospitalized three or more times in a calendar year from 1/1/2009 to 31/12/2013 as RD patients (RDP). We collected sociodemographic and clinical variables of RDP and statistically analyzed the potential RD risk factors. We divided RDP into "high" and "extremely high" utilizers and evaluated the variables related to more frequent readmissions. RDP represented 5.68% of all patients and their hospitalizations (RDH) 25% of all admissions. The statistically significant risk factors for all RDH were "disability pension," "substance abuse/dependence," "mild/severe aggressiveness," and "psychiatric and social rehabilitative programs". The comparison between "high" and "extremely high" utilizers showed that "manic episodes" and "personality disorders," among the diagnoses, "familial relational conflicts" and "violence/suicidality", among the hospitalization reasons, were statistically significant risk factors for more frequent readmissions. RD phenomenon was greatly affected by severe clinical conditions with social disability.

  20. Training needs and role constraints of nurses and assistant nurses working in acute inpatients units of psychiatric hospitals

    Nikolaos Gonis


    Full Text Available Aim: The aim of the research was to record the main clinical problems that mental health nurses and assistant nurses encounter in everyday practice.Material-Method: Data collection based on semi-structured interviews and nurses’ quotes who work in psychiatric acute inpatient wards. Content analysis was carried out and data was categorized into main themes. The total sample consisted of 82 mental health nurses and assistant nurses.Results: Analysis of data revealed that: The constraints of nursing role include the lack of autonomy, the accountability, the medication administration and nursing interventions. Training and clinical needs concern the managing of crisis, the collaboration inside the therapeutic team, the lack of nursing staff that means less time spent with the patient, the security in the work place and the psychological support for nurses.Conclusions: The findings indicated that mental health nurses are called to undertake a demanding role in every day clinical practice with inadequate preparation and training.

  1. The Amsterdam Studies of Acute Psychiatry –II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands.

    Koppelmans, V.; Schoevers, R.A.; Wijk, van C.G.; Mulder, W.; Hornbach, A.; Barkhof, E.; Klaasen, A.; Egmond, van M.; Verlooij, van J.; Bijpost, Y.; Nusselder, H.; Herrewaarden, van M.; Maksimovic, I.; Achilles, A.; Dekker, J.J.M.


    Background The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and

  2. The Amsterdam Studies of Acute Psychiatry - II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands

    Koppelmans, V.; Schoevers, R.; van Wijk, C.G.; Mulder, W.; Hornbach, A.; Barkhof, E.; Klaassen, A.; van Egmond, M.; van Venrooij, J.; Bijpost, Y.; Nusselder, H.; van Herrewaarden, M.; Maksimovic, I.; Achilles, A.; Dekker, J.


    Background: The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and

  3. Acute admissions to medical departments. A comparison between an urban and a rural district

    Hilsted, J C; Evald, T; Elbrønd, R;


    To compare hospitalization into medical departments, acute admissions into a city hospital and into a district hospital were compared prospectively over a two-week period. Patients referred to the city hospital were on average older, were more frequently living alone and they had a greater amount...

  4. High Feasibility of Empiric HIV Treatment for Patients With Suspected Acute HIV in an Emergency Department.

    Jacobson, Kathleen R; Arora, Sanjay; Walsh, Kristin B; Lora, Meredith; Merjavy, Stephen; Livermore, Shanna; Menchine, Michael


    Earlier intervention in acute HIV infection limits HIV reservoirs and may decrease HIV transmission. We developed criteria for empiric antiretroviral therapy (ART) in an emergency department (ED) routine HIV screening program. We assessed the feasibility and willingness of patients with suspected acute HIV infection in the ED to begin ART. A suspected acute HIV infection was defined as a positive HIV antigen antibody combination immunoassay with pending HIV-antibody differentiation test results and HIV RNA viral load. During the study period, there were 16 confirmed cases of acute HIV infection: 11 met our criteria for empiric ART and agreed to treatment, 10 were prescribed ART, and 1 left the ED against medical advice without a prescription for ART. Eight patients completed at least one follow-up visit. Empiric HIV treatment in an ED is feasible, well received by patients, and offers a unique entry point into the HIV care continuum.

  5. Effects of psychiatric disorders on Type A acute aortic dissection pathogenesis and analysis of follow-up results

    Paolo Nardi


    Full Text Available Aims: A connection between psychiatric disorders (PDs and Type A acute aortic dissection (AAD has not been shown. The aim of this study was to define the psychological profile of patients treated for AAD, and to analyze the prevalence of PDs in their medical histories, in the immediate postoperative period, and at a mid-term follow-up. Patients and Methods: From March 2005 to October 2014, 240 consecutive patients underwent surgery for AAD. 60 patients (mean age 60+/-13 years; 43 males underwent psychiatric consultation postoperatively, and they represent the subjects of our retrospective study. Ascending aorta +/- arch replacement was performed in 43 patients, whereas the Bentall procedure +/- arch replacement was performed in 17. Data were retrospectively analyzed. Follow-ups were completed in 59 patients (mean duration 35+/-23 months. Results: PDs were present in the medical histories of 34 patients. Postoperatively, in 28 cases, a definitive diagnosis of PD (group PD was made in agreement with the diagnostic and statistical manual of mental disorders-IV criteria, including: Major depression (n=13, anxious-depressive syndrome (n=6, bipolar disorder Type 2 (n=4, panic attacks (n=2, paranoid schizophrenia (n=1, and anxiety (n=2. 32 patients without a definitive psychiatric diagnosis were classified as Group non-PD. In the postoperative period, clinical manifestations of PDs, including delirium, persistent spatio-temporal disorientation, and psychomotor agitation were evident in 22 patients (78% in group PD versus 8 patients (25% in group non-PD (P<0.0001. During follow-up, only one death for non-cardiac reasons occurred in group PD. There were no suicides; only 10 patients of group PD required PD treatment (P<0.0001 vs. early postoperative findings; 4 patients in group non-PD required PD treatment. Conclusion: Our findings suggest a strong relationship between PD and AAD. Because the psychiatric conditions appeared to be largely stable after

  6. Acute manic and psychotic symptoms following subcutaneous leuprolide acetate in a male patient without prior psychiatric history: A case report and literature review

    Yuan-Hung Pong


    Full Text Available Leuprolide acetate is usually used in the treatment of advanced prostate cancer. The adverse events associated with administration of leuprolide acetate include fatigue, hot flashes, loss of libido, impotence, and depression. These side effects can be treated conservatively. Acute manic and psychiatric symptoms following leuprolide acetate injection are very rare. Few case reports have been published documenting these symptoms. Here, we describe the case of a 62-year-old male with metastatic prostate cancer, who developed acute manic and psychiatric symptoms 2 months after subcutaneous leuprolide acetate injection. These symptoms were relieved after administration of neuroleptic drugs, such as risperidone. Administration of leuprolide acetate was eventually stopped. The exact mechanism causing the manic and psychiatric adverse events is unclear. Some experts have theorized that estrogen withdrawal following leuprolide acetate therapy may induce psychiatric symptoms. Manic episodes may arise from a deficit in central serotonergic neurotransmission. Based on these hypotheses, risperidone, lithium, and some anticonvulsants, such as divalproex sodium and carbamazepine, have been used effectively in the treatment and prophylaxis of manic episodes. Although psychiatric adverse events are rare following administration of leuprolide acetate, clinicians should be aware of the possibility.

  7. [Psychiatric disability and work: assessment of a group of patients examined at the Occupational Medicine Outpatient Department of the Turin University in the period 2000-2012].

    Gullino, A; Coggiola, M; Accomazzo, V; Baracco, A; De Marzi, G P; Occhipinti, R; Perrelli, F; Romano, C


    Problems at workplace with psychiatric subjects are increasing and the role of occupational physicians is basic to achieve a suitable job role. The purpose of this study is to assess the main occupational factors and to evaluate the judgement of fitness to work in 1109 patients with psychiatric diseases examined in our outpatients department during the period 2000-2012. These subjects were sent to our service by family doctors or, more frequently, by the companies seeking for judgement of the working residual capacities. The psychiatric diseases were classified according to the DSM IV; for each group considered, we evaluated the production sector, the specific job role, the pharmacological therapy as compared to the final judgement. The most frequent diagnoses were depressive and anxious disorders. The pharmacological therapy does not seem to be related to the final judgement but the small number of subjects defined as unfit to work does not allow a final evaluation. The study suggests the relevance of team work among the different actors of prevention to achieve a successful management of these workers in a specific job role.

  8. Impact of Experiencing Acute Coronary Syndrome Prior to Open Heart Surgery on Psychiatric Status

    Volkan Yüksel

    Full Text Available Abstract Objective: The incidence of depression and anxiety is higher in patients with acute coronary syndrome. The aim of this study is to determine whether experiencing acute coronary syndrome prior to open heart surgery affects patients in terms of depression, hopelessness, anxiety, fear of death and quality of life. Methods: The study included 63 patients who underwent coronary bypass surgery between January 2015 and January 2016. The patients were divided into two groups: those diagnosed after acute coronary syndrome (Group 1 and those diagnosed without acute coronary syndrome (Group 2. Beck depression scale, Beck hopelessness scale, Templer death anxiety scale and death depression scale, State-Trait anxiety inventory and WHOQOL-Bref quality of life scale were applied. Results: There was no significant difference between the two groups in terms of the total score obtained from Beck depression scale, Beck hopelessness scale - future-related emotions, loss of motivation, future-related expectations subgroups, death anxiety scale, the death depression scale, State-Trait Anxiety Inventory - social and environmental subgroups. The mental quality of life sub-scores of group 2 were significantly higher. The patients in both groups were found to be depressed and hopeless about the future. Anxiety levels were found to be significantly higher in all of the patients in both groups. Conclusion: Acute coronary syndrome before coronary artery bypass surgery impairs more the quality of life in mental terms. But unexpectedly there are no differences in terms of depression, hopelessness, anxiety and fear of death.

  9. Impact of emergency department transitions of care on thrombolytic use in acute ischemic stroke.

    Madej-Fermo, Olga P; Staff, Ilene; Fortunato, Gil; Abbott, Lincoln; McCullough, Louise D


    In-hospital mortality is higher for certain medical conditions based on the time of presentation to the emergency department. The primary goal of this study was to determine whether patients with acute ischemic stroke who arrived to the emergency department during a nursing shift change had similar rates of thrombolytic use and functional outcomes compared with patients presenting during nonshift change hours. A retrospective review of patients with acute ischemic stroke presenting to the emergency department of a primary stroke center from 2005 through 2010. The time to notify the stroke team, perform a head CT scan, and to start intravenous or intra-arterial thrombolysis was assessed. Thrombolysis rates, mortality rate, discharge disposition, change in the National Institutes of Health Stroke Scale, and change in modified Barthel Index at 3 and 12 months were assessed. Of 3133 patients with acute ischemic stroke, 917 met criteria for inclusion. Arrival during nursing shift change, weekends, and July through September had no impact on process times, thrombolysis rates, and functional outcomes. Arrival at night did result in longer time to intra-arterial but not to intravenous thrombolysis, higher mortality rate, and smaller gain in functional status as measured by the modified Barthel Index at 3 months. The degree of emergency department "busyness" also did not influence tissue-type plasminogen activator treatment times. Presentation during a nursing shift change, a time of transition of care, did not delay thrombolytic use in eligible patients with acute ischemic stroke. Presentation with acute ischemic stroke at night did result in delays of care for patients undergoing interventional therapies.

  10. Risk model for suspected acute coronary syndrome is of limited value in an emergency department

    Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre


    INTRODUCTION: Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would...... be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. METHODS: This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1...

  11. Expectations of Care, Perceived Safety, and Anxiety following Acute Behavioural Disturbance in the Emergency Department

    Magdalen Lim


    Full Text Available Objective. We explored perspectives of emergency department users (patients and visitors regarding the management of acute behavioural disturbances in the emergency department and whether these disturbances influenced their levels of anxiety. Methods. Emergency department patients and visitors were surveyed using the State-Trait Anxiety Inventory, and a purpose-designed questionnaire and semistructured interview. The main outcome measures were themes that emerged from the questionnaires, the interviews, and scores from the state component of the State-Trait Anxiety Inventory. Results. 70 participants were recruited. Users of the emergency department preferred behaviourally disturbed people be managed in a separate area from the general emergency department population so that the disturbance was inaudible (=32 and out of view (=40. The state anxiety levels of those that witnessed an acute behavioural disturbance were within the normal range and did not differ to that of ED patients that were not present during such a disturbance (median, control = 37, Code Grey = 33. Conclusions. Behavioural disturbances in the emergency department do not provoke anxiety in other users. However, there is a preference that such disturbances be managed out of visual and audible range. Innovative design features may be required to achieve this.

  12. Comparing the Obvious: Interactional characteristics of staff in acute mental health nursing and forensic psychiatric nursing

    Gildberg, Frederik Alkier; Bradley, Stephen K.; Hounsgaard, Lise


    This article reports on and compares two separate studies of the interactional characteristics of forensic mental health staff and acute mental health staff as they interact with inpatients, respectively. Both studies were conducted using participant observation, along with informal and formal...... interviews. Findings show that both acute and forensic mental health nursing practice is characterized by two overriding themes; ‘trust and relationship-enabling care’ and ‘behavior and perception-corrective care.’ The comparison of the two studies shows no major differences in the characteristics of staff...

  13. Comparing the Obvious: Interactional characteristics of staff in acute mental health nursing and forensic psychiatric nursing

    Gildberg, Frederik Alkier; Bradley, Stephen K.; Hounsgaard, Lise


    interviews. Findings show that both acute and forensic mental health nursing practice is characterized by two overriding themes; ‘trust and relationship-enabling care’ and ‘behavior and perception-corrective care.’ The comparison of the two studies shows no major differences in the characteristics of staff...

  14. Acute childhood arterial ischemic and hemorrhagic stroke in the emergency department.

    Yock-Corrales, Adriana; Mackay, Mark T; Mosley, Ian; Maixner, Wirginia; Babl, Franz E


    Little is known about the presenting features of acute ischemic and hemorrhagic stroke in children presenting to the emergency department (ED). Yet, initial clinical assessment is a key step in the management pathway of stroke. We describe the presentation in the ED of children with confirmed acute ischemic and hemorrhagic stroke subtypes. We conducted a retrospective descriptive case series of consecutive patients aged 1 month to younger than 18 years and presenting to a single-center tertiary ED with radiologically confirmed acute ischemic stroke or hemorrhagic stroke during a 5-year period. Patients were identified by medical record search with International Classification of Diseases, 10th Revision codes for hemorrhagic stroke and through the hospital stroke registry for acute ischemic stroke. Signs, symptoms, and initial management were described. Fifty patients with acute ischemic stroke and 31 with hemorrhagic stroke were identified. Mean age was 8.7 years (SD 5.2), and 51% were male. Fifty-six percent were previously healthy. Median time from onset of symptoms to ED presentation was 21 hours (interquartile range 6 to 48 hours) for acute ischemic stroke and 12 hours (interquartile range 4 to 72 hours) for hemorrhagic stroke. Acute ischemic stroke presented with symptoms of focal limb weakness (64%; 95% confidence interval [CI] 49% to 77%), facial weakness (60%; 95% CI 45% to 73%), and speech disturbance (46%; 95% CI 31% to 60%). Few patients with acute ischemic stroke presented with vomiting and altered mental status. Most patients with acute ischemic stroke had a Glasgow Coma Scale (GCS) score of 14 or greater (86%; 95% CI 73% to 94%) and presented with at least 1 focal neurologic sign (88%; 95% CI 73% to 98%). Hemorrhagic stroke presented with headache (73%; 95% CI 54% to 87%), vomiting (58%; 95% CI 40% to 75%), and altered mental status (48%; 95% CI 30% to 67%). GCS score in hemorrhagic stroke was less than 14 in 38% and less than 8 in 19% (95% CI 7% to

  15. Substance abuse in patients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study

    Anne Opsal


    Full Text Available Background: Substance abuse and mental disorder comorbidity is high among patients admitted to acute psychiatric wards. The aim of the study was to identify this co-occurrence as a reason for involuntary admission and if specific substance use-related diagnoses were associated with such admissions.Methods: The study was a part of a multicentre, cross-sectional national study carried out during 2005-2006 within a research network of acute mental health services. Seventy-five percent of Norwegian hospitals providing acute in-patient treatment participated. Substance use was measured using the Clinician Rating Scale and the ICD-10 diagnoses F10-19. Diagnostic assessments were performed by the clinicians during hospital stay.Results: Overall, 33.2% (n=1,187 of the total patient population (3,506 were abusing alcohol or drugs prior to admission according to the Clinician Rating Scale. No difference in the overall prevalence of substance abuserelated diagnoses between the two groups was found. Overall, 310 (26% of the admissions, 216 voluntarily and 94 involuntarily admitted patients received a double diagnosis. Frequent comorbid combinations among voluntarily admitted patients were; a combination of alcohol and either mood disorder (40% or multiple mental disorders (29%. Among involuntarily admitted patients, a combination of poly drug use and schizophrenia was most frequent (47%. Substance abusing patients diagnosed with mental and behavioral disorders due to the use of psychoactive stimulant substances had a significantly higher risk of involuntary hospitalization (OR 2.3.Conclusion: Nearly one third of substance abusing patients are involuntarily admitted to mental hospitals, in particular stimulant drug use was associated with involuntarily admissions.

  16. The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review

    Domenico de Berardis


    Full Text Available Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.

  17. Evaluation and management of acute abdominal pain in the emergency department

    Macaluso CR


    Full Text Available Christopher R Macaluso, Robert M McNamaraDepartment of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USAAbstract: Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.Keywords: acute abdomen, emergency medicine, peritonitis

  18. Airway Management & Assessment of Dyspnea in Emergency Department Patients with Acute Heart Failure

    Pang, Peter S.; Zaman, Masood


    Shortness of breath is the most common symptom in patients with acute heart failure (AHF). Ensuring adequate oxygenation and ventilation as well as symptomatic relief are key goals of early emergency department management. In this focused review, we describe how to assess dyspnea in clinical practice and how to treat AHF patients to relieve dyspnea, with initial discussion on Airway and Breathing management for patients who present in extremis. PMID:23795334

  19. Antibiotic and bronchodilator prescribing for acute bronchitis in the emergency department.

    Kroening-Roche, Jason C; Soroudi, Arash; Castillo, Edward M; Vilke, Gary M


    Although the overuse of antibiotics and underuse of bronchodilators for treatment of acute bronchitis is well known, few studies have analyzed these trends in the emergency department (ED). To characterize the antibiotic and bronchodilator prescribing practices of physicians at two academic EDs in the diagnosis of acute bronchitis, and to identify factors that may or may not be associated with these practices. A computer database was searched retrospectively for all patients with an ED discharge diagnosis of acute bronchitis, and analyzed, looking at the frequency of antibiotic prescriptions, the class of antibiotic prescribed, and several other related factors including age, gender, chief complaint, duration of cough, and comorbid conditions. During the study period, there were 836 cases of acute bronchitis in adults. Of these, 622 (74.0%) were prescribed antibiotics. Of those prescribed antibiotics, 480 (77.2%) were prescribed broad-spectrum antibiotics. Using multivariate analysis (odds ratio, 95% confidence interval), antibiotics were prescribed significantly more often in patients aged 50 years or older (1.7, 1.2-2.5) and in smokers (1.5, 1.0-2.2). Of patients without asthma, 346 (49.9%) were discharged without a bronchodilator, and 631 (91.1%) were discharged without a spacer device. Antibiotics are over-prescribed in the ED for acute bronchitis, with broad-spectrum antibiotics making up the majority of the antibiotics prescribed. Age ≥50 years and smoking are associated with higher antibiotic prescribing rates. Copyright © 2012. Published by Elsevier Inc.

  20. Predictors of early arrival at the emergency department in acute ischaemic stroke.

    Curran, C


    BACKGROUND: A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window. AIMS: We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area. METHODS: A retrospective review of all case notes for 1 year was performed. RESULTS: Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model. CONCLUSION: The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.

  1. Depart



    Jan 26, 2017 ... Department of Urban and Regional Planning, Ladoke Akintola University of Technology, ... informal automobile workshops in virtually every open space in Nigerian cities that ..... plantation to encourage a green society and.

  2. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats

    Radcliffe, Jonathan; Bird, Laura


    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

  3. State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes.

    Hollander, Judd E; Than, Martin; Mueller, Christian


    It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia. The improvement in cardiac troponin assays, especially in conjunction with well-validated clinical decision algorithms, now enables the clinician to rapidly exclude myocardial infarction. In patients in whom unstable angina remains a concern or there is a desire to evaluate for underlying coronary artery disease, coronary computed tomography angiography can be used in the emergency department. Once a process that took ≥24 hours, computed tomography angiography now can rapidly exclude myocardial infarction and coronary artery disease in patients in the emergency department. © 2016 American Heart Association, Inc.

  4. Characteristics of patients frequently subjected to pharmacological and mechanical restraint--a register study in three Norwegian acute psychiatric wards.

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Mjøsund, Nina Helen; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein


    This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18-29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0-4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients.

  5. Department



    May 25, 2017 ... Department of Animal production Federal University of Technology Minna – Niger state,. Nigeria ... principles by poultry farmers in Kwara State, Nigeria. The ma .... usually incur by broiler and layer farmers ... A multi-stage sampling technique .... their birds under intensive care, which is ... husbandry system.

  6. Proposal for a Stratification Tool for Emergency Department Diabetic Patients with Uncomplicated Acute Hyperglycemia

    Luís Alberto Corona Martínez


    Full Text Available Emergency care services have got an organizational tool of evident usefulness in the stratification of patients. This paper shows a stratification tool for diabetic patients with uncomplicated acute hyperglycemia in the Emergency Department. Group discussion, a process based on several guidelines or principles, was used in its design. The stratification tool classifies patients into one of four groups distinguishable from each other, which contribute to performance of different procedures on patients. It is based on the analysis of clinical information complemented with blood glucose readings, specifically for decision making; each group has a defined context, actions to take and pillars of therapeutic management, primarily focusing on insulin therapy. The tool is accompanied by a flow chart for management of diabetic patients with uncomplicated acute hyperglycemia in the yellow zone.

  7. Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

    Allen, Michael H.; Abar, Beau W.; McCormick, Mark; Barnes, Donna H.; Haukoos, Jason; Garmel, Gus M.; Boudreaux, Edwin D.


    Joint Commission National Patient Safety Goal 15 calls for organizations "to identify patients at risk for suicide." Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%-11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in…

  8. Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica Management of patients with substance use illnesses in psychiatric emergency department

    Ricardo Abrantes do Amaral


    Full Text Available OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica, tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência, sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.OBJECTIVE: Substance use disorders are prevalent in emergency departments in medical and psychiatric services, reaching rates of 28% of cases in medical emergency departments. However, professionals in the emergency department identify less than 50% of cases of alcohol-related problems. This article aims to provide evidence-based interventions for the specific treatment to patients who meet diagnostic criteria for substance use disorders and who present to emergency rooms during intoxication or abstinence. METHOD: A literature review was performed on Medline database, using the descriptors "acute intoxication", "withdrawal", "alcohol", "cocaine", "cannabis", "opioid", "inhalant", "management", using English as the language. RESULTS: AND CONCLUSION: The care of persons with

  9. An Instrument to Prepare for Acute Care of the Individual with Autism Spectrum Disorder in the Emergency Department

    Venkat, Arvind; Migyanka, Joann M.; Cramer, Ryan; McGonigle, John J.


    We present an instrument to allow individuals with autism spectrum disorder, their families and/or their caregivers to prepare emergency department staff for the care needs of this patient population ahead of acute presentation.

  10. Benign Nuchal Rigidity: The Emergency Department Evaluation of Acute Prevertebral Calcific Tendonitis

    Zachary Levy


    Full Text Available Acute prevertebral calcific tendonitis (APCT is a rare condition, the exact incidence of which isunknown. It is of particular interest to the emergency physician owing to the other potentiallydevastating conditions in the differential diagnosis of neck stiffness and/or odynophagia (includingretropharyngeal abscess, infectious spondylitis, and meningitis. In contrast, APCT has a benignclinical course and can be easily managed in the emergency department. We will present a case ofAPCT, followed by a brief discussion of the disease and current literature. [West J Emerg Med.2012;13(1:114–116.

  11. Psychosocial profile of male patients presenting with sexual dysfunction in a psychiatric outpatient department in Mumbai, India

    Kalra, Gurvinder; Kamath, Ravindra; Subramanyam, Alka; Shah, Henal


    Introduction: Sexual dysfunction can occur due to biological problems, relationship problems, lack of proper sexual knowledge or a combination of these. India is often known as the land of Kamasutra. But as far as sexuality research is concerned, there is a paucity of relevant data from India. In view of this, we conducted a study to assess the psychosocial profile of males presenting with sexual dysfunction to psychiatry out-patient department of a tertiary medical hospital. Materials and Me...

  12. Effects of music therapy on self- and experienced stigma in patients on an acute care psychiatric unit: a randomized three group effectiveness study.

    Silverman, Michael J


    Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N=83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for "the stigma blues." Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided.

  13. Computed Tomography Diagnosis of Nonspecific Acute Chest Pain in the Emergency Department: From Typical Acute Coronary Syndrome to Various Unusual Mimics.

    Yoo, Seung Min; Chun, Eun Ju; Lee, Hwa Yeon; Min, Daniel; White, Charles S


    It is a challenging task for emergency department physicians to establish a precise and rapid diagnosis based only on clinical and laboratory findings in patients who present with nonspecific acute chest pain. In this circumstance, CT angiography can provide important clues to the diagnosis. To provide a rapid diagnosis of acute coronary syndrome (ACS) and its various mimics, the physician should enumerate each possible cause of acute chest pain on the basis of an objective assessment of pretest probability. On the basis of clinical suspicion, the appropriate CT protocol should then be performed. Moreover, radiologists should be familiar with typical CT findings of ACS and its various mimics to assist the emergency department physician in diagnosing patients with nonspecific acute chest pain. This review article presents an overview on choosing an appropriate CT protocol in patients with nonspecific acute chest pain and provides specific CT findings of ACS and various mimics of ACS.

  14. Emergency department shift change is associated with pneumonia in patients with acute ischemic stroke.

    Jones, Erica M; Albright, Karen C; Fossati-Bellani, Marco; Siegler, James E; Martin-Schild, Sheryl


    Emergency department (ED) nurses play a pivotal role in early acute ischemic stroke patient management. We hypothesized that patients exposed to ED nursing shift changes (SC) may develop pneumonia (PNA) more frequently and have worse early outcomes than do patients who have continuity of care until stroke unit admission. Consecutive acute ischemic stroke patients presenting to our ED were studied using chart review and prospectively collected registry data. We evaluated the association of patient presence during an ED SC (ie, 07:00-08:00, 19:00-20:00) with length of stay in the ED, PNA rates, and early outcome measures (discharge disposition, modified Rankin Scale score, and death). Three hundred sixty-six consecutive acute ischemic stroke patients met the criteria. Of those, 54.9% were present during an SC. After adjusting for baseline National Institutes of Health Stroke Scale, admission glucose, and intravenous tissue-type plasminogen activator, patients present during SC were half as likely to be discharged home or to inpatient rehab (OR, 0.50; 95% CI, 0.26-0.96; P=0.04) and were 2.5 times more likely to develop PNA (OR, 2.54; 95% CI, 1.02-6.30; P=0.045). After additional adjustment for time in the ED, the difference in favorable discharge disposition was no longer significant, but SC was associated with 5 times the odds of PNA (OR, 5.35; 95% CI, 1.34-21.39; P=0.018) compared with patients with continuity of care. In our center, acute ischemic stroke patients present during an ED nursing SC experienced higher rates of PNA and had decreased rates of favorable discharge disposition compared with patients with continuity of care. Strategies to prevent PNA and improve hand-off communication during SC may reduce this risk.

  15. Student-selected component in the medical curriculum: investigations and psychiatric referral for paracetamol overdose in an accident and emergency department

    Cowman JG


    Full Text Available James G Cowman, Manuel Bakheet Royal College of Surgeons in Ireland – Medical University of Bahrain, Manama, Bahrain Background: A student-selected component (SSC of the medical curriculum requires the student to be self-directed in locating and undertaking a placement in a clinical specialty of their choosing and completing a project. The clinical area for experience was an accident and emergency department, and our topic was a focused audit on the investigations and referral for paracetamol overdose. The purpose of this paper is twofold: to reflect on the education value to medical students of an SSC in a medical curriculum, and to highlight learning and understanding through completion of an audit.Materials and methods: An audit approach was applied. The aim of the project study was to investigate the level of compliance with best-practice guidelines for investigations and psychiatric referral in paracetamol overdose.Results: A total of 40 cases meeting the inclusion criteria were randomly selected. The sample had a mean age of 27 years, of whom 70.5% were female, and the ingested dose of paracetamol ranged from 0.864 to 80 g. Paracetamol abuse may present as intentional and unintentional overdose. In our study, 85% of cases were identified as intentional overdose and 76% had a history of psychiatric illness. Generally, medical management was compliant with guidelines, with some minor irregularities. The international normalized ratio was the most underperformed test.Conclusion: Our choice of topic, paracetamol overdose, contributed to our understanding of the breadth of factors to be considered in the emergency medical management of a patient. In this regard, we had the benefit of understanding how the diagnostic and therapeutic factors, when applied in accordance with best-practice guidelines, work very effectively. The SSC impacted positively on our cognitive, personal, and professional development. In facilitating the student with

  16. Psychiatric symptoms and service utilization among refugee children referred to a child psychiatry department: a retrospective comparative case note study.

    Vaage, Aina Basilier; Garløv, Ida; Hauff, Edvard; Thomsen, Per Hove


    Refugee children may encounter barriers to accessing mental health services. We conducted a case-control study based on a systematic review of clinic records to compare psychopathology and service utilization in refugee and Norwegian children referred to a child psychiatry department in a county in southern Norway. Sixty-one refugee children were compared with 61 Norwegian-born children matched for gender, age and time of referral to the clinic. There was no significant difference in rates of referral or level of service utilization, which were proportional to the population. Compared with Norwegian children, refugee children were diagnosed more frequently with post-traumatic stress disorder and other affective and emotional disorders, and less often with pervasive developmental disorders and attention deficit hyperactivity disorder. The results are discussed in terms of referral pathways and the need for culturally competent care for refugee children.

  17. Knowledge, Self-Confidence and Attitudes towards Suicidal Patients at Emergency and Psychiatric Departments: A Randomised Controlled Trial of the Effects of an Educational Poster Campaign

    van Landschoot, Renate; Portzky, Gwendolyn; van Heeringen, Kees


    Educational posters are used to enhance knowledge, attitudes and self-confidence of patients. Little is known on their effectiveness for educating health care professionals. As these professionals may play an important role in suicide prevention, the effects of a poster and accompanying evaluation and triage guide on knowledge, self-confidence and attitudes regarding suicidal thoughts and behaviours, were studied in a multicentre cluster randomised controlled trial, involving staff from 39 emergency and 38 psychiatric departments throughout Flanders (n = 1171). Structured self-report questionnaires assessed the knowledge, confidence and beliefs regarding suicidal behaviour management, and attitudes. Data were analysed through a Solomon four-group design, with random assignment to the different conditions. Baseline scores for knowledge and provider confidence were high. The poster and accompanying evaluation and triage guide did not have an effect on knowledge about suicide and self-confidence in suicidal behaviour management. However, the poster campaign appeared to be beneficial for attitudes towards suicidal patients, but only among staff from mental health departments that were assigned to the un-pretested condition. Given the limited effects of the poster campaign in the studied population with a relatively high baseline knowledge, the evaluation of this poster as part of a multimodal educational programme in a more heterogeneous sample of health care professionals is recommended. PMID:28335446

  18. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge.

    Mahler, Simon A; Riley, Robert F; Hiestand, Brian C; Russell, Gregory B; Hoekstra, James W; Lefebvre, Cedric W; Nicks, Bret A; Cline, David M; Askew, Kim L; Elliott, Stephanie B; Herrington, David M; Burke, Gregory L; Miller, Chadwick D


    The HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care. Adult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, emergency department providers used the HEART score, a validated decision aid, and troponin measures at 0 and 3 hours to identify patients for early discharge. Usual care was based on American College of Cardiology/American Heart Association guidelines. The primary outcome, objective cardiac testing (stress testing or angiography), and secondary outcomes, index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, or coronary revascularization), were assessed at 30 days by phone interview and record review. Participants had a mean age of 53 years, 16% had previous myocardial infarction, and 6% (95% confidence interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of randomization. Compared with usual care, use of the HEART Pathway decreased objective cardiac testing at 30 days by 12.1% (68.8% versus 56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours; P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%; P<0.001). No patients identified for early discharge had major adverse cardiac events within 30 days. The HEART Pathway reduces objective cardiac testing during 30 days, shortens length of stay, and increases early discharges. These important efficiency gains occurred without any patients identified for early discharge suffering MACE at 30 days. URL: Unique Identifier: NCT01665521. © 2015 American Heart Association, Inc.

  19. Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment.

    Walsh, Jim; Boyle, Joan


    This paper has been undertaken by people with experience with mental health issues and mental health care systems. The aim of the research was to explore psychiatric inpatients' strategies for coping with mental ill health and in what ways acute inpatient psychiatric hospital services are facilitative to the individual attempting recovery. Ten focus groups were facilitated and data were analysed through systematic content analysis. Findings revealed that the main areas of concern for inpatients were: information, communication, relationships, activities, self-help, patient involvement in care treatment plans, and the physical environment. The authors also make a case to improve the status of user-led research as a means to understand the needs of mental health service users.

  20. Psychosocial profile of male patients presenting with sexual dysfunction in a psychiatric outpatient department in Mumbai, India.

    Kalra, Gurvinder; Kamath, Ravindra; Subramanyam, Alka; Shah, Henal


    Sexual dysfunction can occur due to biological problems, relationship problems, lack of proper sexual knowledge or a combination of these. India is often known as the land of Kamasutra. But as far as sexuality research is concerned, there is a paucity of relevant data from India. In view of this, we conducted a study to assess the psychosocial profile of males presenting with sexual dysfunction to psychiatry out-patient department of a tertiary medical hospital. Hundred consecutive male patients presenting with sexual dysfunction were screened using Arizona Sexual Experiences Scale for clinical sexual dysfunction and after obtaining their informed consent were included in this study. They were assessed using a semi-structured proforma, Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition, Text Revision criteria, Mini-International Neuropsychiatric Interview, and Dyadic Adjustment Scale. Majority of our respondents were in the 18-30 years age group and were married. The main source of sex knowledge for 69% of them was peer group. Age of onset of masturbation was 11-13 years for 43% of them. Premature ejaculation was the most common sexual dysfunction seen in the respondents. Marital discord was seen in significantly lesser number of respondents (32.35%) as also major depressive disorder that was seen in only 16%. Premature ejaculation was the most common sexual dysfunction in our sample. Despite the sexual dysfunction, marital discord and depression were seen less commonly in our respondents.

  1. Efficacy of Acute Pain Control Protocol in Triage Department on Analgesics Administration Time and Patients' Satisfaction

    Seyedhossein Seyyedhoseini Davaraani


    Full Text Available Objective: Current study was conducted to develop a pain control protocol by Morphine Sulfate (MS Suppository in triage ward with the main primary outcomes of first analgesic administration time, patients' satisfaction and also the changes in pain intensity. Methods: In this randomized clinical trial, 318 consecutive patients attending to an academic tertiary health care center in Tehran, Iran in 2011 and 2012 were enrolled. The patients were randomly assigned to receive either routine pain control by emergency medicine residents in emergency department (n=132 or pain control protocol in triage level by nurses (n=186. Those with pain in control group were treated with conventional pain control program and those in intervention group with pain intensities higher than four were treated with suppository stat 10 mg dose of MS administered by nurses in triage ward. Results: The mean change in pain intensity was significantly (P<0.0001 higher in intervention group (4.2 versus 0.2 and the first analgesic administration time was significantly different between groups (P<0.05 being less in the intervention group (43.1 versus 4.6. Also the patients' satisfaction was significantly higher in the intervention group (P<0.0001. No drug adverse effects were seen. Conclusions: Totally, according to the obtained results, it may be concluded that acute pain control protocol in triage department by suppository of MS would result in reduced analgesics administration time and higher patients' satisfaction.   Keywords: Analgesia; Emergency Department; Pain Control

  2. Acute poisoning in children; changes over the years, data of pediatric clinic department of toxicology

    Keka Alije; Ramosaj A; Toro H; Azemi M; Baloku A; Sylaj B; Lenjani B; Kyseni K


    Objective:To present the frequency, etiology, changes over the years of acute poisoning in children admitted toPediatricClinic ofPristina and to determine the extent and characteristics of the problem, according to which related preventive measures can be taken.Methods:Retrospectively we have analyzed the epidemiology of accidental and suicidal poisonings in children hospitalization inPediatricClinicDepartment ofToxicology during the year2012. Our data we compared with data from previous studies on acute poisoning in children in the PediatricClinic conducted during the years1976-1985 and2001.Results:During the year2012, inPediatricClinic ofPristina5723 children were hospitalized,136 of them or2.3% were treated due to acute poisoning inDepartment ofToxicology,82 of them was boys and54 was girls, rate boys girls was1.5:1.The majority of cases101 or74.2% were under five years with peak age three and35% or25.7% were over five years.The most of the cases was accidentally97% and only 2.9% was suicidal and all of them were over the age of ten.Drugs were the most common agent causing the poisoning71(52.2%) followed by house cleaning products38(27.9%), food10(5.8%), pesticides7(5.14%), rare agent that caused poisoning were: narcotic substances, plant, heavy metals, alcohol, carbon monoxide, carburant.Poisoning occurred mostly in spring and the peak was observed inMay,(1.17% of all patients).January was the month of lowest rate of poisoning. During the years1976-1985, inPediatricClinic ofPristina900 children were hospitalized due to acute poisoning,44.11% were from drugs,15.88% from pesticides,65(7.2%), while during2001 in the unit care intensive were hospitalized66 children due to acute poisoning, among them51.5% were poisoning from drugs,30.03 from pesticides,12.2% from cleaning products.Conclusion:In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than5 years-old, this age of children is the most

  3. Novel Antiplatelet Agent Use for Acute Coronary Syndrome in the Emergency Department: A Review

    M. Curial


    Full Text Available Background. Acute Coronary Syndrome (ACS is a clinical condition encompassing ST Segment Elevation Myocardial Infarction (STEMI, Non-ST Segment Elevation Myocardial Infarction (NSTEMI, and Unstable Angina (UA and is characterized by ruptured coronary plaque, ischemic stress, and/or myocardial injury. Emergency department (ED physicians are on the front lines of ACS management. The role of new antiplatelet agents ticagrelor and prasugrel in acute ED management of ACS has not yet been defined. Objective. To critically review clinical trials using ticagrelor and prasugrel in the treatment of ACS and inform practitioners of their potential utility in treating ACS in the ED. Results. Trials on the efficacy of ticagrelor and prasugrel achieve statistical significance in decreasing composite endpoints in select patient populations. Conclusion. The use of ticagrelor and prasugrel as first line ED treatment of ACS is not well established. Current evidence supports the use of several agents with the final decision based on treatment protocols conjointly developed between cardiology and emergency medicine (EM. Further clinical trials involving head-to-head trials or comparisons of drug-based strategies are required to show superiority in reducing cardiac endpoints with regard to ED initiation of treatment.

  4. The use of mobile phones for acute wound care: attitudes and opinions of emergency department patients.

    Sikka, Neal; Carlin, Katrina N; Pines, Jesse; Pirri, Michael; Strauss, Ryan; Rahimi, Faisil


    There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.

  5. Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

    Cássio M.C. Bottino

    Full Text Available Abstract In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1 to present the evidence found on Brazilian (LILACS, SCIELO and International (MEDLINE databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and 2 to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption.


    Podsevatkin, V G; Blinov, D S; Podsevatkin, D V; Podsevatkina, S V; Smirnova, O A


    The new technology of hospital psychiatric care, developed and implemented in the Mordovia republican clinical hospital, permits resolving problems of hospitalism, lethality, pharmaceutical resistance and others. The essence of this technology is in staging of hospital care under condition of intensification and standardization of curative diagnostic process, implementation of complex approach to treatment of psychiatric disorders. The patient sequentially passes through three stages: intensive diagnostics and intensive treatment (intensive care department, intensive therapy department), supportive therapy (general psychiatric department); rehabilitation measures (curative rehabilitative department). The concentration of resources at the first stage, application of intensive therapy techniques permit in the shortest period to arrest acute psychotic symptomatic. The described new technology of hospital psychiatric care permits enhancing effectiveness of treatment, significantly shorten period of hospitalization (37.5 days), to obtain lasting and qualitative remission, to rehabilitate most fully social working status of patient and to significantly decrease lethality.

  7. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    Madsen, Tracy E.


    Full Text Available Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV tissue plasminogen activator (tPA. Emergency department (ED triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI levels and use of ED critical care beds. Methods: This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ≥18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results: There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001, and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001. Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77; 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53. After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81] and 3

  8. Advanced management of acute iliofemoral deep venous thrombosis: emergency department and beyond.

    Pollack, Charles V


    Recent attention to the increasing incidence of venous thromboembolism has included a call to action from the surgeon general and new guidelines from various specialty organizations. The standard of care for treatment of deep venous thrombosis in the emergency department (ED), supported by the 2008 American College of Chest Physicians (ACCP) guidelines, involves initiation of anticoagulation with low-molecular-weight heparin, pentasaccharide, or unfractionated heparin. For selected appropriate patients with extensive acute proximal deep venous thrombosis, the ACCP guidelines now recommend thrombolysis in addition to anticoagulation to reduce not only the risk of pulmonary embolism but also the risk of subsequent postthrombotic syndrome and recurrent deep venous thrombosis. Postthrombotic syndrome is a potentially debilitating chronic cluster of lower-extremity symptoms occurring in 20% to 50% of deep venous thrombosis patients subsequent to the acute insult, sometimes not until years later. A strategy of early thrombus burden reduction or frank removal might reduce the incidence of postthrombotic syndrome, as per natural history studies, venous thrombectomy data, observations after systemic and catheter-directed thrombolysis, and the still-limited number of randomized trials of catheter-directed thrombolysis (with anticoagulation) versus anticoagulation alone. Contemporary invasive (endovascular) treatments mitigate the drawbacks historically associated with thrombolytic approaches by means of intrathrombus delivery of drugs with greater fibrin specificity and lower allergenicity, followed by mechanical dispersion to accelerate lysis and then aspiration of remaining drug and clot debris. With a 2016 target completion date, the National Heart, Lung, and Blood Institute--sponsored Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-Directed Thrombolysis trial is comparing the safety and efficacy, in terms of both deep venous thrombosis and

  9. IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments.

    Sartelli, Massimo; Binda, Gian Andrea; Brandara, Francesco; Borasi, Andrea; Feroci, Francesco; Vadalà, Salvatore; Labricciosa, Francesco M; Birindelli, Arianna; Luridiana, Gianluigi; Coccolini, Federico; Di Saverio, Salomone; Catena, Fausto; Ansaloni, Luca; Campanile, Fabio Cesare; Agresta, Ferdinando; Piazza, Diego


    In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.

  10. The Amsterdam Studies of Acute Psychiatry - II (ASAP-II: a comparative study of psychiatric intensive care units in the Netherlands

    van Venrooij Janine


    Full Text Available Abstract Background The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU. From several studies and reports it has become evident that important dissimilarities exist between PICU's. The current study seeks to describe organisational as well as clinical and patient related factors across ten PICU's in and outside the Amsterdam region, adjusted for or stratified by level of urbanization. Method/Design This paper describes the design of the Amsterdam Studies of Acute Psychiatry II (ASAP-II. This study is a prospective observational cohort study comparing PICU's in and outside the Amsterdam region on various patient characteristics, treatment aspects and recovery related variables. Dissimilarities were measured by means of collecting standardized forms which were filled out in the framework of care as usual, by means of questionnaires filled out by mental health care professionals and by means of extracting data from patient files for every consecutive patient admitted at participating PICU's during a specific time period. Urbanization levels for every PICU were calculated conform procedures as proposed by the Dutch Central Bureau for Statistics (CBS. Discussion The current study may provide a deeper understanding of the differences between psychiatric intensive care units that can be used to promote best practice and benchmarking procedures, and thus improve the standard of care.

  11. Video capsule endoscopy in the emergency department: a prospective study of acute upper gastrointestinal hemorrhage.

    Meltzer, Andrew C; Ali, M Aamir; Kresiberg, Roderick B; Patel, Gayatri; Smith, Jeff P; Pines, Jesse M; Fleischer, David E


    Video capsule endoscopy has been used to diagnose gastrointestinal hemorrhage and other small bowel diseases but has not been tested in an emergency department (ED) setting. The objectives in this pilot study are to demonstrate the ability of emergency physicians to detect blood in the upper gastrointestinal tract with capsule endoscopy after a short training period, measure ED patient acceptance of capsule endoscopy, and estimate the test characteristics of capsule endoscopy to detect acute upper gastrointestinal hemorrhage. During a 6-month period at a single academic hospital, eligible patients underwent video capsule endoscopy (Pillcam Eso2; Given Imaging) in the ED. Video images were reviewed by 4 blinded physicians (2 emergency physicians with brief training in capsule endoscopy interpretation and 2 gastroenterologists with capsule endoscopy experience). A total of 25 subjects with acute upper gastrointestinal hemorrhage were enrolled. There was excellent agreement between gastroenterologists and emergency physicians for the presence of fresh or coffee-ground blood (0.96 overall agreement; κ=0.90). Capsule endoscopy was well tolerated by 96% of patients and showed an 88% sensitivity (95% confidence interval 65% to 100%) and 64% specificity (95% confidence interval 35% to 92%) for the detection of fresh blood. Capsule endoscopy missed 1 bleeding lesion located in the postpyloric region, which was not imaged because of expired battery life. Video capsule endoscopy is a sensitive way to identify upper gastrointestinal hemorrhage in the ED. It is well tolerated and there is excellent agreement in interpretation between gastroenterologists and emergency physicians. Copyright © 2012. Published by Mosby, Inc.

  12. Assessing hospital performance for acute myocardial infarction: how should emergency department transfers be attributed.

    Samadashvili, Zaza; Hannan, Edward L; Cozzens, Kimberly; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Venditti, Ferdinand J; Curtis, Jeptha


    The Centers for Medicare and Medicaid Services publicly reports risk-standardized mortality rates (RSMRs) to assess quality of care for hospitals that treat acute myocardial infarction patients, and the outcomes for inpatient transfers are attributed to transferring hospitals. However, emergency department (ED) transfers are currently ignored and therefore attributed to receiving hospitals. New York State administrative data were used to develop a statistical model similar to the one used by Centers for Medicare and Medicaid Services to risk-adjust hospital 30-day mortality rates. RSMRs were calculated and outliers were identified when ED transfers were attributed to: (1) the transferring hospital and (2) the receiving hospital. Differences in hospital outlier status and RSMR tertile between the 2 attribution methods were noted for hospitals performing and not performing percutaneous coronary interventions (PCIs). Although both methods of attribution identified 3 high outlier non-PCI hospitals, only 2 of those hospitals were identified by both methods, and each method identified a different hospital as a third outlier. Also, when transfers were attributed to the referring hospital, 1 non-PCI hospital was identified as a low outlier, and no non-PCI hospitals were identified as a low outlier with the other attribution method. About one sixth of all hospitals changed their tertile status. Most PCI hospitals (89%) that changed status moved to a higher (worse RSMR) tertile, whereas the majority of non-PCI hospitals (68%) that changed status were moved to a lower (better) RSMR tertile when ED transfers were attributed to the referring hospital. Hospital quality assessments for acute myocardial infarction are affected by whether ED transfers are assigned to the transferring or receiving hospital. The pros and cons of this choice should be considered.

  13. A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

    Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan


    Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents.

  14. Evolution of the clinical profile of patients with acute heart failure treated in Spanish emergency departments.

    Escoda, R; Miró, Ò; Martín-Sánchez, F J; Jacob, J; Herrero, P; Gil, V; Garrido, J M; Pérez-Durá, M J; Fuentes, M; Llorens, P


    To analyse the changes in epidemiology, outpatient and emergency department clinical care, and outcomes of patients treated for acute heart failure (AHF) in Spanish hospital emergency departments (HEDs) between 2007 and 2014. A multicentre cohort study was conducted that consecutively included patients with AHF diagnosed in 9HEDs during 4 periods (2007, 2009, 2011 and 2014). The study analysed the changes observed in 20 variables corresponding to baseline data, outpatient care and emergency care data and outcome data. A total of 4,845 patients were included. There were significant changes in 13 variables: there was an increase in patients older than 80years (2007/2014: 45.9%/55.4%; P<.001) and a decrease in severe functional dependence (28.2%/19.7%; P<.001). In terms of long-term outpatient care, there was an increased use of beta-blockers (44.6%/57.8%; P=.002) and aldosterone antagonists (26.6%/37.7%; P<.05) among patients with reduced ejection fraction and an increase use of echocardiography (42.8%/56.2%; P=.001). The use of digoxin decreased (25.4%/16.9%; P=.005). In terms of emergency care, there was an increase in requests for troponins (54.6%/61.9%; P<.001), natriuretic peptides (7.8%/48.5%; P<.001) and the use of noninvasive ventilation (3.2%/6.9%; P=.004). Requests for endovenous perfusion drugs decreased (diuretics: 21.3%/10.4%; P<.001; nitrates: 21.3%/17.5%; P=.001; vasopressors: 4.2%/1.5%; P<.001). Finally, discharges directly from the emergency department without hospitalization increased (20.0%/25.9%; P<.001), and emergency department readmissions at 30days decreased (27.3%/17.6%; P=.007). Hospital mortality and mortality at 30days did not change. Changes in outcomes were detected during a 7-year period in patients with AHF treated in HEDs, with care that was more in line with the clinical guidelines. There are, however, areas for improvement. There was a noteworthy increase in outpatient follow-up without hospitalisation and a reduction in HED

  15. The periodicities in and biometeorological relationships with bed occupancy of an acute psychiatric ward in Antwerp, Belgium

    Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.


    Recently, some investigators have established a seasonal pattern in normal human psychology, physiology and behaviour, and in the incidence of psychiatric psychopathology. In an attempt to elucidate the chronopsy and meteotropism in the latter, we have examined the chronograms of, and the biometeorological relationships to bed occupancy of the psychiatric ward of the Antwerp University Hospital during three consecutive calendar years (1987 1989). Weather data for the vicinity were provided by a local meteorological station and comprise mean atmospheric pressure, air temperature, relative humidity, wind speed and minutes of sunlight and precipitation/day. The number of psychiatric beds occupied during the study period exhibited a significant seasonal variation. Peaks in bed occupancy were observed in March and November, with lows in August. An important part of the variability in the number of beds occupied could be explained by the composite effects of weather variables of the preceding weeks. Our results suggest that short-term fluctuations in atmospheric activity may dictate some of the periodicities in psychiatric psychopathology.

  16. Acute intoxication patients presenting to an emergency department in The Netherlands: admit or not? Prospective testing of two algorithms.

    Ambrosius, R.G.; Vroegop, M.P.; Jansman, F.G.A.; Hoedemaekers, C.W.E.; Aarnoutse, R.E.; Wilt, G.J. van der; Kramers, C.


    STUDY OBJECTIVE: After acute intoxication, most patients presenting to the emergency department (ED)--76% of them in The Netherlands--are admitted to hospital. Many will not need medical treatment on the ward. The authors tested two algorithms in the ED, based on vital parameters, ECG findings, and

  17. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    Yuwares Sittichanbuncha


    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  18. An online tool for nurse triage to evaluate risk for acute coronary syndrome at emergency department.

    Sittichanbuncha, Yuwares; Sanpha-Asa, Patchaya; Thongkrau, Theerayut; Keeratikasikorn, Chaiyapon; Aekphachaisawat, Noppadol; Sawanyawisuth, Kittisak


    Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  19. Accuracy of Current Diagnostic Criteria for Acute Bacterial Infection in Older Adults in the Emergency Department.

    Caterino, Jeffrey M; Leininger, Robert; Kline, David M; Southerland, Lauren T; Khaliqdina, Salman; Baugh, Christopher W; Pallin, Daniel J; Stevenson, Kurt B


    To compare the accuracy of the Loeb criteria, emergency department (ED) physicians' diagnoses, and Centers for Disease Control and Prevention (CDC) guidelines for acute bacterial infection in older adults with a criterion standard expert review. Prospective, observational study. Urban, tertiary-care ED. Individuals aged 65 and older in the ED, excluding those who were incarcerated, underwent a trauma, did not speak English, or were unable to consent. Two physician experts identified bacterial infections using clinical judgement, participant surveys, and medical records; a third adjudicated in cases of disagreement. Agreement and test characteristics were measured for ED physician diagnosis, Loeb criteria, and CDC surveillance guidelines. Criterion-standard review identified bacterial infection in 77 of 424 participants (18%) (18 (4.2%) lower respiratory, 19 (4.5%) urinary tract (UTI), 22 (5.2%) gastrointestinal, 15 (3.5%) skin and soft tissue). ED physicians diagnosed infection in 71 (17%), but there were 33 with under- and 27 with overdiagnosis. Physician agreement with the criterion standard was moderate for infection overall and each infection type (κ = 0.48-0.59), but sensitivity was low (<67%), and the negative likelihood ratio (LR(-)) was greater than 0.30 for all infections. The Loeb criteria had poor sensitivity, agreement, and LR(-) for lower respiratory (50%, κ = 0.55; 0.51) and urinary tract infection (26%, κ = 0.34; 0.74), but 87% sensitivity (κ = 0.78; LR(-) 0.14) for skin and soft tissue infections. CDC guidelines had moderate agreement but poor sensitivity and LR(-). Emergency physicians often under- and overdiagnose infections in older adults. The Loeb criteria are useful only for diagnosing skin and soft tissue infections. CDC guidelines are inadequate in the ED. New criteria are needed to aid ED physicians in accurately diagnosing infection in older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics

  20. Acute alcohol consumption and motivation to reduce drinking among injured patients in a Swedish emergency department.

    Trinks, Anna; Festin, Karin; Bendtsen, Preben; Cherpitel, Cheryl J; Nilsen, Per


    Injuries constitute a major public health problem. Millions of people are injured each year, and acute drinking is a well-known risk factor for injuries. Research suggests that acknowledgment of alcohol as a factor in an injury enhances willingness to change drinking behavior, possibly because the patient becomes aware of the negative consequences of their drinking. This study aims to investigate the prevalence of acute alcohol consumption (drinking before the event) among injury patients and to examine the importance of factors potentially associated with motivation to reduce alcohol consumption among these patients. All patients aged 18-69 years were requested to answer alcohol-related questions on a touchscreen computer. Fifteen percent of injured patients were categorized as acute drinkers, and of these, 64% reported that their injury was connected to alcohol. There were significant differences for all sociodemographic and drinking characteristics between acute drinkers and nonacute drinkers. Acute drinkers were categorized as risky drinkers to a much higher extent than nonacute drinkers. Acute drinkers had a considerably higher average weekly alcohol consumption and engaged far more frequently in heavy episodic drinking than nonacute drinkers. Acute drinkers were motivated to reduce their alcohol intake to a greater extent than nonacute drinkers; 51% were in the action, preparation, and contemplation stages, compared with 19% of the nonacute drinkers. Acute drinkers had considerably more detrimental alcohol consumption than nonacute drinkers, and the acute drinkers were more motivated to reduce their drinking than the nonacute drinkers.

  1. Clinical Factors and Outcomes in Patients with Acute Mesenteric Ischemia in the Emergency Department

    Hsien-Hao Huang


    Conclusion: A high index of suspicion and aggressive diagnostic imaging can facilitate early diagnosis and improve outcomes for patients with acute mesenteric ischemia. Risk stratification showed that elderly patients with metabolic acidosis, bandemia, or elevated AST and BUN had a poor prognosis. Greater therapeutic intervention is advocated to reduce mortality in high-risk patients with acute mesenteric ischemia.

  2. Acute psychiatric treatment and the use of physical restraint in first-generation immigrants in Italy: a prospective concurrent study.

    Tarsitani, Lorenzo; Pasquini, Massimo; Maraone, Annalisa; Zerella, Maria Paola; Berardelli, Isabella; Giordani, Roberta; Polselli, Gian Marco; Biondi, Massimo


    and Immigrants in Europe appear at higher risk of psychiatric coercive interventions. No studies have investigated this issue in Italy. The aim of this study is to investigate whether the use of physical restraint, compulsory admission and other treatment characteristics differ in immigrated and Italian-born patients admitted to a psychiatric intensive care unit. One hundred first-generation immigrant patients were compared to 100 age-, gender- and diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Clinical data and treatment characteristics were collected. Immigrant patients were more likely to be physically restrained as compared to Italian-born patients (11% vs 3%; χ (2) = 4.92; p = 0.027; RR = 3.67; 95% CI = 1.05-12.7). No differences in the proportion of involuntary treatment were found. Immigrant patients did not receive higher doses of antipsychotics or benzodiazepines, but they had a longer stay in the hospital. The higher rate of physical restraint among migrants may reflect cultural, ethnic and language differences leading to communication problems between immigrant patients and mental health professionals. Since coercive interventions can be harmful, specific strategies to prevent this phenomenon in immigrants are needed.

  3. Failure of a patient-centered intervention to substantially increase the identification and referral for-treatment of ambulatory emergency department patients with occult psychiatric conditions: a randomized trial [ISRCTN61514736

    Nezami Wais A


    Full Text Available Abstract Background We previously demonstrated that a computerized psychiatric screening interview (the PRIME-MD can be used in the Emergency Department (ED waiting room to identify patients with mental illness. In that trial, however, informing the ED physician of the PRIME-MD results did not increase the frequency of psychiatric diagnosis, consultation or referral. We conducted this study to determine whether telling the patient and physician the PRIME-MD result would result in the majority of PRIME-MD-diagnosed patients being directed toward treatment for their mental illness. Methods In this single-site RCT, consenting patients with non-specific somatic chief complaints (e.g., fatigue, back pain, etc. completed the computerized PRIME-MD in the waiting room and were randomly assigned to one of three groups: patient and physician told PRIME-MD results, patient told PRIME-MD results, and neither told PRIME-MD results. The main outcome measure was the percentage of patients with a PRIME-MD diagnosis who received a psychiatric consultation or referral from the ED. Results 183 (5% of all ED patients were approached. 123 eligible patients consented to participate, completed the PRIME-MD and were randomized. 95 patients had outcomes recorded. 51 (54% had a PRIME-MD diagnosis and 8 (16% of them were given a psychiatric consultation or referral in the ED. While the frequency of consultation or referral increased as the intervention's intensity increased (tell neither = 11% (1/9, tell patient 15% (3/20, tell patient and physician 18% (4/22, no group came close to the 50% threshold we sought. For this reason, we stopped the trial after an interim analysis. Conclusion Patients willingly completed the PRIME-MD and 54% had a PRIME-MD diagnosis. Unfortunately, at our institution, informing the patient (and physician of the PRIME-MD results infrequently led to the patient being directed toward care for their psychiatric condition.

  4. The Clinical Epidemiology and 30-Day Outcomes of Emergency Department Patients With Acute Kidney Injury

    Frank Xavier Scheuermeyer


    Full Text Available Background: Acute kidney injury (AKI is associated with increased mortality and dialysis in hospitalized patients but has been little explored in the emergency department (ED setting. Objective: The objective of this study was to describe the risk factors, prevalence, management, and outcomes in the ED population, and to identify the proportion of AKI patients who were discharged home with no renal-specific follow-up. Design: This is a retrospective cohort study using administrative and laboratory databases. Setting: Two urban EDs in Vancouver, British Columbia, Canada. Patients: We included all unique ED patients over a 1-week period. Methods: All patients had their described demographics, comorbidities, medications, laboratory values, and ED treatments collected. AKI was defined pragmatically, based upon accepted guidelines. The cohort was then probabilistically linked to the provincial renal database to ascertain renal replacement (transplant or dialysis and the provincial vital statistics database to obtain mortality. The primary outcome was the prevalence of AKI; secondary outcomes included (1 the proportion of AKI patients who were discharged home with no renal-specific follow-up and (2 the combined 30-day rate of death or renal replacement among AKI patients. Results: There were 1651 ED unique patients, and 840 had at least one serum creatinine (SCr obtained. Overall, 90 patients had AKI (10.7% of ED patients with at least one SCr, 95% confidence interval [CI], 8.7%-13.1%; 5.5% of all ED patients, 95% CI, 4.4%-6.7% with a median age of 74 and 70% male. Of the 31 (34.4% AKI patients discharged home, 4 (12.9% had renal-specific follow-up arranged in the ED. Among the 90 AKI patients, 11 died and none required renal replacement at 30 days, for a combined outcome of 12.2% (95% CI, 6.5%-21.2%. Limitations: Sample sizes may be small. Nearly half of ED patients did not obtain an SCr. Many patients did not have sequential SCr testing, and a

  5. Features and Prognostic Factors for Elderly With Acute Poisoning in the Emergency Department

    Yu-Hui Hu


    Conclusion: Our results demonstrated that elderly patients with acute poisoning had a mortality rate of 9.6%. Suicide attempts resulted in more serious complications. The risk factors for mortality were herbicide intoxication, hypotension and respiratory failure.

  6. The role of neopterine in the diagnosis of patients with acute pancreatitis on admission to the emergency department

    Keziban Ucar Karabulut


    Full Text Available Purpose: There are difficulties observed in the diagnosis of acute pancreatitis in emergency departments due to its different clinical properties and the insufficiencies in the methods of diagnosis. Since there is no specific biochemical indicator, the diagnosis is made usually late or with difficulty. Neopterine is an enzyme secreted from the macrophages and is an indicator of cellular immunity activation. The aim of this study was to determine the role of neopterine in the early diagnosis of acute pancreatitis . Material and Methods: 39 patients, who had been hospitalized with the complaints of abdominal pain and diagnosed as acute pancreatitis via laboratory and screening methods, and 30 healthy controls were included in the study. Amylase, lipase, cholesterol and neopterine were measured in the patients' samples. The diagnoses were confirmed with abdominal ultrasound and computed tomography. Results: The neopterine values in patients with acute pancreatitis were significantly higher than those of the control group. Conclusion: Neopterine is an indicator which is elevated in certain inflammatory and autoimmune situations. We believe that it is important in the early diagnosis of acute pancreatitis. Further experimental and clinical studies should be conducted on the subject. [Cukurova Med J 2016; 41(1.000: 51-54

  7. European Society of Cardiology - Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department.

    Miró, Òscar; Peacock, Frank W; McMurray, John J; Bueno, Héctor; Christ, Michael; Maisel, Alan S; Cullen, Louise; Cowie, Martin R; Di Somma, Salvatore; Martín Sánchez, Francisco J; Platz, Elke; Masip, Josep; Zeymer, Uwe; Vrints, Christiaan; Price, Susanna; Mebazaa, Alexander; Mueller, Christian


    Heart failure is a global public health challenge frequently presenting to the emergency department. After initial stabilization and management, one of the most important decisions is to determine which patients can be safely discharged and which require hospitalization. This is a complex decision that depends on numerous subjective factors, including both the severity of the patient's underlying condition and an estimate of the acuity of the presentation. An emergency department observation period may help select the correct option. Ideally, during an observation period, risk stratification should be carried out using parameters specifically designed for use in the emergency department. Unfortunately, there is little objective literature to guide this disposition decision. An objective and reliable definition of low-risk characteristics to identify early discharge candidates is needed. Benchmarking outcomes in patients discharged from the emergency department without hospitalization could aid this process. Biomarker determinations, although undoubtedly useful in establishing diagnosis and predicting longer-term prognosis, require prospective validation for emergency department disposition guidance. The challenge of identifying emergency department acute heart failure discharge candidates will only be overcome by future multidisciplinary research defining the current knowledge gaps and identifying potential solutions.

  8. 精神科男护士留职意愿现状及其影响因素研究%The current situation of stay intention of male nurses in psychiatric department and its influence factors

    张丽; 胡娟娟; 武晓静


    Objective To investigate the current situation of stay intention of male nurses in psychiatric department,and explore the relationship between stay intention of male nurses and job stress,job satisfaction.Methods 70 male nurses in psychiatric department were selected as the research object.The general information questionnaire,stay intention scale,job satisfaction scale,and nurses stressor scale were used in the survey.Results The average score of stay intention of male nurses in psychiatric department was (3.38±0.82).Stay intention of male nurses in psychiatric department was negatively correlated to work pressure (r=-0.252,P<0.05),positively correlated to job satisfaction (r=0.430,P<0.01).Stepwise regression analysis showed that job satisfaction was the main factor influencing stay intention of male nurses in psychiatric department.Conclusions The score of stay intention of male nurses in psychiatric department is in the middle level;the hospital and related departments should take effective measures to improve the job satisfaction of male nurses,enhance the retention rate of male nurses,promote the sustainable development of the construction of nursing team.%目的 了解精神科男护士留职意愿现状,探讨男护士留职意愿和工作压力、工作满意度的关系.方法 选取70名精神科男护士为研究对象,采用一般资料问卷、留职意愿量表、工作满意度量表和护士压力源量表进行调查研究.结果 精神科男护士留职意愿平均得分为(3.38±0.82),精神科男护士工作压力与留职意愿呈负相关(r=-0.252,P<0.05),工作满意度与留职意愿呈正相关(r=0.430,P<0.01);多因素逐步回归分析显示工作满意度是影响精神科男护士留职意愿的主要因素.结论 精神科男护士的留职意愿得分处于中等水平,管理者应该采取有效措施,提高男护士工作满意度,以提升男护士的留职率,推动护理队伍建设的可持续发展.

  9. Acute abdominal pain in children: usefulness of three-view abdominal radiographs in the emergency department.

    He, Lulu; Park, Ellen; Vachhani, Neil; Vogelius, Esben; Thupili, Chakradhar; Udayasankar, Unni


    Diagnostic imaging is often an integral component in the workup of a pediatric patient with acute abdominal pain. The purpose of this study was to compare the diagnostic value of a three-view acute abdominal series (AAS) with that of a single supine view (SSV) in children with acute abdominal pain. All subjects aged ≤18 years that underwent an emergency three-view AAS examination for acute abdominal pain at a single urban hospital system were included. Retrospective evaluation of radiological diagnosis, number of radiological images, further imaging, management, and clinical outcomes was performed. "Positive" AAS studies were compared with corresponding SSV images for direct comparison of diagnostic value. Standard nonparametric statistical evaluation was performed. Five hundred forty-one AAS studies were included in the study. Greater than three radiographs were acquired in 29 % (153/541) of the subjects. Two hundred ninety-nine out of 541 AAS studies included a technically adequate SSV of the abdomen and pelvis. Most AAS examinations were categorized as negative (n = 485; 90 %). Of the 56 examinations initially classified as positive, there was no significant statistical difference between diagnostic accuracy between the AAS and SSV on retrospective evaluation. For pediatric subjects with nontraumatic acute abdominal pain, the yield of conventional radiographic study is exceedingly low. If required, a technically adequate single supine anteroposterior (AP) view of the abdomen and pelvis is sufficient for initial radiographic evaluation while reducing unnecessary radiation exposure to the patient.

  10. Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit

    Schultz, Helen; Qvist, Niels; Mogensen, Christian B;


    AIMS AND OBJECTIVES: To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit. BACKGROUND: An increase in emergency department observation units has led...... to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses. DESIGN: A comparative field study. METHODS: The study included 21 patients. Participant observation and qualitative interviews...... were performed, and the analyses were phenomenological-hermeneutic. RESULTS: Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating...



    2004536 Association study of clinical presentation in first-episode schizophrenia and possible candidate genes in chromosome 22. MA Xiaohong (马小红), et al. Dept Psychiatr, West China Hosp, Sichuan U-niv, Chengdu 610041. Chin J Psychiatr 2004;37(3): 145-148.

  12. Geographic clustering of emergency department presentations for acute coronary syndromes and heart failure in Alberta: a population-based study.

    Rosychuk, Rhonda J; Rowe, Brian H; McAlister, Finlay A


    Collectively, the most common acute cardiac presentations to emergency departments are acute coronary syndromes (ACSs) and heart failure. We examined geographic variation and clustering in emergency department presentations by adults for ACS or heart failure in Alberta in 2010/11. All emergency department presentations for ACS or heart failure made by Alberta residents aged 35 years or more during 2010/11 were extracted from 5 linked population-based Alberta administrative health databases. Data extracted included demographic characteristics, hospital admissions and physician claims. Spatial scan tests and logistic regression analyses were performed. There were 6342 patients with ACS (mean age 65.9 yr, 63.1% male) and 4780 patients with heart failure (mean age 76.6 yr, 49.9% male). For both ACS and heart failure, a primary cluster and 2 secondary clusters were identified. Different clusters were identified for the 2 conditions. For both conditions, patients living in the clusters had more primary care physician claims, prior emergency department visits and prior hospital admissions than did patients living outside the clusters. However, they were less likely to have had a specialist claim in the prior 2 years (odds ratio 0.64 [95% confidence interval 0.56-0.73] for ACS and 0.51 [95% confidence interval 0.43-0.61] for heart failure). Geographic areas were identified with higher numbers than expected of patients presenting to the emergency department for ACS or heart failure. Lower specialist access in these areas was associated with increased emergency department use. Copyright 2017, Joule Inc. or its licensors.

  13. Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals.

    Steger, Florian


    During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

  14. Management of Acute Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease in the Emergency Department.

    Suau, Salvador J; DeBlieux, Peter M C


    Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers.

  15. Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

    Millet, Ingrid; Pages-Bouic, Emma; Curros-Doyon, Fernanda; Taourel, Patrice [CHU Lapeyronie, Department of Medical Imaging, Montpellier Cedex 5 (France); Sebbane, Mustapha [Department of Emergency Medicine, CHU Lapeyronie, Montpellier (France); Molinari, Nicolas [Department of Medical Information and Statistics, CHU Montpellier (France); Riou, Bruno [GH Pitie-Salpetriere, APHP, Department of Emergency Medicine and Surgery, Paris (France)


    To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms. Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up. Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p=1.1 x 10{sup -6}) and management (88.5% to 95.8%, p=2.6 x 10{sup -6}) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement. Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice. (orig.)

  16. Acupuncture Treatment for Acute Ankle Injury in the Emergency Department: A Preliminary Case Report.

    Tantivesruangdet, Nopmanee


    Acupuncture is an ancient medical treatment that is increasingly attracting the interest of the public. It is a complementary therapy that is widely used for management of pain, especially chronic discomfort caused by migraine, low-back pain and osteoarthritis of the knee(¹⁻³). The evidence base for the effectiveness of acupuncture and its clinical applications is controversial, and although its efficacy and safety in the management of acute pain have been demonstrated, the quality of this modality is still questionable. The present study reports a case of acute ankle injury, which was treated with acupuncture. A 33-year-old man presented with acute twisted ankle injury. He had pain with swelling around the ankle, and he was experiencing difficulty in walking. His clinical diagnosis was acute ankle sprain with severe pain. Several drug treatments are used for pain control, but in this case, we used acupuncture. After treatment, his pain diminished significantly with a decrease in VAS pain level from 8 to 4 in 20 minutes. At follow-up after one month, we found no skin infection in this case.

  17. Unenhanced computed tomography in acute renal colic reduces cost outside radiology department

    Lauritsen, J.; Andersen, J.R.; Nordling, J.


    BACKGROUND: Unenhanced multidetector computed tomography (UMDCT) is well established as the procedure of choice for radiologic evaluation of patients with renal colic. The procedure has both clinical and financial consequences for departments of surgery and radiology. However, the financial effect...... outside the radiology department is poorly elucidated. PURPOSE: To evaluate the financial consequences outside of the radiology department, a retrospective study comparing the ward occupation of patients examined with UMDCT to that of intravenous urography (IVU) was performed. MATERIAL AND METHODS......) saved the hospital USD 265,000 every 6 months compared to the use of IVU. CONCLUSION: Use of UMDCT compared to IVU in patients with renal colic leads to cost savings outside the radiology department Udgivelsesdato: 2008/12...

  18. 精神专科病案管理的特殊性%Discussion on Speciality of Psychiatric Department Medical Records Management



    This paper discusses the speciality of psychiatric hospital medical records management, patient privacy respect; medical records management strengthening, service consciousness raising and humanization service achievement which making medical records information to serve social.%探讨精神专科医院病案管理的特殊性,尊重患者隐私,加强病案管理,增强服务意识,做到人性化服务,使病案信息最大限度服务于社会.

  19. Practice Variations between Emergency Physicians and Pediatricians in Treating Acute Bronchiolitis in the Emergency Department: A Nationwide Study.

    Ho, Sai-Wai; Huang, Ka-Yi; Teng, Ying-Hock; Ku, Min-Sho; Chiou, Jeng-Yuan


    Although supportive care is the mainstay management for acute bronchiolitis, non-evidence-based diagnostic testing and medications remain common in emergency departments (EDs). Our aim was to compare emergency physicians (EPs) and pediatricians practice patterns in the management of acute bronchiolitis in the ED. A cross-sectional study was conducted by using registration and claims datasets from 2008 to 2011. Patients with acute bronchiolitis were divided into EP group and pediatrician group. A total of 2174 patients were enrolled. The diagnostic tests used, including chest x-ray (63.7% vs. 46%; adjusted odds ratio [OR] = 2.27; 95% CI 1.77-2.91), complete blood count (33.2% vs. 21.8%; adjusted OR = 1.74; 95% CI 1.33-2.26), C-reactive protein (35.1% vs. 22.6%; adjusted OR = 1.79; 95% CI 1.38-2.33), blood culture (23.9% vs. 14.3%; adjusted OR = 1.79; 95% CI 1.33-2.39), and arterial blood gas (3.7% vs. 1.8%, adjusted OR = 2.38; 95% CI 1.21-4.67), were higher in the EP group than in the pediatrician group. Intravenous fluid administration was also higher in the EP group (20.8% vs. 3.5%; adjusted OR = 7.49; 95% CI 5.12-10.8). In addition, EPs more frequently arranged for hospital admissions (36% vs. 19.5%; adjusted OR = 2.51; 95% CI 1.15-3.26). Both EPs and pediatricians had high rates of ordering diagnostic testing for acute bronchiolitis patients in ED. Compared with pediatricians, EPs used more diagnostic tests for the patients with acute bronchiolitis in ED. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Finding solutions through empowerment: a preliminary study of a solution-orientated approach to nursing in acute psychiatric settings.

    Stevenson, C; Jackson, S; Barker, P


    Acute inpatient care is not a therapeutic milieu, perhaps owing to the lack of nursing skills. Solution-focused therapy (SFT) has been successful in US inpatient facilities in relation to both objective and subjective 'measures'. This paper reports a study of SFT in a UK context, with the aim of developing a user-friendly SFT training course and assessing its impact on both nurses and clients, via a multifaceted, triangulated data collection design. Nurses' knowledge and clinical performance were assessed, as was the client's perspective. There was a significant difference in nurses' SFT knowledge after training and strong evidence of the model being used in practice during the course of training, although nursing documentation was not fully completed. Eighty-three per cent of nurses said that they would continue using the model, and clients found the SFT approach helpful. The findings match the US experience of using SFT.

  1. Acute poisoning in children; changes over the years, data of pediatric clinic department of toxicology

    Alije Keka


    Conclusion: In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than 5 years-old, this age of children is the most susceptible in terms of morbidity. Compared with the previous studies in Pediatric Clinic of Pristina, drugs are still the most frequent cause of acute poisoning in children; the number of poisoning with pesticides has fallen but has increased the number of poisoning with cleaning products. All preventive measures against poisoning should be taken including preventive strategies of education at national level especially in drug and household product storage.

  2. Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study

    Yen-Ting Liu


    Full Text Available Introduction. Low back pain (LBP is one of the most common complaints in the emergency department (ED. There are several research articles providing evidence for acupuncture for treating chronic LBP but few about treating acute LBP. This study assessed the efficacy and safety of acupuncture for the treatment of acute LBP in the ED. Materials and methods. A clinical pilot cohort study was conducted. 60 participants, recruited in the ED, were divided into experimental and control groups with 1 dropout during the study. Life-threatening conditions or severe neurological defects were excluded. The experimental group (n=45 received a series of fixed points of acupuncture. The control group (n=14 received sham acupuncture by pasting seed-patches near acupoints. Back pain was measured using the visual analog scale (VAS at three time points: baseline and immediately after and 3 days after intervention as the primary outcome. The secondary outcomes were heart rate variability (HRV and adverse events. Results. The VAS demonstrated a significant decrease (P value <0.001 for the experimental group after 15 minutes of acupuncture. The variation in HRV showed no significant difference in either group. No adverse event was reported. Conclusion. Acupuncture might provide immediate effect in reducing the pain of acute LBP safely.

  3. Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study.

    Liu, Yen-Ting; Chiu, Chih-Wen; Chang, Chin-Fu; Lee, Tsung-Chieh; Chen, Chia-Yun; Chang, Shun-Chang; Lee, Chia-Ying; Lo, Lun-Chien


    Introduction. Low back pain (LBP) is one of the most common complaints in the emergency department (ED). There are several research articles providing evidence for acupuncture for treating chronic LBP but few about treating acute LBP. This study assessed the efficacy and safety of acupuncture for the treatment of acute LBP in the ED. Materials and methods. A clinical pilot cohort study was conducted. 60 participants, recruited in the ED, were divided into experimental and control groups with 1 dropout during the study. Life-threatening conditions or severe neurological defects were excluded. The experimental group (n = 45) received a series of fixed points of acupuncture. The control group (n = 14) received sham acupuncture by pasting seed-patches near acupoints. Back pain was measured using the visual analog scale (VAS) at three time points: baseline and immediately after and 3 days after intervention as the primary outcome. The secondary outcomes were heart rate variability (HRV) and adverse events. Results. The VAS demonstrated a significant decrease (P value acupuncture. The variation in HRV showed no significant difference in either group. No adverse event was reported. Conclusion. Acupuncture might provide immediate effect in reducing the pain of acute LBP safely.

  4. Using Fresh Frozen Plasma for Acute Airway Angioedema to Prevent Intubation in the Emergency Department: A Retrospective Cohort Study

    Aya Saeb


    Full Text Available Background. Angioedema (AE is a common condition which can be complicated by laryngeal edema, having up to 40% mortality. Although sporadic case reports attest to the benefits of fresh frozen plasma (FFP in treating severe acute bouts of AE, little evidence-based support for this practice is available at present. Study Objectives. To compare the frequency, duration of intubation, and length of intensive care unit (ICU stay in patients with acute airway AE, with and without the use of FFP. Methods. A retrospective cohort study was conducted, investigating adults admitted to large community hospital ICU with a diagnosis of AE during the years of 2007–2012. Altogether, 128 charts were reviewed for demographics, comorbidities, hospital courses, and outcomes. A total of 20 patients received FFP (108 did not. Results. Demographics and comorbidities did not differ by treatment group. However, nontreated controls did worse in terms of intubation frequency (60% versus 35%; p=0.05 and ICU stay (3.5 days versus 1.5 days; p<0.001. Group outcomes were otherwise similar. Conclusion. In an emergency department setting, the use of FFP should be considered in managing acute airway nonhereditary AE (refractory to steroid, antihistamine, and epinephrine. Larger prospective, better controlled studies are needed to devise appropriate treatment guidelines.

  5. Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.

    Tabit, Corey E; Coplan, Mitchell J; Spencer, Kirk T; Alcain, Charina F; Spiegel, Thomas; Vohra, Adam S; Adelman, Daniel; Liao, James K; Sanghani, Rupa Mehta


    Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Can emergency physicians accurately and reliably assess acute vertigo in the emergency department?

    Vanni, Simone; Nazerian, Peiman; Casati, Carlotta; Moroni, Federico; Risso, Michele; Ottaviani, Maddalena; Pecci, Rudi; Pepe, Giuseppe; Vannucchi, Paolo; Grifoni, Stefano


    To validate a clinical diagnostic tool, used by emergency physicians (EPs), to diagnose the central cause of patients presenting with vertigo, and to determine interrater reliability of this tool. A convenience sample of adult patients presenting to a single academic ED with isolated vertigo (i.e. vertigo without other neurological deficits) was prospectively evaluated with STANDING (SponTAneousNystagmus, Direction, head Impulse test, standiNG) by five trained EPs. The first step focused on the presence of spontaneous nystagmus, the second on the direction of nystagmus, the third on head impulse test and the fourth on gait. The local standard practice, senior audiologist evaluation corroborated by neuroimaging when deemed appropriate, was considered the reference standard. Sensitivity and specificity of STANDING were calculated. On the first 30 patients, inter-observer agreement among EPs was also assessed. Five EPs with limited experience in nystagmus assessment volunteered to participate in the present study enrolling 98 patients. Their average evaluation time was 9.9 ± 2.8 min (range 6-17). Central acute vertigo was suspected in 16 (16.3%) patients. There were 13 true positives, three false positives, 81 true negatives and one false negative, with a high sensitivity (92.9%, 95% CI 70-100%) and specificity (96.4%, 95% CI 93-38%) for central acute vertigo according to senior audiologist evaluation. The Cohen's kappas of the first, second, third and fourth steps of the STANDING were 0.86, 0.93, 0.73 and 0.78, respectively. The whole test showed a good inter-observer agreement (k = 0.76, 95% CI 0.45-1). In the hands of EPs, STANDING showed a good inter-observer agreement and accuracy validated against the local standard of care. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  7. Prevalence and predictors of hypoxemia in acute respiratory infections presenting to pediatric emergency department

    Singhi S


    Full Text Available Rational & Objective: Early detection of hypoxemia and oxygen therapy improves the outcome of children with acute respiratory illnesses (ARI. However, facility to measure oxygen saturation (SpO2 is not available in many health facilities of resource poor countries. We have studied prevalence of hypoxemia in children with ARI and examined value of various clinical signs to predict hypoxemia. Subjects & Methods: Consecutive children, aged 2 months - 59 months, with respiratory symptom(s attending the pediatric emergency service between Oct 2001 to December 2002 were studied. Presence or absence of cough, nasal flaring, ability to feed/drink, cyanosis, chestwall indrawing, wheeze, tachypnoea (respiratory rate >50/min in children up to 11 months and >40/min up to 59 months, crepitations on auscultation and oxygen saturation (SpO2, by Nellcore™pulse oximeter and clinical diagnosis were recorded. Results: Of 2216 children studied 266 (11.9% had hypoxemia (SpO2 £90%. It was seen in 73.8% of 126 patients with WHO defined very severe pneumonia, 25.8% of 331 patients with severe pneumonia, 11% of 146 patients with bronochiolitis and 6.5% of 338 patients with acute asthma. Most sensitive indicators of hypoxemia were chestwall indrawing (sensitivity-90%, negative predictive value -98% and crepitations (sensitivity-75%, negative predictive value 95.7% while the best positive predictive value was seen with cyanosis (71.4% and inability to feed (47.6%. Nasal flaring had the good balance of sensitivity (64%, specificity (82% and positive predictive value (33% among the signs studied. Conclusion: None of the clinical signs of respiratory distress had all the attributes of a good predictors of hypoxemia. Chest wall indrawing was the most sensitive and 'inability to feed/ drink' was the most specific indicator.

  8. Comparative analysis of nursing adverse events between psychiatric and general departments with SHEL model%采用SHEL模式对精神科与综合科护理不良事件的对照研究

    朱彩文; 王娅丽; 黄昶荃; 郭琼; 苏娜; 王玉秀; 张莉华


    Objective To compare and analyze the causes that occurred in psychiatric and general department using SHEL models, in order to provide evidence of preventing nursing adverse events.Methods We analyzed causes of 136 nursing adverse events using SHEL models, and compared the classification, causes, incidence of nursing adverse events between psychiatric and general departments. Results The first three nursing adverse events in psychiatric department were medication error,going outside, suicide and self harm, and those in general department were medication errors, specimens being wrong, improper operation and pipeline off. 91.18% of nursing adverse events accounted for quality of nursing services, 43.38% accounted for nursing environment, 41.18% accounted for clinical environment,and 57.35% accounted for parties and others. Incidence of nursing adverse events in psychiatric department were higher than that in general department. Conclusions SHEL model can objectively and comprehensively analyze the causes of nursing adverse events, and make nursing managers take the appropriate management strategy and the best safeguard against the risk of development of response.%目的 应用SHEL模式对精神科与综合科护理不良事件发生的原因进行分析比较,为管理者制订有针对性的防范措施提供依据.方法 用SHEL模式对某三级甲等医院2007年至2009年发生的136例护理不良事件原因进行分析,并对精神科、综合科发生不良事件进行分类、发生率进行对比分析.结果 精神科发生护理不良事件位于前3位的是:用药错误、外走、自杀与自伤,综合科发生护理不良事件位于前3位的是:用药错误、操作不当与管道脱落.发生护理不良事件与护士业务素质有关占91.18%,与护理工作场所有关占43.38%,与临床环境有关的占41.18%,与当事人及他人有关的占57.35%.精神科较综合科护理不良事件的发生率高.结论 采用SHEL模式分析精神

  9. Acute Mallory-Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    Dae Hee Kim; Dong Yoon Rhee; Seon Hee Woo; Woon Jeong Lee; Seung Hwan Seol; Won Jung Jeong


    A report of a 62-year-old female patient with severe Mallory-Weiss syndrome after successful cardiopulmonary resuscitation (CPR) by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient’s total blood loss was estimated to be approximately 3 000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory-Weiss syndrome afterCPR may occur and should be considered as a potentially serious complication afterCPR.

  10. Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

    Nathan Finnerty


    Full Text Available Endovascular aneurysm repair (EVAR is perhaps the most widely utilized surgical procedure for patients with large abdominal aortic aneurysms. This procedure is minimally invasive and reduces inpatient hospitalization requirements. The case involves a 72-year-old male who presented to the emergency department with right testicular ischemia two days following EVAR. Given the minimal inpatient hospitalization associated with this procedure, emergency physicians are likely to encounter associated complications. Ischemic and thromboembolic events following EVAR are extremely rare but require prompt vascular surgery intervention to minimize morbidity and mortality.

  11. Acute Headache at Emergency Department: Reversible Cerebral Vasoconstriction Syndrome Complicated by Subarachnoid Haemorrhage and Cerebral Infarction

    M. Yger


    Full Text Available Introduction. Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome. Case Report. A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. Conclusion. Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.

  12. Pulmonary Function Tests in Emergency Department Pediatric Patients with Acute Wheezing/Asthma Exacerbation

    Kathryn Giordano


    Full Text Available Background. Pulmonary function tests (PFT have been developed to analyze tidal breathing in patients who are minimally cooperative due to age and respiratory status. This study used tidal breathing tests in the ED to measure asthma severity. Design/Method. A prospective pilot study in pediatric patients (3 to 18 yrs with asthma/wheezing was conducted in an ED setting using respiratory inductance plethysmography and pneumotachography. The main outcome measures were testing feasibility, compliance, and predictive value for admission versus discharge. Results. Forty patients were studied, of which, 14 (35% were admitted. Fifty-five percent of the patients were classified as a mild-intermittent asthmatic, 30% were mild-persistent asthmatics, 12.5% were moderate-persistent asthmatics, and 2.5% were severe-persistent. Heart rate was higher in admitted patients as was labored breathing index, phase angle, and asthma score. Conclusions. Tidal breathing tests provide feasible, objective assessment of patient status in the enrolled age group and may assist in the evaluation of acute asthma exacerbation in the ED. Our results demonstrate that PFT measurements, in addition to asthma scores, may be useful in indicating the severity of wheezing/asthma and the need for admission.

  13. Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis: A Randomized Clinical Trial.

    Angoulvant, François; Bellêttre, Xavier; Milcent, Karen; Teglas, Jean-Paul; Claudet, Isabelle; Le Guen, Christèle Gras; de Pontual, Loïc; Minodier, Philippe; Dubos, François; Brouard, Jacques; Soussan-Banini, Valérie; Degas-Bussiere, Vanessa; Gatin, Amélie; Schweitzer, Cyril; Epaud, Ralph; Ryckewaert, Amélie; Cros, Pierrick; Marot, Yves; Flahaut, Philippe; Saunier, Pascal; Babe, Philippe; Patteau, Géraldine; Delebarre, Mathilde; Titomanlio, Luigi; Vrignaud, Bénédicte; Trieu, Thanh-Van; Tahir, Abdelilah; Regnard, Delphine; Micheau, Pascale; Charara, Oussama; Henry, Simon; Ploin, Dominique; Panjo, Henri; Vabret, Astrid; Bouyer, Jean; Gajdos, Vincent


    Acute bronchiolitis is the leading cause of hospitalization among infants. Previous studies, underpowered to examine hospital admission, have found a limited benefit of nebulized hypertonic saline (HS) treatment in the pediatric emergency department (ED). To examine whether HS nebulization treatment would decrease the hospital admission rate among infants with a first episode of acute bronchiolitis. The Efficacy of 3% Hypertonic Saline in Acute Viral Bronchiolitis (GUERANDE) study was a multicenter, double-blind randomized clinical trial on 2 parallel groups conducted during 2 bronchiolitis seasons (October through March) from October 15, 2012, through April 15, 2014, at 24 French pediatric EDs. Among the 2445 infants (6 weeks to 12 months of age) assessed for inclusion, 777 with a first episode of acute bronchiolitis with respiratory distress and no chronic medical condition were included. Two 20-minute nebulization treatments of 4 mL of HS, 3%, or 4 mL of normal saline (NS), 0.9%, given 20 minutes apart. Hospital admission rate in the 24 hours after enrollment. Of the 777 infants included in the study (median age, 3 months; interquartile range, 2-5 months; 468 [60.2%] male), 385 (49.5%) were randomized to the HS group and 387 (49.8%) to the NS group (5 patients did not receive treatment). By 24 hours, 185 of 385 infants (48.1%) in the HS group were admitted compared with 202 of 387 infants (52.2%) in the NS group. The risk difference for hospitalizations was not significant according to the mixed-effects regression model (adjusted risk difference, -3.2%; 95% CI, -8.7% to 2.2%; P = .25). The mean (SD) Respiratory Distress Assessment Instrument score improvement was greater in the HS group (-3.1 [3.2]) than in the NS group (-2.4 [3.3]) (adjusted difference, -0.7; 95% CI, -1.2 to -0.2; P = .006) and similarly for the Respiratory Assessment Change Score. Mild adverse events, such as worsening of cough, occurred more frequently among children in the HS group

  14. Excited delirium: Consideration of selected medical and psychiatric issues

    Edith Samuel


    Full Text Available Edith Samuel1, Robert B Williams1, Richard B Ferrell21Department of Psychology, Atlantic Baptist University, Moncton, New Brunswick Canada; 2Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USAAbstract: Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions.Keywords: excited delirium, excited states, cocaine misuse, restraint or in custody deaths

  15. Prevalence of acute diseases in the elderly assisted in emergency department of orthopedics

    Dotta, Thiago de Angelis Guerra; Bonadio, Marcelo Batista; Furlaneto, Maria Elisabet; Silva, Jorge dos Santos; Leme, Luiz Eugênio Garcez


    OBJECTIVE: To make an analysis of the care of elderly in an Emergency Department of Orthopedics with the primary objective to know the percentage of elderly treated, their conditions of origin and level of accidental conditions, and examine possible comorbidities, evolution and mortality rate. METHODS: Retrospective observational epidemiological study based on survey records of a tertiary hospital during one year (January to December 2006) RESULTS: In the year 2006 (January to December) 12,916 calls to patients older than 60 were performed. CONCLUSION: Massive attendance of the elderly population was observed, however, the vast majority related to chronic problems that do not require urgent attention. Patients requiring urgent attention suffer from trauma related to falls and are between the seventh and ninth decades of life, mostly female and requiring hospitalization for longer periods. Level of Evidence VI, Cases Series. PMID:24868189

  16. Incidence of violent behavior among patients in Psychiatric Intensive Care Units

    Valentina C. Iversen


    Full Text Available Background and Objectives: Both psychiatric acute units and psychiatric intensive care units (PICUs focus on acute treatment of behavioral disturbances such as violence and aggressive threats and acts. The aim of the present study is to describe the frequency of violent behavior; such as verbal or physical threats and physical attacks, among patients admitted to psychiatric intensive care unit (PICU. In addition the relationship between the episodes of threats and/or attacks in relation to time of the day, days of the week, and their seasonal variations was explored. Methods: All violent behavior was continuously assessed at the psychiatric emergency department. Data were collected during the period from May 2010 to May 2012. Results: Patients with only one hospitalization were less violent than those who have had two hospitalizations. There was a statistically significant difference in violence among patients without formal secondary education and those who have not formal education. Violent behavior showed two peaks during the day; the first occurring at 1 pm and the second at 8 pm. In regard to seasonality, summer had a higher incidence of violence. The most peaceful seasons of the year were spring and autumn. Conclusions: Violent behavior shows variation in daytime, days of the week and season in acute psychiatric intensive care. Daytime variation shows two peaks of violence at 1 pm and 8 pm, Sundays and Wednesdays being the quietest days regarding violence both in winter and summer. Patient's level of education and hospitalization status partially explain the variation.

  17. Depressive symptoms and disability in acute patients with comorbidities in departments of internal medicine

    Salvatore La Carrubba


    Full Text Available Introduction: There are few data on the prevalence of depression among acute patients with comorbidities. The current study aimed to determine the prevalence of depressive symptoms in hospitalized patients admitted to Internal Medicine Units and the correlation between these symptoms and comorbidities and disability indexes. Materials and methods: All consecutive patients admitted to 26 Internal Medicine Units of the Italian National Public Health System in Sicily, Italy, from September 2001 to March 2002 were screened. Within 24 hours of admission, patients were administered the Geriatric Depression Scale (GDS, Mini-Mental State Examination, Activities of Daily Living (ADL, Instrumental Activities of Daily Living (IADL and Charlson’s Comorbidity Index. Results: 1,947 subjects were included in the analyses. Of the patients, 509 (26.1% showed depressive symptoms (indicated by GDS score > 15. Depression was significantly associated (univariate analyses with hypertension (OR 1.45; CI 95% 1.18-1.79, diabetes (OR 1.48, CI 95% 1.17-1.87, cerebrovascular disease (OR 1.50, CI 95% 1.08-2.07, cirrhosis (OR 1.49, CI 95% 1.01- 2.19, ADL score (OR 0.72: CI 95% 0.63-0.82, and IADL score (OR 0.83; CI 95% 0.78-0.87, but not with Charlson’s Comorbidity Index (OR 1.04; CI 95% 0.98-1.10. Multivariate analysis showed that independent predictive factors for depression were age (OR 1.02, CI 95% 1.01-1.02, female gender (OR 2.29, CI 95% 1.83 - 2.87, and IADL score (OR 0.86, CI 95% 0.81 - 0.93. Conclusions: The data suggest that depressive symptoms are not linked to worse clinical conditions but are associated with the loss of autonomy in Instrumental Activities of Daily Living.

  18. Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care System

    Piñeros Sandy


    Full Text Available Abstract Background Mortality from acute myocardial infarction (AMI is declining worldwide. We sought to determine if mortality in the Veterans Health Administration (VHA has also been declining. Methods We calculated 30-day mortality rates between 2004 and 2006 using data from the VHA External Peer Review Program (EPRP, which entails detailed abstraction of records of all patients with AMI. To compare trends within VHA with other systems of care, we estimated relative mortality rates between 2000 and 2005 for all males 65 years and older with a primary diagnosis of AMI using administrative data from the VHA Patient Treatment File and the Medicare Provider Analysis and Review (MedPAR files. Results Using EPRP data on 11,609 patients, we observed a statistically significant decline in adjusted 30-day mortality following AMI in VHA from 16.3% in 2004 to 13.9% in 2006, a relative decrease of 15% and a decrease in the odds of dying of 10% per year (p = .011. Similar declines were found for in-hospital and 90-day mortality. Based on administrative data on 27,494 VHA patients age 65 years and older and 789,400 Medicare patients, 30-day mortality following AMI declined from 16.0% during 2000-2001 to 15.7% during 2004-June 2005 in VHA and from 16.7% to 15.5% in private sector hospitals. After adjusting for patient characteristics and hospital effects, the overall relative odds of death were similar for VHA and Medicare (odds ratio 1.02, 95% C.I. 0.96-1.08. Conclusion Mortality following AMI within VHA has declined significantly since 2003 at a rate that parallels that in Medicare-funded hospitals.

  19. Critical outcomes: clinical and team performance across acute illness scenarios in emergency departments of critical access hospitals.

    Coleman, Nana Ekua; Baker, David; Gallo, Jonathan; Slonim, Anthony D


    In their provision of acute care services, emergency department (ED) providers in critical access hospitals (CAHs) are uniquely challenged by limitations in personnel, facility resources, and available expertise. We sought to define the impact of team behaviors among ED staff in CAHs on clinical performance by studying the relationship between team and clinical performance scores across 100 simulated scenarios. Team and clinical performance scores were calculated for each scenario using standardized checklists to quantify goal achievement and aggregated across teams and scenario types. These scores were compared using bivariate analysis and correlated with clinical and team performance outcomes using Pearson's correlation (r coefficient). There was a positive correlation between team and clinical performance across all scenarios; the relationship was statistically significant (pteam performance may be a function of the critical care event itself or the unique characteristics of CAHs that make them more vulnerable when faced with high acuity, complex, and infrequently encountered clinical scenarios. © 2011 National Association for Healthcare Quality.

  20. Identification of women exposed to acute physical intimate partner violence in an emergency department setting in Finland.

    Leppäkoski, Tuija; Astedt-Kurki, Päivi; Paavilainen, Eija


    Intimate partner violence (IPV) is seen as a serious health risk factor for women with significant acute and long-term health consequences and it affects women from all ethnic and socioeconomic groups. Knowledge of these consequences of IPV may help emergency department (ED) professionals to identify these women and provide them with appropriate care, including information on a variety of community services, and refer those women to such services if necessary. The study aimed to describe the frequency of ED visits by women exposed to physical intimate partner violence as estimated by ED professionals (nurses, practical nurses, emergency medical technicians) and identification of acute IPV. In this study 'partner' is defined as a woman's husband, former husband, current or former cohabitant or partner. This design was used as part of a larger, descriptive, cross-sectional multi-centre and multi-method study. Data were collected from 28 EDs in 13 Finnish hospital districts. Altogether 488 questionnaires were returned, which yielded a response rate of 51%. The data were analysed using descriptive statistics and quantitative content analysis. Findings showed that 48% (n = 231) of the ED professionals reported that they encountered women in IPV relationships at least once a month. Over one-fifth of the ED professionals reported having repeatedly encountered the same women visiting the ED for IPV related injuries. Over half of the participants reported having problems 'often' or 'now and then' when identifying women exposed to IPV. Those with training on IPV estimated that they had identified women exposed to IPV more often. To conclude, the research suggests that improvement of identification of acute IPV requires that training be arranged and jointly agreed written procedures for handling IPV be introduced. © 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

  1. Evaluation of empirical antibiotherapy for acute community-acquired pneumonia prescribed in emergency departments.

    Fraisse, T; Fayad, G; Jardy, C; Sotto, A


    The authors assessed the management of community-acquired pneumonia (CAP) and empirical antibiotic prescription in a primary care center. A retrospective study was made on medical charts of patients admitted to the emergency department for CAP. Seventy-six patients were included. Their mean age was 65years for a sex ratio of 1.81. Fever (83%) and cough (72%) were the most common symptoms. Chest X-ray was abnormal in 86%. The median CRP value was 138mg/L (58-235). The median Fine's score was 85.5 (60-127). Blood cultures were sterile for 82.5% of samples. Pneumococcal and legionella antigenuria were performed for 70% of patients, only one was positive for legionella. Antibiotherapy was prescribed to 18 patients before hospitalization. Amoxicillin-clavulanic acid was the most frequently prescribed empirical treatment (48.5%), followed by ceftriaxone (15%). The therapeutic adequation index was calculated at a median of 1.7 by three investigators (0-3.7). Kendall's concordance coefficient for the three investigators was good at 0.86 (P<0.0001). Close to 39% of antibiotic prescription had a bad therapeutic adequation index more than three. Our clinical, radiological, and microbiological data was quite similar to reported data from teaching hospital series except for severity that seemed lower in primary care centers. The therapeutic adequation index is a useful tool to assess the adequacy of antibiotic prescription. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  2. Comparison of the HEART and TIMI Risk Scores for Suspected Acute Coronary Syndrome in the Emergency Department.

    Sun, Benjamin C; Laurie, Amber; Fu, Rongwei; Ferencik, Maros; Shapiro, Michael; Lindsell, Christopher J; Diercks, Deborah; Hoekstra, James W; Hollander, Judd E; Kirk, J Douglas; Peacock, W Frank; Anantharaman, Venkataraman; Pollack, Charles V


    The emergency department evaluation for suspected acute coronary syndrome (ACS) is common, costly, and challenging. Risk scores may help standardize clinical care and screening for research studies. The Thrombolysis in Myocardial Infarction (TIMI) and HEART are two commonly cited risk scores. We tested the null hypothesis that the TIMI and HEART risk scores have equivalent test characteristics. We analyzed data from the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS) from 9 EDs on patients with suspected ACS, 1999-2001. We excluded patients with an emergency department diagnosis consistent with ACS, or without sufficient data to calculate TIMI and HEART scores. The primary outcome was 30-day major adverse cardiovascular events, including all-cause death, acute myocardial infarction, and urgent revascularization. We describe test characteristics of the TIMI and HEART risk scores. The study cohort included 8255 patients with 508 (6.2%) 30-day major adverse cardiovascular events. Receiver operating curve and reclassification analyses favored HEART [c statistic: 0.753, 95% confidence interval (CI): 0.733-0.773; continuous net reclassification improvement: 0.608, 95% CI: 0.527-0.689] over TIMI (c statistic: 0.678, 95% CI: 0.655-0.702). A HEART score 0-3 [negative predictive value (NPV) 0.982, 95% CI: 0.978-0.986; positive predictive value (PPV) 0.103, 95% CI: 0.094-0.113; likelihood ratio (LR) positive 1.76; LR negative 0.28] demonstrates similar or superior NPV/PPV/LR compared with TIMI = 0 (NPV 0.978, 95% CI: 0.971-0.983; PPV 0.077, 95% CI: 0.071-0.084; LR positive 1.28; LR negative 0.35) and TIMI = 0-1 (NPV 0.963, 95% CI: 0.958-0.968; PPV 0.102, 95% CI: 0.092-0.113; LR positive 1.73; LR negative 0.58). The HEART score has better discrimination than TIMI and outperforms TIMI within previously published "low-risk" categories.

  3. Contingent Valuation Analysis of an Otolaryngology and Ophthalmology Emergency Department: The Value of Acute Specialty Care.

    Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H G; Gray, Stacey T; Shrime, Mark G


    Specialty emergency departments (EDs) provide a unique mechanism of health care delivery, but the value that they add to the medical system is not known. Evaluation of patient preferences to determine value can have a direct impact on resource allocation and direct-to-specialist care. To assess the feasibility of contingent valuation (CV) methodology using a willingness-to-pay (WTP) survey to evaluate specialty emergency services, in the context of an ophthalmology- and otolaryngology-specific ED. Contingent valuation analysis of a standalone otolaryngology and ophthalmology ED. Participants were English-speaking adults presenting to a dedicated otolaryngology and ophthalmology ED. The WTP questions were assessed using a payment card format, with reference to an alternative modality of treatment (ie, general ED), and were analyzed with multivariate regression. Validated WTP survey administered from October 14, 2014, through October 1, 2015. Sociodemographic data, level of distress, referral data, income, and WTP. A total of 327 of 423 (77.3%) ED patients responded to the WTP survey, with 116 ophthalmology and 211 otolaryngology patients included (52.3% female; mean [range] age, 46 [18-90] years). The most common reason for seeking care at this facility was a reputation for specialty care for both ear, nose, and throat (80 [37.9%]) and ophthalmology (43 [37.1%]). Mean WTP for specialty-specific ED services was $377 for ophthalmology patients, and $321 for otolaryngology patients ($340 overall; 95% CI, $294 to $386), without significant difference between groups (absolute difference, $56; 95% CI, $-156 to $43). Self-reported level of distress was higher among ear, nose, and throat vs ophthalmology patients (absolute difference, 0.47 on a Likert scale of 1-7; 95% CI, 0.10 to 0.84). Neither level of distress, income, nor demographic characteristics influenced WTP, but patients with higher estimates of total visit cost were more likely to have higher WTP (β coefficient

  4. Psychiatric rehabilitation


    Psychiatric rehabilitation is an important component in the management of the mentally ill. This article presents a selective review of the publications in this journal. Questions addressed in this review range from assessment of rehabilitation needs to different rehabilitative approaches. Although the number of publications providing the answers is meager, there are innovative initiatives. There is a need for mental health professionals to publish the models they follow across the country.

  5. Profile of mortality of patients admitted to Weskoppies Psychiatric ...

    Introduction. Mortality amongst psychiatric patients is higher than in the .... Hospital Administration and Gauteng Department of Health to access ... emergency, observation or state patients) ..... psychiatric hospitals do not have laboratory and.

  6. HEART score performance in Asian and Caucasian patients presenting to the emergency department with suspected acute coronary syndrome.

    de Hoog, Vince C; Lim, Swee Han; Bank, Ingrid Em; Gijsberts, Crystel M; Ibrahim, Irwani B; Kuan, Win Sen; Ooi, Shirley Bs; Chua, Terrance Sj; Tai, E Shyong; Gao, Fei; Pasterkamp, Gerard; den Ruijter, Hester M; Doevendans, Pieter A; Wildbergh, Thierry X; Mosterd, Arend; Richards, A Mark; de Kleijn, Dominique Pv; Timmers, Leo


    The HEART score is a simple and effective tool to predict short-term major adverse cardiovascular events in patients suspected of acute coronary syndrome. Patients are assigned to three risk categories using History, ECG, Age, Risk factors and Troponin (HEART). The purpose is early rule out and discharge is considered safe for patients in the low risk category. Its performance in patients of Asian ethnicity is unknown. We evaluated the performance of the HEART score in patients of Caucasian, Chinese, Indian and Malay ethnicity. The HEART score was assessed retrospectively in 3456 patients presenting to the emergency department with suspected acute coronary syndrome (1791 Caucasians, 1059 Chinese, 344 Indians, 262 Malays), assigning them into three risk categories. The incidence of major adverse cardiovascular events within six weeks after presentation was similar between the ethnic groups. A smaller proportion of Caucasians was in the low risk category compared with Asians (Caucasians 35.8%, Chinese 43.5%, Indians 45.3%, Malays 44.7%, p<0.001). The negative predictive value of a low HEART score was comparable across the ethnic groups, but lower than previously reported (Caucasians 95.3%, Chinese 95.0%, Indians 96.2%, Malays 96.6%). Also the c-statistic for the HEART score was not significantly different between the groups. These results show that the overall performance of the HEART score is equal among Caucasian and Asian ethnic groups. The event rate in the low risk group, however, was higher than reported in previous studies, which queries the safety of early discharge of patients in the low risk category.

  7. 413例精神科住院患者精神药物使用时点调查%Time survey of psychotropic drugs use among 413 inpatients in psychiatric department

    周艳璞; 冯长军; 戴劲


    Objective To understand the use condition and its rationality of psychotropic drugs in inpatients of psychiatric department in our hospital. Methods The use condition of psychotropic drugs in inpatients of psychiatric department at 18:00 on February 17, 2011 was investigated by the hospital information system (HIS) of Beijing Ankang hospital. Results Among 413 inpatients in the psychotropic department, 407 used antipsychotics, involved 24 kinds of drugs. 225 patients (55.28%) were given single drug, of whom 81 patients (36.00%) used Risperidone Tablets (Zhuofei, Ketong, Risperdal), 51 patients (22.67%) used Aripiprazole Tablets and 33 patients (14.67%) used Clozapine. 182 patients were given combination drugs. Among the two-drugs combination, benzodiazepines (Lorazepam, Clonazepam, Nitrazepam, Diazepam, Estazolam) combined with other drugs were used in 66 patients (41.51%) and Risperidone + Zaleplon were used in 21 patients (13.21%). Among the three-drugs combination, benzodiazepines + Risperidone + other drugs were used in 8 patients (34.78%) and Zaleplon combination was used in 6 patients (26.09%). Conclusion The use of psychotropic drugs among the inpatients in the psychiatric department of Beijing Ankang Hospital is rational and the use of new atypical antipsychotics increases gradually. However, doctors should adhere to the principle of using single drug first and reduce the multi-drug combination.%目的 了解我院精神科住院患者精神药物使用情况及其合理性.方法 利用北京市安康医院HIS系统查阅2011年2月17日精神科住院患者精神药物用药情况,于18∶00时进行用药时点调查.结果 413例精神科住院患者中407例使用抗精神药物,涉及24种药物,单一用药物者225例(55.28%),其中,使用利培酮片(卓菲、可同、维思通)81例(36.00%),阿立哌唑片51例(22.67%),氯氮平33例(14.67%);联合用药者182例.两种药物联合应用患者中苯二氮(艹卓)类(劳拉西泮、氯硝西泮、

  8. Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study

    McCarthy C


    Full Text Available Cormac McCarthy,1 John R Brennan,1 Lindsay Brown,1 Deirdre Donaghy,1 Patricia Jones,1 Rory Whelan,2 Niamh McCormack,3 Ian Callanan,4 John Ryan,2 Timothy J McDonnell1,3 1Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland; 2Department of Emergency Medicine, St Vincent's University Hospital, Dublin, Ireland; 3Clinical Strategy and Programmes Directorate, Health Service Executive, Dublin, Ireland; 4Department of Audit, St Vincent's University Hospital, Dublin, Ireland Aim: To determine the efficacy and usefulness of a chronic obstructive pulmonary disease (COPD care bundle designed for the initial management of acute exacerbations of COPD and to assess whether it improves quality of care and provides better outcomes. Introduction: The level of care provided in the emergency department (ED for COPD exacerbations varies greatly, and there is a need for a more systematic, consistent, evidence-based quality improvement approach to improve outcomes and costs. Methods: A prospective before and after study was carried out in a university teaching hospital. Fifty consecutive patients were identified in the ED with COPD exacerbations and their management was reviewed. Following the education of ED staff and the implementation of a COPD care bundle, the outcome for 51 consecutive patients was analyzed. This COPD care bundle consisted of ten elements considered essential to the management of COPD exacerbations and was scored 0–10 according to the number of items on the checklist implemented correctly. Results: Following implementation, the mean bundle score out of 10 improved from 4.6 to 7 (P<0.001. There was a significant decrease in the unnecessary use of intravenous corticosteroids from 60% to 32% (P=0.003 and also a marked improvement in the use of oxygen therapy, with appropriate treatment increasing from 76% to 96% (P=0.003. Prophylaxis for venous thromboembolism also improved from 54% to 73% (P=0.054. The 30-day

  9. Effects of critical pathway on the management of patients with ST-elevation acute myocardial infarction in an emergency department.

    Ryu, Dong Ryeol; Choi, Jang Won; Lee, Bong-Ki; Cho, Byung Ryul


    Critical pathways (CP) are clinical management plans that provide the sequence and timing of actions of medical staff. The main goal of a CP is to provide optimal patient care and to improve time-effectiveness. Current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend a door-to-balloon time of intervention (PCI). The aim of this study was to identify the effects of CP on the management of patients with STEMI in an emergency department. The study population consisted of 175 patients undergoing primary PCI for STEMI who presented to the emergency department of Kangwon National University Hospital (Chuncheon, South Korea) with chest pain from July 1, 2005 to November 30, 2010. We retrospectively analyzed medication use, symptom onset-to-door times, door-to-balloon times, total ischemic times, and the reperfusion rate within 90 minutes. We also measured the 30-day and 1-year total mortality rates pre- and post-CP implementation. The effects of CP implementation on the medication use outcomes in patients with acute myocardial infarction were increased between the pre- and post-CP patients groups. The median door-to-balloon time declined significantly from 85 to 64 minutes after CP implementation (P = 0.001), and the primary PCI rate within 90 minutes was significantly increased (57% vs. 79%, P = 0.01). However, the symptom to door time was not changed between the pre- and post-CP groups (150 minutes vs. 149 minutes; P = 0.841). Although the total ischemic time was decreased after CP implementation, it was not statistically insignificant (352.5 minutes vs. 281 minutes; P = 0.397). Moreover, the 30-day and 1-year total mortality rates of the 2 groups did not change (12.0% vs. 12.0%, P > 0.999; 13.0% vs. 17.3%, P = 0.425, respectively). However, the 1-year mortality rates of 2 groups based on a total ischemic time of 240 minutes, which was median value, decreased significantly from 19.0% to 9.0%. (P = 0. 018) CONCLUSION

  10. Psychiatric wards: places of safety?

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K


    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience.

  11. Comparison of mortality in patients with acute myocardial infarction accidentally admitted to non-cardiology departments versus that in patients admitted to coronary care units

    D'Souza, Maria; Saaby, Lotte; Poulsen, Tina S


    The aim of this study was to prospectively investigate the clinical characteristics including symptoms and long-term mortality in patients with acute myocardial infarction (AMI) accidentally admitted to non-cardiology departments (NCDs). For comparison, similar observations in patients admitted...

  12. The characteristics of emergency department presentations related to acute herbicide or insecticide poisoning in South Korea between 2011 and 2014.

    Moon, Jeong Mi; Chun, Byeong Jo; Cho, Yong Soo


    The aim of this study was to examine epidemiologic data regarding acute herbicide or insecticide poisoning in adults from 2011 to 2014 at the national level in South Korea. Further, the association between governmental regulations involving pesticides and changes in pesticide poisoning occurrences over time was determined. Data were obtained from the emergency department (ED)-based Injury In-depth Surveillance system conducted by the Korea Center for Disease Control and Prevention (KCDC). Governmental regulations on pesticides were downloaded from the homepage of the Korea Rural Development Administration. Pesticides were classified according to guidelines provided by the World Health Organization (WHO) and by the respective Resistance Action Committee (RAC). Trends in the number of ED presentations and case fatality rate (CFR) due to pesticide poisoning were investigated. The overall CFR due to poisoning from herbicides or insecticides in adults in South Korea was 16.8% during 2011-2014. However, CFR significantly decreased over the 4-year period. The ED presentations of paraquat (PQ) poisoning fell significantly, whereas poisoning due to glyphosate, glufosinate, or combined herbicides increased markedly over the 4 years. Between 2011 and 2013, PQ was the most common pesticide poisoning, whereas glyphosate became the most frequent in 2014. PQ produced the highest rate of fatality followed by endosulfan. Although the frequency of PQ poisoning decreased, which may be attributed to governmental regulations, the CFR and incidence of pesticide poisoning in adults remain a public health concern that needs to be addressed.

  13. An Algorithm for Opioid and Barbiturate Reduction in the Acute Management of Headache in the Emergency Department.

    Ahmed, Zubair A; Nacopoulos, Dimitrios A; John, Seby; Papesh, Nancy; Levine, David; Bamford, Cynthia C


    To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications. In addition, discharge plans seldom include measures to prevent recurrence or instructions to re-treat if pain persists. At this time, there is no standardized management protocol directed at acute headaches presenting to the ED. An ED headache treatment algorithm with step-wise instructions for diagnosis, treatment, and discharge planning was piloted at Lakewood Hospital, a regional Cleveland Clinic affiliated hospital. This non-randomized interventional study compared outcomes after implementation of the algorithm to historical controls. Patient demographic data including age, gender, and payer mix was collected. Outcomes measured included the frequency of treatment with opioids or barbiturates, imaging, neurology consults, admissions, and a patient reported pain score. Data relevant to patient disposition and follow-up, including prescriptions for opioids or barbiturates given at discharge, and ensuring PCP or neurology follow-up appointments at discharge was also reviewed. Demographic data did not differ significantly between the pre- and post-algorithm groups. There was a significant decline in the number of patients treated with opioids and barbiturates from 66.0% pre-algorithm to 6.8% immediately after algorithm implementation (P <. 001), and to 28% (P < .001) one year after algorithm implementation, indicating both an immediate effect of the algorithm and a sustained effect. Similarly, pre-algorithm implementation, 37% of patients were discharged

  14. Psychiatric Treatment

    Rudin, Edward; Zimmerman, Rick


    The California legislature enacted tight constraints on the use of psychosurgery and electroconvulsive therapy in 1974. In April 1976 a State Court of Appeals declared part of the law to be unconstitutional. In doing so, the court enunciated several principles for regulating medical procedures. It affirmed the inherent police powers which permit the state to safeguard the public, especially incompetent, involuntary or confined persons, with respect to intrusive and hazardous medical procedures and to procedures which affect thought or feeling. Although limited to legislation concerning two psychiatric procedures, the court's decision, and subsequently enacted legislation governing these procedures, has implications for other medical procedures and for other parts of the nation. PMID:664647



    14.1 Schizophrenia2007133 A comparative study of intramuscular ziprasidone and haloperidol in treating acute agitation in schizophrenia. LI Lehua(李乐华), et al. Mental Health Insit, 2nd Xiangya Hosp, Centr South Univ, Changsha 410011. Chin J Psychiat 2006;39(4):216-219. Objective To evaluate the efficacy and safety of injection ziprasidone in the treatment of acute agitation behavior in schizophrenia.

  16. Etiology and Risk Factors of Acute Gastroenteritis in a Taipei Emergency Department: Clinical Features for Bacterial Gastroenteritis

    Chao-Chih Lai


    Full Text Available Background: The causative pathogen is rarely identified in the emergency department (ED, since the results of cultures are usually unavailable. As a result, antimicrobial treatment may be overused. The aim of our study was to investigate the pathogens, risk factors of acute gastroenteritis, and predictors of acute bacterial gastroenteritis in the ED. Methods: We conducted a matched case-control study of 627 stool samples and 612 matched pairs. Results: Viruses (41.3% were the leading cause of gastroenteritis, with noroviruses (32.2% being the most prevalent, followed by bacteria (26.8% and Giardia lamblia (12.4%. Taking antacids (adjusted odds ratio [aOR] 4.10; 95% confidence interval [CI], 2.57–6.53, household members/classmates with gastroenteritis (aOR 4.69; 95% CI, 2.76–7.96, attending a banquet (aOR 2.29; 95% CI, 1.64–3.20, dining out (aOR 1.70; 95% CI, 1.13–2.54, and eating raw oysters (aOR 3.10; 95% CI, 1.61–5.94 were highly associated with gastroenteritis. Elders (aOR 1.04; 05% CI, 1.02–1.05, those with CRP >10 mg/L (aOR 2.04; 95% CI, 1.15–3.62, or those who were positive for fecal leukocytes (aOR 2.04; 95% CI, 1.15–3.62 or fecal occult blood (aOR 1.97; 95% CI, 1.03–3.77 were more likely to be hospitalized in ED. In addition, presence of fecal leukocytes (time ratio [TR] 1.22; 95% CI, 1.06–1.41, abdominal pain (TR 1.20; 95% CI, 1.07–1.41, and frequency of vomiting (TR 0.79; 95% CI, 0.64–0.98 were significantly associated with the duration of acute gastroenteritis. Presence of fecal leukocytes (aOR 2.08; 95% CI, 1.42–3.05, winter season (aOR 0.45; 95% CI, 0.28–0.74, frequency of diarrhea (aOR 1.69; 95% CI, 1.01–2.83, and eating shrimp or crab (aOR 1.53; 95% CI, 1.05–2.23 were highly associated with bacterial gastroenteritis. The area under the receiver operating characteristic curve of the final model was 0.68 (95% CI, 0.55–0.63. Conclusions: Acute bacterial gastroenteritis was highly associated with

  17. Establishment of a local psychiatric service

    Wang, A G


    of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily...

  18. Implementing a Music Therapy Program at a New 72-Hour Acute Psychiatric Admissions Unit: A Case Study of a Patient Who Was Malingering

    Silverman, Michael J.


    Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons who…

  19. Implementing a Music Therapy Program at a New 72-Hour Acute Psychiatric Admissions Unit: A Case Study of a Patient Who Was Malingering

    Silverman, Michael J.


    Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons who…

  20. Does it require to exclude cardiobiliary reflex in every acute coronary syndrome follow up patient with bedside ultrasound on emergency department

    Mustafa Bolatkale


    Full Text Available In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside cardiac ultrasonography. But these two methods are not always sufficient to explain the underlying another pathologies such as pancreatitis and acute cholecystitis which can mimick acute cardiac events. Patients who are followed up with a preliminary diagnosis of acute coronary syndrome in the emergency department, might have underlying biliary or pancreatic pathologies, or even more, these might be the sole reason of the clinical picture. So bedside abdomen ultrasonography and liver enzymes may be requested in all patients with suspected cardiac pathology with a normal cardiac ultrasonography when a patient presented with acute chest or abdominal pain. Physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations. So the diagnostic tests for gallbladder pathology could be added to cardiac ultrasonography

  1. 护理标识在精神科护理安全管理中的应用及效果%Application and Effect of Nursing Mark on Nursing Safety Management in Psychiatric Department



    Objective To investigate the nursing; identification application in nursing service in the Department of psychiatry ef ect.Methods To formulate a unified eye-catching care identification, specification, targeted use of nursing marks. Results The application of nursing marks, enhance safety consciousness of psychiatric nurses in hospital, to prevent accidents, improve the patients' satisfaction to nursing work. Conclusion The application of nursing marks, ef ective control of nursing adverse accidents. To ensure the safety of nursing.%目的探讨护理标识在精神科护理服务中应用的效果。方法制定统一醒目的护理标识,规范、有针对性使用护理标识。结果应用护理标识,增强精神科护士安全意识,杜绝院内事故的发生,提高患者对护理工作的满意度。结论护理标识的应用,有效控制护理不良事故的发生。确保了护理安全。

  2. Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review.

    Weiland, Tracey J; Ivory, Sean; Hutton, Jennie


    Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Non-pharmacological interventions for ABD management generally fall into four categories: environmental modifications; policies; practice changes; and education. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice. We performed systematic searches of CINAHL Plus with Full Text, PsycINFO, MEDLINE, and EMBASE, as well as reference lists of relevant review articles to identify relevant studies published between January 1985 - April 2016. We included studies written in English, which reported management of behavioural disturbances in adults associated with the ED through the use of environmental modifiers (including seclusion, restraint, specialised rooms, architectural changes), policy, and practice-based interventions excepting education-only interventions. Efficacy outcomes of interest included incidence, severity, and duration of ABD, incidence of injuries, staff absenteeism, restraint use, restraint duration, and staff and patient perceptions. Two reviewers independently screened titles and abstracts, and assessed the relevancy and eligibility of studies based on full-text articles. Two authors independently appraised included studies. A narrative synthesis of findings was undertaken. Studies reporting interventions for managing ABDs within the ED are limited in number and quality. The level of evidence for efficacy is low, requiring caution in conclusions. While there is preliminary evidence for environmental change in the form of specialised behavioural rooms, security upgrades and ED modifications, these are not supported by evidence from controlled studies. Many of these "common sense" environmental changes recommended in

  3. How CAGE, RAPS4QF and AUDIT can help practitioners for patients admitted with acute alcohol intoxication in emergency departments?

    Georges eBrousse


    Full Text Available Aims: To help clinicians to identify the severity of Alcohol Use Disorders (AUD from optimal thresholds found for recommended scales. Especially, taking account of the high prevalence of alcohol dependence among patients admitted to the Emergency Department (ED for acute alcohol intoxication (AAI, we propose to define thresholds of severity of dependence based on the AUDIT score.Methods: All patients admitted to the ED with AAI (blood alcohol level >0.8g/L, in a two-month period, were assessed using the CAGE, RAPS-QF and AUDIT, with the alcohol dependence/abuse section of the Mini International Neuropsychiatric Interview (MINI used as the gold standard. To explore the relation between the AUDIT and the MINI the sum of the positive items on the MINI (dependence as a quantitative variable and as an ordinal parameter were analyzed. From the threshold score (TS found for each scale we proposed intervals of severity of Alcohol Use Disorders (AUDs. Results: The mean age of the sample (122 males, 42 females was 46 years. Approximately 12 % of the patients were identified with alcohol abuse and 78 % with dependence (DSM-IV. Cut points were determined for the AUDIT in order to distinguish mild and moderate dependence from severe dependence. A strategy of intervention based on levels of severity of AUD was proposed. Conclusion: Different thresholds proposed for the CAGE, RAPS4-QF and AUDIT could be used to guide the choice of intervention for a patient: brief intervention, brief negotiation interviewing or longer more intensive motivational intervention.

  4. Serum Cystatin C for the Diagnosis of Acute Kidney Injury in Patients Admitted in the Emergency Department

    Cristina Bongiovanni


    Full Text Available Background. Early diagnosis of acute kidney injury (AKI at emergency department (ED is a challenging issue. Current diagnostic criteria for AKI poorly recognize early renal dysfunction and may cause delayed diagnosis. We evaluated the use of serum cystatin C (CysC for the early and accurate diagnosis of AKI in patients hospitalized from the ED. Methods. In a total of 198 patients (105 males and 93 females, serum CysC, serum creatinine (sCr, and estimated glomerular filtration rate (eGFR were calculated at 0, 6, 12, 24, 48, and 72 hours after presentation to the ED. We compared two groups according to the presence or absence of AKI. Results. Serial assessment of CysC, sCr, and eGFR was not a strong, reliable tool to distinguish AKI from non-AKI. CysC > 1.44 mg/L at admission, both alone (Odds Ratio = 5.04; 95%CI 2.20–11.52; P<0.0002 and in combination with sCr and eGFR (Odds Ratio = 5.71; 95%CI 1.86–17.55; P<0.002, was a strong predictor for the risk of AKI. Conclusions. Serial assessment of CysC is not superior to sCr and eGFR in distinguishing AKI from non-AKI. Admission CysC, both alone and in combination with sCr and eGFR, could be considered a powerful tool for the prediction of AKI in ED patients.

  5. Serum Cystatin C for the Diagnosis of Acute Kidney Injury in Patients Admitted in the Emergency Department

    Bongiovanni, Cristina; Magrini, Laura; Salerno, Gerardo; Gori, Chiara Serena; Cardelli, Patrizia; Hur, Mina; Buggi, Marco; Di Somma, Salvatore


    Background. Early diagnosis of acute kidney injury (AKI) at emergency department (ED) is a challenging issue. Current diagnostic criteria for AKI poorly recognize early renal dysfunction and may cause delayed diagnosis. We evaluated the use of serum cystatin C (CysC) for the early and accurate diagnosis of AKI in patients hospitalized from the ED. Methods. In a total of 198 patients (105 males and 93 females), serum CysC, serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were calculated at 0, 6, 12, 24, 48, and 72 hours after presentation to the ED. We compared two groups according to the presence or absence of AKI. Results. Serial assessment of CysC, sCr, and eGFR was not a strong, reliable tool to distinguish AKI from non-AKI. CysC > 1.44 mg/L at admission, both alone (Odds Ratio = 5.04; 95%CI 2.20–11.52; P < 0.0002) and in combination with sCr and eGFR (Odds Ratio = 5.71; 95%CI 1.86–17.55; P < 0.002), was a strong predictor for the risk of AKI. Conclusions. Serial assessment of CysC is not superior to sCr and eGFR in distinguishing AKI from non-AKI. Admission CysC, both alone and in combination with sCr and eGFR, could be considered a powerful tool for the prediction of AKI in ED patients. PMID:26170529

  6. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome.

    Ghoshhajra, Brian B; Takx, Richard A P; Staziaki, Pedro V; Vadvala, Harshna; Kim, Phillip; Neilan, Tomas G; Meyersohn, Nandini M; Bittner, Daniel; Janjua, Sumbal A; Mayrhofer, Thomas; Greenwald, Jeffrey L; Truong, Quyhn A; Abbara, Suhny; Brown, David F M; Januzzi, James L; Francis, Sanjeev; Nagurney, John T; Hoffmann, Udo


    To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. • ED Coronary CTA using advanced systems is associated with low radiation exposure. • Negative coronary CTA is associated with low rates of MACE. • CTA in ED patients enables short median time to discharge home. • CTA strategy is characterized by few downstream tests including unnecessary ICA.

  7. Utility of the History and Physical Examination in the Detection of Acute Coronary Syndromes in Emergency Department Patients

    Dezman, Zachary DW; Mattu, Amal; Body, Richard


    Chest pain accounts for approximately 6% of all emergency department (ED) visits and is the most common reason for emergency hospital admission. One of the most serious diagnoses emergency physicians must consider is acute coronary syndrome (ACS). This is both common and serious, as ischemic heart disease remains the single biggest cause of death in the western world. The history and physical examination are cornerstones of our diagnostic approach in this patient group. Their importance is emphasized in guidelines, but there is little evidence to support their supposed association. The purpose of this article was to summarize the findings of recent investigations regarding the ability of various components of the history and physical examination to identify which patients presenting to the ED with chest pain require further investigation for possible ACS. Previous studies have consistently identified a number of factors that increase the probability of ACS. These include radiation of the pain, aggravation of the pain by exertion, vomiting, and diaphoresis. Traditional cardiac risk factors identified by the Framingham Heart Study are of limited diagnostic utility in the ED. Clinician gestalt has very low predictive ability, even in patients with a non-diagnostic electrocardiogram (ECG), and gestalt does not seem to be enhanced appreciably by clinical experience. The history and physical alone are unable to reduce a patient’s risk of ACS to a generally acceptable level (<1%). Ultimately, our review of the evidence clearly demonstrates that “atypical” symptoms cannot rule out ACS, while “typical” symptoms cannot rule it in. Therefore, if a patient has symptoms that are compatible with ACS and an alternative cause cannot be identified, clinicians must strongly consider the need for further investigation with ECG and troponin measurement. PMID:28611898

  8. Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study.

    McCarthy, Cormac


    Aim: To determine the efficacy and usefulness of a chronic obstructive pulmonary disease (COPD) care bundle designed for the initial management of acute exacerbations of COPD and to assess whether it improves quality of care and provides better outcomes. Introduction: The level of care provided in the emergency department (ED) for COPD exacerbations varies greatly, and there is a need for a more systematic, consistent, evidence-based quality improvement approach to improve outcomes and costs. Methods: A prospective before and after study was carried out in a university teaching hospital. Fifty consecutive patients were identified in the ED with COPD exacerbations and their management was reviewed. Following the education of ED staff and the implementation of a COPD care bundle, the outcome for 51 consecutive patients was analyzed. This COPD care bundle consisted of ten elements considered essential to the management of COPD exacerbations and was scored 0–10 according to the number of items on the checklist implemented correctly. Results: Following implementation, the mean bundle score out of 10 improved from 4.6 to 7 (P,0.001). There was a significant decrease in the unnecessary use of intravenous corticosteroids from 60% to 32% (P=0.003) and also a marked improvement in the use of oxygen therapy, with appropriate treatment increasing from 76% to 96% (P=0.003). Prophylaxis for venous thromboembolism also improved from 54% to 73% (P=0.054). The 30-day readmission rate did not significantly improve. Conclusion: The use of a bundle improves the delivery of care for COPD exacerbations in the ED. There is more appropriate use of therapeutic interventions, especially oxygen therapy and intravenous corticosteroids.

  9. 精神科低年资护士轮转培训的效果分析%Effect analysis of rotated training for low seniority nurses in Psychiatric Department

    宋乃云; 郝晶晶; 杨文丽; 李明俊


    Objective To Explore low seniority psychiatric nurses′ system, standard, professional training effect, improve the overall level of psychiatric nursing team. Methods A total of 68 healthy nurses, who recruited from October 2011 to June 2013, were selected and randomly divided into experimental group (n=34) and control group (n=34). Experimental group members had rotated training who went to different departments ( each departments for 3 months and 1 year totally) including male ward, female ward, open ward and MECT room with specific teaching and counseling. The control group nurses given routine training. We compared the result of training by specialized theory knowledge assessment of psychiatric, technical operation evaluation, emergency ability and comprehensive quality assessment, nursing staff discussion, job satisfaction surveys and daily work of observation and measurement before and behind training. Results After Low seniority nurses rotated training, nurses in the experimental group compared with before training, specialized subject theoretical level, operation skill, emergency ability and comprehensive quality significant difference ( t =-11. 677, -3. 049, -10. 717, -12. 581;P<0. 01). The experimental group compared with control group, specialized subject theoretical level, comprehensive quality difference was statistically significant ( t=3. 916, 4. 511;P<0. 01), while operating skills, emergency ability (t=3. 916, 4. 511,P<0. 01). After implementing of rotated training, nurses′ satisfaction was 94. 12%, beyond 61. 76% before the implementation, and the difference was statistically significant (χ2 =10. 350,P < 0. 01). Conclusions Implementation of rotated training can effectively improve psychiatric low qualification nurses specialized theoretical level and the comprehensive quality of the psychiatric clinical practical ability, communication and cooperation ability and the improvement of humanistic quality, etc.%目的:探讨精神科低年资

  10. Inpatient Psychiatric Prospective Payment System (IPF PPS)

    U.S. Department of Health & Human Services — This file contains case level data for inpatient psychiatric stays and is derived from 2011 MEDPAR data file and the latest available provider specific file. The...

  11. Clinical analysis of seven cases with acute myocardial infarction complicated psychiatric symptoms%急性心肌梗死患者并发精神症状临床分析(附7例报告)

    任澎; 王勇; 古孜丽; 李国庆; 涂良珍


    目的:探讨急性心肌梗死(AMI)并发精神症状的原因和治疗方法.方法:回顾分析7例AMI并发精神症状患者的临床资料、诊断和治疗方法.结果:所有患者均给以规范的冠心病二级预防治疗.病例1、3给以心境稳定剂,心理疏导、亲人安慰关怀,症状很快缓解;病例4转脑外科治疗;病例5予以小剂量镇静剂联合心理辅导;病例2、6、7给以小剂量抗精神病药物治疗.所有患者出院前均恢复正常.出院后1,3,6月随访患者无精神症状发生.结论:急性心肌梗死并发精神症状在常规冠心病治疗基础上给予心理治疗及抗精神病药物治疗预后良好.%Objective: To study causes and therapeutic methods of acute myocardial infarction (AMI) complicated psychiatric symptoms. Methods: Clinical data, diagnosis and therapeutic methods of seven AMI patients complicated psychiatric symptoms were retrospectively analyzed. Results: All patients received uniform secondary prevention and therapy for coronary heart disease. First case and third case received mood stabilizers, psychological counseling and comforts from family, and symptoms relieved soon; fourth case was transferred to brain surgery; fifth case received amall dose of sedative combined psycholgical counseling; second, sixth and seventh cases received small dose of antipsychotics. All patients recovered before discharge. No psychiatric symptoms occurred on first, third and sixth month after discharge. Conclusion: Psychological therapy and antipsychotic drug treatment based on routine treatment of coronary heart disease can achieve good prognosis in patients with acute myocardial infarction complicated psychiatric symptoms.

  12. Psychiatric sequelae of induced abortion.

    Gibbons, M


    were compared with 82 patients referred directly to a gynecological department. Termination caused little psychiatric disturbance provided the patient wanted an abortion. Cases of severe psychiatric outcome in the form of psychosis, severe depression, and schizophrenia have been reported. The outcome for women who were refused an abortion and the effects on the children born as a result have been discussed in several studies. In 1 survey, 24% of 249 women who were refused abortion were significantly disturbed after 18 months. Many studies comment on the value of counseling in the abortion decision, but few comparison studies have actually evaluated abortion counseling. A large amount of previously reported research on the psychiatric indications of abortion may be unreliable because women seeking abortions on mainly social grounds used to have to show psychiatric disturbance in order to obtain a legal abortion.

  13. Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section.

    Musey, Paul I; Linnstaedt, Sarah D; Platts-Mills, Timothy F; Miner, James R; Bortsov, Andrey V; Safdar, Basmah; Bijur, Polly; Rosenau, Alex; Tsze, Daniel S; Chang, Andrew K; Dorai, Suprina; Engel, Kirsten G; Feldman, James A; Fusaro, Angela M; Lee, David C; Rosenberg, Mark; Keefe, Francis J; Peak, David A; Nam, Catherine S; Patel, Roma G; Fillingim, Roger B; McLean, Samuel A


    Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender

  14. Diagnostic value of S100B protein in the differential diagnosis of acute vertigo in the emergency department.

    Kartal, Aslı Gülfer; Yılmaz, Serkan; Yaka, Elif; Pekdemir, Murat; Sarısoy, Hasan Tahsin; Çekmen, Mustafa Baki; Yüksel, Melih


    Vertigo is a common presenting complaint resulting from central or peripheral etiologies. Because central causes may be life-threatening, ascertaining the nature of the vertigo is crucial in the emergency department (ED). With a broad range of potential etiologies, distinguishing central causes from benign peripheral causes is a diagnostic challenge. Cranial magnetic resonance imaging (MRI) is the recommended neuroimaging method when clinical findings are ambiguous. However, MRI scanning for every patient with an uncertain diagnosis may not be efficient or possible. Therefore, to improve ED resource utilization for patients with vertigo, there is a need to identify the subset most likely to have MRI abnormalities. It has previously been shown that S100B protein provides a useful serum marker of stroke, subarachnoid hemorrhage, and traumatic brain injury. This study evaluated whether S100B levels could predict central causes of vertigo as identified by cranial MRI in the ED. This prospective, observational study was conducted with adult patients with acute-onset vertigo (within 6 hours) in the ED of a teaching hospital in Kocaeli, Turkey. Patients with nausea or dizziness complaints without previously known vertigo or cranial pathology, and who agreed to participate in the study, were included. Patients with trauma or with neurologic findings that developed concurrent with their symptoms were excluded. Serum levels of S100B were measured with an electrochemiluminescence immunoassay kit. All subjects underwent cranial MRI. The predictors of positive MRI results were evaluated using logistic regression analysis. Sensitivity and specificity of S100B​ levels for identifying subjects with central causes of vertigo on MRI were calculated with receiver operating characteristic (ROC) curve. Of the 82 subjects included in the study, 48 (58.5%) were female, and the mean (±SD) age was 51 (±16) years. Thirty-one (37.8%) subjects had positive MRI results. Median (with

  15. Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review

    Weiland, Tracey J.; Ivory, Sean; Hutton, Jennie


    Introduction Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Non-pharmacological interventions for ABD management generally fall into four categories: environmental modifications; policies; practice changes; and education. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice. Methods We performed systematic searches of CINAHL Plus with Full Text, PsycINFO, MEDLINE, and EMBASE, as well as reference lists of relevant review articles to identify relevant studies published between January 1985 – April 2016. We included studies written in English, which reported management of behavioural disturbances in adults associated with the ED through the use of environmental modifiers (including seclusion, restraint, specialised rooms, architectural changes), policy, and practice-based interventions excepting education-only interventions. Efficacy outcomes of interest included incidence, severity, and duration of ABD, incidence of injuries, staff absenteeism, restraint use, restraint duration, and staff and patient perceptions. Two reviewers independently screened titles and abstracts, and assessed the relevancy and eligibility of studies based on full-text articles. Two authors independently appraised included studies. A narrative synthesis of findings was undertaken. Results Studies reporting interventions for managing ABDs within the ED are limited in number and quality. The level of evidence for efficacy is low, requiring caution in conclusions. While there is preliminary evidence for environmental change in the form of specialised behavioural rooms, security upgrades and ED modifications, these are not supported by evidence from controlled studies. Many of these “common sense

  16. Acute Myeloid Leukemia in Adolescents and Young Adults Treated in Pediatric and Adult Departments in the Nordic Countries

    Wennström, Lovisa; Edslev, Pernille Wendtland; Abrahamsson, Jonas;


    countries. RESULTS: The incidence of AML was 4.9/million/year for the age group 10-14 years, 6.5 for 15-18 years, and 6.9 for 19-30 years. Acute promyelocytic leukemia (APL) was more frequent in adults and in females of all ages. Pediatric patients with APL had similar overall survival as pediatric patients......BACKGROUND: Studies on adolescents and young adults with acute lymphoblastic leukemia suggest better results when using pediatric protocols for adult patients, while corresponding data for acute myeloid leukemia (AML) are limited. PROCEDURE: We investigated disease characteristics and outcome...

  17. Departments applying for consultation-liaison psychiatry and distribution of diagnosed different psychiatric diseases in general hospitals: Analysis of 154 cases%综合医院内联络精神病学会诊科室及病种分布特征:154例分析

    林志雄; 邹晓波; 林举达; 陆兰; 律东


    背景:在综合医院临床专科存在着越来越多的精神心理问题,需要在医院内进行联络会诊.目的:在综合医院中,通过开展精神心理的联络会诊,加强非精神科临床医师对精神医学疾病的认识.设计:病例分析.单位:广东医学院附属医院心理科.对象:选择广东医学院附属医院2003-04/2004-04心理科会诊,不同性别、年龄与文化程度的住院患者154例.方法:统计会诊例数,对154例患者进行申请精神心理科会诊的科室分布和精神障碍病种的分布情况的调查.主要观察指标:①申请精神心理科会诊的科室分布.②精神障碍病种的分布情况. 结果:纳入患者154例,均进入结果分析,无脱落者.①申请精神心理科会诊的科室分布:申请会诊的科室中,内科占首位57例(37.0%),其次是急诊科26例(16.8%),传染科17例(11.0%)和神经内科13例(8.4%).②精神障碍病种的分布情况:会诊诊断最多见的是脑器质性神经症性障碍(31.1%)、精神障碍(25.3%)和躯体疾病所致的精神障碍(13.6%).结论:在综合医院临床各科均存在精神医学问题.在综合医院中,加强开展联络精神病学会诊是必要的.%BACKGROUND: More and more psychiatric problems require liaison consultation in specific clinical departments of general hospital.OBJECTIVE: To enhance the recognition of physicians in non-psychiatric departments on psychiatric illness by carrying on psychiatric liaison consultation in general hospital.DESIGN: Case analysis.SETTING: Department of Psychology in the affiliated hospital to Guangdong Medical College.PARTICIPANTS: Totally 154 inpatients for the consultation in Department of Psychology were selected in the Affiliated Hospital of Guangdong Medical College from April 2003 to April 2004, of either sex and different age and educational backgrounds.METHODS: It was to investigate the distributions of departments and diseases with consultation-liaison psychiatry (CLP) in

  18. Results of the Implementation of a Tool for the Stratification and Management of Diabetic Patients with Uncomplicated Acute Hyperglycemia in the Emergency Department

    Luis Alberto Corona Martínez


    Full Text Available Background: decompensated diabetes is a common cause of visits to emergency departments.Objective: to describe the introduction and validation of a tool for the stratification and management of diabetic patients with uncomplicated acute hyperglycemia in the Emergency Department. Methods: the experimental application of the tool was conducted from February through June 2014 involving 202 patients. Several process and outcome indicators were used for its assessment. Results: diagnosis was reached through blood tests in 97% of cases. There was a gradual increase of stratification per month; most patients were classified into groups one and two. Classification was correct in only 70% of the cases. Adherence to the suggested initial procedures was low (57%, which was determined by the outcomes in the group two (13% since most of the patients were not admitted to the observation ward. Adherence to insulin therapy was higher (67%. Adherence to the recommended follow-up was low due to early discharge of patients. The resolution rate in the emergency services was 93%. Only one case of hypoglycemia was registered. No patient developed any other serious metabolic complication. Resolution of the condition in the yellow zone of the emergency department was high regardless of being in the group one or two. No other serious metabolic complications were observed. Conclusions: continuation of the stratification of diabetic patients with uncomplicated acute hyperglycemia in the Emergency Department is recommended, with modifications to the stratification tool in the groups one and two and the time for clinical and laboratory reassessment.

  19. Psychiatric Morbidity in Patients with Chikungunya Fever: First Report from India.

    Bhatia, M S; Gautam, Priyanka; Jhanjee, Anurag


    Chikungunya fever is an acute illness caused by an arbovirus and has various complications like neurological, psychological, dermatological and even multi organ failure. Psychiatric co-morbidity is not very well studied till now. This is the first report from India. Aim of the study was to assess the psychiatric morbidity during or after the onset of Chikungunya fever. Patients referred from Medicine department with confirmed diagnosis of Chikungunya fever were recruited, after taking informed consent. Patient's socio-demographic characteristics were noted and Psychiatric co-morbidity was assessed by complete history taking and mental status examination, using WHO International Classification of Diseases, 10(th) edition (ICD -10) of Mental and Behavioural Disorders, Diagnostic criteria for research. The age range of the study group was found to be 23-48 years. Fourteen (70%) were males and 6 (30%) were females. Five (25%) patients were diagnosed with depressive disorder, 3 (15%) patients had Generalized Anxiety Disorder (GAD), 2 (10%) patients GAD with Panic attacks, 1(5%) patients phobic disorder (claustrophobia), 3 (15%) patients Somatoform Disorder, 3 (15%), Neurasthenia (Fatigue Syndrome), etc. Two (10%) patients presented with vague somatic complaints which did not fit into any of the diagnostic category. Chikungunya fever can result in significant psychiatric morbidity, mainly in the form of depressive episode, anxiety disorder and even long persisting illnesses like somato-form disorders. Further research is required to know about the phenomenology or the neurobiology of the psychiatric disorders occurring in the course of this illness.

  20. Lactate levels as a marker of tissue hypoperfusion in acute heart failure patients seen in the emergency department: a pilot study

    Kori Sauser


    Full Text Available Acute heart failure (AHF may lead to subclinical tissue ischemia due to hypoperfusion from inadequate forward flow or congestion. The aim of the present study is to test whether lactate levels are elevated in emergency department (ED patients with AHF. A prospective pilot study of ED AHF patients was conducted. Venous lactate level was measured at baseline and 6-12 hours after initial draw. Of the 50 patients enrolled, mean age was 65.3 years, 68% were male. Only 7 (14% had an elevated lactate on either draw, with no differences in baseline characteristics between patients with and without elevated lactate. Patients with an elevated lactate had a higher mean heart rate (99 vs 81, P=0.03 and trended toward an increased rate of abnormal initial temperature (57 vs 23%, P=0.06. In this pilot study, only a minority of acute HF patients had an elevated lactate on presentation.

  1. 精神科心身病房优质护理服务模式及效果%Model and Effect of High Quality Nursing Service in Psychosomatic Disease Ward, Psychiatric Department

    罗珊霞; 陈晶晶; 余建英; 张宇珊; 唐蕊; 李继平


    目的 探讨精神科心身病房优质护理服务模式及效果.方法 2010年7月起心身病房加入优质护理活动,通过了解患者对优质护理的需求,结合精神科专业特色,从培训和提高护理人员业务能力着手,实行医护共同交班制、共同查房制、开展思维纠正和行为训练、加强康复指导等措施建立优质护理服务模式,并对优质护理的效果以满意度进行评价.结果 患者对优质护理的希望与要求集中反映在主动热情服务、沟通好、康复治疗效果好等方面;实施优质护理服务后,患者、医生及护士的满意度均有不同程度上升.结论 心身病房开展优质护理服务,能有效满足患者的需求和体验,提高护士的专科护理技能,达到患者、医生、护士共同满意的良好效果.%Objective To explore the model and effect of high quality nursing service in Psychosomatic Disease Ward of Psychiatric Department. Methods From July 2010, the content of high quality nursing service were surveyed. In combination of professional characteristics of psychiatry, a high quality nursing service model was developed according to the following aspects: training and improving the skills of nurses, the application of doctor-nurse common shift system, doctor-nurse common ward-rounds system, strengthening the instruction of rehabilitation, implementation of thinking correction and behavior training. The effect of high quality nursing service was evaluate with the satisfaction degree. Results The main aspects of high quality nursing service appraised by the patients were active warm service, good communication and effective rehabilitation. After the implementation of high quality nursing service, satisfaction degree of patients, doctors and nurses improved with statistic significant difference. Conclusion The application of high quality nursing service model in Psychosomatic Disease Ward can effectively meet the needs of patients, improve the

  2. Psychiatric Disorder


    15.1 Schizophrenia2007274 Effect and safety of combination therapy of valproate with lithium on recurrent mania. XU Wenwei(徐文炜), et al. Dept Psychiat, Wuxi Ment Health Center, Wuxi 214151. Chin J Psychiat 2007;40(2):86-89. Objective The study was to explore the effectiveness and safety of chronic combination reatment of valproate with lithium on recurrent mania. Method All 105 patients with mania-onset were andomly assigned to receive sodium valproate plus lithium (n=35), and monotherapy with lithium n=35) or sodium valproate (n=35), and were followed up for 5 years. At baseline, the symptom was valuated with the Bech-Rafaelsen Mania Rating Scale (BRMS). The drug dosage, times of relapse, effects nd safcty was compared among the three groups. Results After the acute therapy, the reductions in BRMS core were(43±29)% in lithium group, (42±27)% in valproate group, and (58±25)% in combination roup, respectively, with significant differences between the three groups (F=3.579, P=0.031). At ollowed-up, tile relapse times was significantly less in combination group than that in lithium and valproate roup(mean times of 2.0±1.5, 3.5±1.8, and 3.5±2.2, P=0.001). The combination therapy had etter effectiveness especially in patients with rapid cycling bipolar disorder(F=4.120, P=0.033) than the ther two monotherapy group. The mean dosage of single drug in combination group was significantly lower han that in lithium and valproate group (P<0.01; P<0.001). There were no significantly statistic differences on side-effects among three groups. Conclusion The efficacy of combination therapy of valproate with lithium on mania is better than the monotherapy of lithium or valproate in the light of safety and reduced occurrence.

  3. Elements of Successful School Reentry after Psychiatric Hospitalization

    Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.


    Psychiatric hospitalization is an intensive intervention designed to stabilize adolescents who are experiencing an acute mental health crisis. Reintegrating to school after discharge from psychiatric hospitalization can be overwhelming for many adolescents (E. V. Clemens, L. E. Welfare, & A. M. Williams, 2010). The authors used a consensual…

  4. The value of pancreatic stone protein in predicting acute appendicitis in patients presenting at the emergency department with abdominal pain

    Tschuor Christoph


    Full Text Available Abstract Background Pancreatic Stone Protein (PSP is a protein naturally produced mainly in the pancreas and the gut. There is evidence from experimental and clinical trials that blood PSP levels rise in the presence of inflammation or infection. However, it is not known whether PSP is superior to other established blood tests (e.g. White Blood Count, Neutrophils or C - reactive protein in predicting appendicitis in patients presenting with abdominal pain and a clinical suspicion of appendicitis at the emergency room. Methods/design The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. 245 patients will be prospectively recruited. Interim analysis will be performed once 123 patients are recruited. The primary endpoint of the study concerns the diagnostic accuracy of PSP in predicting acute appendicitis and therefore the evidence of appendicitis on the histopathological specimen after appendectomy. Discussion The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. Trial registration NCT01610193; Institution Ethical Board Approval ID: KEKZH- Nr. 2011–0501


    Chaturvedi, Santosh K.; Michael, Albert


    SUMMARY Known cases of hypertension and those fulfilling WHO criteria for diagnosis of hypertension were identified in psychiatric patients and compared with non - hypertensive psychiatric patients. Hypertension was detected in 141 (9.98%) cases, and was significantly more associated with elder age, married status, urban background and neurotic illness. The implications are in early detection and effective management of hypertension in psychiatric patients.

  6. Nurses' experiences of patient suicide and suicide attempts in an acute unit



    PUBLISHED Suicide and suicide attempts in Ireland have increased dramatically in the last twenty years. Many of the presentations of suicide attempts to Emergency Departments are recommended an admission to an acute mental health unit. A psychiatric staff nurse working in an acute mental health setting has a high chance of experiencing a patient suicide or suicide attempt during their career. The occurrence of an inpatient suicide or suicide attempt is unquestionably an overwhelmingly stre...

  7. Psychiatric disorders after radiation exposure

    Kokai, Masahiro [Hyogo Coll. of Medicine, Nishinomiya (Japan); Soejima, Toshinori; Wang, Shangdong; Shinfuku, Naotaka


    This review focuses on the mental and psychological effects of medical radiation exposure, the nuclear accident at Three Mile Island, the Chernobyl disaster, atomic bomb explosions at Nagasaki and Hiroshima, and accidents at nuclear power plants and nuclear waste plants. Studies have shown that anxiety about the adverse effects of radiation in medicine (such as infertility, carcinogenicity, and genotoxicity) and fear for exposure has caused psychiatric disorders. Several studies on the mental health effects of the nuclear accident at Three Mile Island were conducted, and the results indicated that psychiatric distress persisted for a certain period of time, particularly in pregnant women and women who have children, even when no evidence of substantial of radiation exposure is seen clinically. The psychological consequences of the Chernobyl disaster have been investigated continuously, and various problems, e.g., acute stress reaction, neurosis, and psychosis, have been identified, although no physical damage due to the radiation or PTSD have been reported. By contrast, PTSD has been seen in survivors of the Nagasaki and Hiroshima nuclear explosions. A study in Ohio, (United States), which has a nuclear waste plant, investigated PTSD in people living near the plant and found that the symptom level was mild. In general, the most common symptoms among people with mental and psychological disorders due to radiation exposure are depression and anxiety, with many people having associated somatoform disorders, and some people complain of PTSD. Vague anxiety and fear of sequelae, regardless of the exposure dose, appears to cause such psychiatric disorders. Although it is rare for psychiatrists to see such cases of psychiatric disorders due to radiation exposure, their number may increase as psychiatric services become more widely available. (K.H.)

  8. [Acute alcohol intoxication among children and adolescents admitted to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Katowice during 2000-2010--preliminary study].

    Kamińska, Halla; Agnieszka, Zachurzok-Buczyńska; Gawlik, Aneta; Małecka-Tendera, Ewa


    The alcohol drinking at the young age is a risk factor of alcohol addiction later in life, and is connected with school problems, binge drinking, tobacco addiction, illegal drug use, violence, crime commitment, and risky sexual behaviors. Alcohol drinking in the last 12 months is declared by 78% Polish children. The aim of the study was to evaluate the frequency of admissions due to alcohol intoxication to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Pediatric Center of Silesia and the identification of the risk factors of the acute alcohol intoxication among Polish children and adolescents. Ten-year retrospective study includes investigation of patients medical records from the Department of Pediatrics. Among 8048 patients hospitalized in the Department of Pediatrics between the years 2000-2010, 220 (2.7%) cases of acute alcohol poisoning occurred The detailed data analysis from 139 patients [66 (47.5%) girls, 73 (52,5%) boys] was done. In the years 2006-2010 the number of girls admitted to the department increased in comparison to boys. The largest group of patients was at age between 14 and 16 years [61 (44%) children]. The blood alcohol concentration at the moment of admission to the hospital was 0.1 to 4.0 per thousand. In most cases (92.8%) the alcohol intoxication was intentional. Five percent of them were suicide attempts. In the youngest group of children alcohol abuse was unintentional. 23 (16.5%) of patients initially needed admission to the intensive care unit. In 30 (21.6%) patient the family was incomplete and five times more often father was absent. The alcohol addiction occurs in 18 (13.0%) fathers and 10 (7.2%) mothers of our patients. It is concluded that over the last decade the number of girls admitted due to alcohol abuse increased. Children at school grade between 7-9 are intoxicated most often. One six of intoxicated patents needed hospitalization at intensive care unit.

  9. Psychiatrists and psychiatric rehabilitation.

    Torrey, William C; Green, Ronald L; Drake, Robert E


    Interventions that focus directly on functional impairments related to mental illnesses are termed psychiatric rehabilitation. Research demonstrates that rehabilitation services are increasingly able to help adults with psychiatric disabilities achieve the functional outcomes they desire, particularly in the areas of housing and employment. To support the community lives of adults with severe mental illnesses, psychiatrists must stay current with advances in this field and know how to integrate psychiatric rehabilitation with other interventions. This article reviews the concept of psychiatric rehabilitation, current approaches in the field, the psychiatrist's role in these services, and implications for psychiatric training and continuing education.

  10. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M


    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting.

  11. Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar.

    Khudair, I F; Jassim, Z; Hanssens, Y; Alsaad, W A


    Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as "poisoning case" with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

  12. A Survey on the Choice of Transportation to come to Emergency Department among Patients with Acute Coronary Syndrome of A Community in Malaysia.

    Chew, K S; Wan Masliza, W M A; Nik Hisamuddin, N A R; Mohd Hashairi, F; Shaik Farid, A W; Tuan Hairulnizam, T K; Zikri, A M; Zurkurnai, Y


    Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (peducation as well as past history of ischemic heart disease did not significantly influence the patients' choice of transportation. The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultural and logistic factors may need to be addressed.

  13. [Recurrent psychiatric manifestations during malaria prevention with mefloquine. A case report].

    Rodor, F; Bianchi, G; Grignon, S; Samuelian, J C; Jouglard, J


    The authors report the case of a 22 years old woman without psychiatric antecedent who started a prophylaxis with mefloquine for a journey in a chloroquino resistant area. The first tablet induced an acute psychiatric syndrome which lasted five days; the second tablet induced the recidive of the psychiatric data and a suicide attempt by drowning.

  14. Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea

    Daniel Mantuani, MD


    Full Text Available Introduction: Determining the etiology of acute dyspnea in emregency department (ED patients is often difficult. Point-of-care ultrasound (POCUS holds promise for improving immediate diagnostic accuracy (after history and physical, thus improving use of focused therapies. We evaluate the impact of a three-part POCUS exam, or “triple scan” (TS – composed of abbreviated echocardiography, lung ultrasound and inferior vena cava (IVC collapsibility assessment – on the treating physician’s immediate diagnostic impression. Methods: A convenience sample of adults presenting to our urban academic ED with acute dyspnea (Emergency Severity Index 1, 2 were prospectively enrolled when investigator sonographers were available. The method for performing components of the TS has been previously described in detail. Treating physicians rated the most likely diagnosis after history and physical but before other studies (except electrocardiogram returned. An investigator then performed TS and disclosed the results, after which most likely diagnosis was reassessed. Final diagnosis (criterion standard was based on medical record review by expert emergency medicine faculty blinded to TS result. We compared accuracy of pre-TS and post-TS impression (primary outcome with McNemar’s test. Test characteristics for treating physician impression were also calculated by dichotomizing acute decompensated heart failure (ADHF, chronic obstructive pulmonary disease (COPD and pneumonia as present or absent. Results: 57 patients were enrolled with the leading final diagnoses being ADHF (26%, COPD/ asthma (30%, and pneumonia (28%. Overall accuracy of the treating physician’s impression increased from 53% before TS to 77% after TS (p=0.003. The post-TS impression was 100% sensitive and 84% specific for ADHF. Conclusion: In this small study, POCUS evaluation of the heart, lungs and IVC improved the treating physician’s immediate overall diagnostic accuracy for ADHF

  15. Inpatient Psychiatric Facility Quality Measure Data – by State

    U.S. Department of Health & Human Services — The Inpatient Psychiatric Facility Quality Reporting (IPFQR) program currently uses six measures. Psychiatric facilities that are eligible for this program may have...

  16. Acute hepatitis at the Department of Pediatrics, School of Medicine, University of North Sumatra/Dr. Pirngadi Hospital Medan.

    Mahadi; Pasaribu, S; Lubis, M; Lubis, C P


    A retrospective study was done during 1984-1988 in the pediatric ward of Dr. Pirngadi Hospital revealing 41 cases of acute hepatitis, consisted of 61.0% boys and 39.0% girls. The majority of patients were below five years of age (68.3%). There were 37.1% cases with malnutrition. The common symptoms were fever, jaundice, vomiting and dark urine. On laboratory examination there were 10 cases with positive HBs Ag. Accompanying diseases were malnutrition, bronchopneumonia, anemia, bronchitis and pulmonary tuberculosis. A total of 63.4% of patients were healed, 29.3% discharged against medical advice and 7.3% died because of bronchopneumonia and hepatic coma.

  17. Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

    Lorenzi, Olga D.; Gregory, Christopher J.; Santiago, Luis Manuel; Acosta, Héctor; Galarza, Ivonne E.; Hunsperger, Elizabeth; Muñoz, Jorge; Bui, Duy M.; Oberste, M. Steven; Peñaranda, Silvia; García-Gubern, Carlos; Tomashek, Kay M.


    In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2–7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs. PMID:23382160

  18. Psychiatric emergency services in Copenhagen 2012

    Moltke, Katinka; Høegh, Erica B; Sæbye, Ditte;


    BACKGROUND: Since the first publication of the psychiatric emergency units (PEUs) in Copenhagen 1985, outpatient facilities have undergone considerable changes. Our aim is to examine how these changes have influenced the activities in the PEUs in the same catchment area. METHODS: We conducted...... reduced the number of visits in the PEUs considerably. The results have shown a change of diagnostic distribution and more severe conditions requiring acute admissions for emergency treatment. Close collaboration with the patients' families, GPs, social authorities and specialized psychiatric outpatient...

  19. The Cost-Effectiveness Analysis of Video Capsule Endoscopy Compared to Other Strategies to Manage Acute Upper Gastrointestinal Hemorrhage in the Emergency Department

    Meltzer, Andrew C.; Ward, Michael J.; Gralnek, Ian M.; Pines, Jesse M.


    Study objective Acute upper gastrointestinal (GI) hemorrhage is a common presentation in hospital-based emergency departments (EDs). A novel diagnostic approach is to use video capsule endoscopy to directly visualize the upper GI tract and identify bleeding. Our objective was to evaluate and compare the relative costs and benefits of video capsule endoscopy compared to other strategies in low to moderate risk ED patients with acute upper GI hemorrhage. Methods We constructed a model using standard decision analysis software to examine the cost-effectiveness of four available strategies for a base-case patient who presents to the ED with either mild or moderate risk scenarios (by Glasgow-Blatchford Score) for requiring invasive hemostatic intervention (i.e., endoscopic, surgical, etc.) The four available diagnostic strategies were (1) direct imaging with video capsule endoscopy performed in the ED, (2) risk stratification using the Glasgow-Blatchford score, (3) nasogastric tube placement and, finally, (4) an admit-all strategy. Results In the low-risk scenario, video capsule endoscopy was preferred strategy (cost $5,691, 14.69 QALYs) and more cost effective than the remaining strategies including nasogastric tube strategy (cost $8,159, 14.69 QALYs), risk stratification strategy (cost $10,695, 14.69 QALYs) and admit-all strategy (cost $22,766, 14.68 QALYs). In the moderate risk scenario, video capsule endoscopy continued to be preferred strategy (cost $9,190, 14.56 QALYs) compared to nasogastric tube (cost $9,487, 14.58 QALYs, ICER $15,891) and more cost effective than admit-all strategy (cost, $22,584, 14.54 QALYs.) Conclusion Video capsule endoscopy may be cost-effective for low and moderate risk patients presenting to the ED with acute upper GI hemorrhage. PMID:24961149

  20. Time to cranial computerised tomography for acute traumatic brain injury in paediatric patients: Effect of the shorter stays in emergency departments target in New Zealand.

    Jones, Peter G; Kool, Bridget; Dalziel, Stuart; Shepherd, Michael; Le Fevre, James; Harper, Alana; Wells, Susan; Stewart, Joanna; Curtis, Elana; Reid, Papaarangi; Ameratunga, Shanthi


    Timely access to computerised tomography (CT) for acute traumatic brain injuries (TBIs) facilitates rapid diagnosis and surgical intervention. In 2009, New Zealand introduced a mandatory target for emergency department (ED) stay such that 95% of patients should leave ED within 6 h of arrival. This study investigated whether this target influenced the timeliness of cranial CT scanning in children who presented to ED with acute TBI. We retrospectively reviewed a random sample of charts of children target was introduced in 2009. Among the 190 cases eligible for study (n = 91 pre-target and n = 99 post-target), no significant difference was found in time to CT scan pre- and post-target: least squares mean (LSM) with 95% confidence interval = 68 (56-81) versus 65 (53-78) min, respectively, P = 0.66. Time to neurosurgery (LSM 8.7 (5-15) vs. 5.1 (2.6-9.9) h, P = 0.19, or hospital length of stay (LSM: 4.9 (3.9-6.3) vs. 5.2 (4.1-6.7) days, P = 0.69) did not change significantly. However, ED length of stay decreased by 45 min in the post-target period (LSM = 211 (187-238) vs. 166 (98-160) min, P = 0.006). Implementation of the shorter stays in ED target was not associated with a change in the time to CT for children presenting with acute TBI, but an overall reduction in the time spent in ED was apparent. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  1. Short- and Long-Term Prognostic Utility of the HEART Score in Patients Evaluated in the Emergency Department for Possible Acute Coronary Syndrome.

    Jain, Tarun; Nowak, Richard; Hudson, Michael; Frisoli, Tiberio; Jacobsen, Gordon; McCord, James


    The HEART score is a risk-stratification tool that was developed and validated for patients evaluated for possible acute coronary syndrome (ACS) in the emergency department (ED). We sought to determine the short-term and long-term prognostic utility of the HEART score. A retrospective single-center analysis of 947 patients evaluated for possible ACS in the ED in 1999 was conducted. Patients were followed for major adverse cardiac events (MACEs) at 30 days: death, acute myocardial infarction, or revascularization procedure. All-cause mortality was assessed at 5 years. The HEART score was compared with the Thrombolysis in Myocardial Infarction (TIMI) score. At 30 days, 14% (135/947) of patients had an MACE: 48 deaths (5%), 84 acute myocardial infarctions (9%), and 48 (5%) revascularization procedures. The MACE rate in patients with HEART score ≤3 was 0.6% (1/175) involving a revascularization procedure, 9.5% (53/557) in patients with HEART score between 4 and 6, and 38% (81/215) with HEART score ≥7. The C-statistic for the HEART score was 0.82 and 0.68 for the TIMI score for predicting 30-day MACE (P < 0.05). Patients with HEART score ≤3 had lower 5-year mortality rate compared with those with TIMI score of 0 (10.6% vs. 20.5%, P = 0.02). The HEART score is a valuable risk-stratification tool in predicting not only short-term MACE but also long-term mortality in patients evaluated for possible ACS in the ED. The HEART score had a superior prognostic value compared with the TIMI score.

  2. The simple query "Do you want more pain medication?" is not a reliable way to assess acute pain relief in patients in the emergency department.

    Chauny, Jean-Marc; Marquis, Martin; Paquet, Jean; Lavigne, Gilles; Cournoyer, Alexis; Manzini, Christiane; Daoust, Raoul


    The management of acute pain constitutes an essential skill of emergency department (ED) physicians. However, the accurate assessment of pain intensity and relief represents a clinically challenging undertaking. Some studies have proposed to define effective pain relief as the patient's refusal for additional analgesic administration. The aim of this study was to verify whether such a refusal is effectively indicative of pain relief. This prospective cohort study included ED patients who received single or multiple doses of pain medication for an acute pain problem. Patients were evaluated for pain relief using one Likert scale and two dichotomous questions: Is your pain relieved? and Do you want more analgesics? Non-relieved patients were further analysed using a checklist as to the reasons behind their refusal for supplemental pain medication. We have recruited 378 adult patients with a mean age of 50.3 years (±19.1); 60% were women and had an initial mean pain level of 7.3 (±2.0) out of 10. We observed that 68 out of 244 patients who were adequately relieved from pain asked for more analgesics (28%), whereas 51 out of 134 patients who were not relieved from pain refused supplemental drugs (38%). Reasons for refusal included wanting to avoid side effects, feeling sufficiently relieved, and disliking the medication's effects. Over a third of ED patients in acute pain were not relieved but refused supplemental pain medication. Patients have reported legitimate reasons to decline further analgesics, and this refusal cannot be used as an indication of pain relief.

  3. [Crisis interventions: a psychotherapeutical challenge for psychiatric emergencies?].

    Bressi, Cinizia; Damsa, Cristian; Pirrotta, Roberto; Lazignac, Coralie; Invernizzi, Giordano


    Taking care of patients consulting the emergency psychiatric unit, raises nosological, legal, ethical and even logistic questions for the emergency departments. The need for emergency psychiatric interventions has grown constantly during the last twenty years and clinicians were challenged to find a new psychotherapeutic approach, more focused on the actual symptoms presented by the patients than the 'classic' psychiatric interventions. The goal of this article is to discuss the possibility of a psychotherapeutic approach in an emergency department, departing from a treatment model that has been developed at the psychiatric emergency of the University of Milan. In this approach, the psychotherapeutic treatment is divided in four different stages: preparation, incubation, transformation and verification. The "psychiatric crisis" becomes an opportunity to change for the patient, being a passage rite towards a new and better psychological functioning.

  4. Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department - a retrospective analysis.

    Horvath, Christian Michael; Brutsche, Martin Hugo; Baty, Florent; Rüdiger, Jochen Julius


    Transcutaneous measurement of carbon dioxide (PtCO2) has been suggested as an alternative to invasively obtained PaCO2 for the monitoring of patients with hypercapnic respiratory failure during noninvasive ventilation (NIV). Current data on monitoring in hypoxaemic respiratory failure are scarce and show conflicting results in hypercapnic patients in the emergency department. We performed a retrospective comparison of real-time PtCO2 (SenTec Digital Monitor) and arterial/venous carbon dioxide tension (PaCO2/PvCO2) measurements in patients with severe hypoxaemic and/or hypercapnic respiratory failure during NIV. Agreement between PtCO2 and PaCO2/PvCO2 was the primary endpoint. Bland-Altman analysis and linear regression were used. 102 patients had at least one matched measurement of PtCO2 and PaCO2/PvCO2. For patients with arterial blood gas analysis, the mean difference was 0.46 kPa at baseline (95% confidence interval [CI] 0.23 to 0.60, limits of agreement 95% CI -0.54 to 1.45) and 0.12 kPa after NIV (95% CI -0.04 to 0.29, limits of agreement 95% CI: -0.61 to 0.86). The linear regression analysis found a correlation R2 of 0.88 (p 8 kPa was associated with a lesser degree of agreement between the levels of PtCO2 and PaCO2/PvCO2 (p Transcutaneous PCO2 monitoring shows a good concordance with PaCO2 and is a reliable, feasible, patient-friendly and safe alternative to repeated blood gas analysis for patients with severe hypoxaemic and/or hypercapnic respiratory failure receiving emergency NIV in the emergency department. An initial blood gas analysis to evaluate the respiratory and metabolic state and to rule out a significant discrepancy compared with the transcutaneous measurement is recommended.

  5. Do the residents in the emergency department appropriately manage patients with acute asthma attack? A study of self-criticism.

    Akoglu, Sebahat; Topacoglu, Hakan; Karcioglu, Ozgur; Cimrin, Arif Hikmet


    The objective of this study was to investigate the management of patients with asthma attack admitted to the emergency department (ED) in terms of compliance with international guidelines. The records of patients with asthma who were admitted to a university-based ED between December 2001 and December 2002 were evaluated. A total of 72 cases with available data were evaluated retrospectively. Twenty-six patients (36.1%) were admitted more than once during the study period. The number of multiple admissions ranged from 2 (15 patients, 20.0%) to 11 (2 patients, 2.8%). Peak expiratory flow (PEF) measurements were recorded in 17 patients (23.6%) on presentation. Pulse and respiratory rates were recorded in 70 (97.0%) and 67 patients (93.0%), respectively. Thirty-four patients (47.2%) underwent chest x-ray; results were normal in most patients. Salbutamol was the most commonly used drug as first-line therapy. Ipratropium bromide (inhaled) and systemic corticosteroids were added to the salbutamol in 47 (65.2%), 42 (58.4%), and 32 patients (44%), respectively. Pulmonologists were consulted in only 7 cases (9.7%). Thirty patients (43.4%) were prescribed corticosteroids on discharge. The role of functional parameters in determining asthma severity and monitoring treatment effects should be emphasized in clinical practice. Finally, more prevalent use of management guidelines will help determine their usefulness.

  6. 28 CFR 549.43 - Involuntary psychiatric treatment and medication.


    ... medication. 549.43 Section 549.43 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.43 Involuntary psychiatric treatment and medication. Title 18 U.S.C. 4241-4247 and federal...

  7. 42 CFR 456.170 - Medical, psychiatric, and social evaluations.


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456.170 Section 456.170 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Medical, Psychiatric, and...

  8. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456.482 Section 456.482 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric Services for Individuals Under Age 21: Admission...

  9. 28 CFR 551.114 - Medical, psychiatric and psychological.


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Medical, psychiatric and psychological. 551.114 Section 551.114 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.114 Medical, psychiatric and psychological. (a) Staff shall provide the pretrial inmate with...

  10. A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department.

    Kostic, Mark A; Gutierrez, Francisco J; Rieg, Thomas S; Moore, Tammy S; Gendron, Richard T


    Intravenous (IV) prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine patients presenting to the emergency department (ED). In this randomized, double-blind, placebo-controlled trial, after providing written informed consent, patients presenting to the ED with a chief complaint of migraine received a 500-mL bolus of IV saline solution and either 10 mg prochlorperazine with 12.5 mg diphenhydramine IV plus saline solution placebo subcutaneously or saline solution placebo IV plus 6 mg sumatriptan subcutaneously. Pain intensity was assessed with 100-mm visual analog scales (visual analog scale at baseline and every 20 minutes for 80 minutes). The primary outcome was change in pain intensity from baseline to 80 minutes or time of ED discharge if subjects remained in the ED for fewer than 80 minutes after treatment. Sedation and nausea were assessed every 20 minutes with visual analog scale scales, and subjects were contacted within 72 hours to assess headache recurrence. Sixty-eight subjects entered the trial, with complete data for 66 subjects. Baseline pain scores were similar for the prochlorperazine/diphenhydramine and sumatriptan groups (76 versus 71 mm). Mean reductions in pain intensity at 80 minutes or time of ED discharge were 73 mm for the prochlorperazine/diphenhydramine group and 50 mm for those receiving sumatriptan (mean difference 23 mm; 95% confidence interval 11 to 36 mm). Sedation, nausea, and headache recurrence rates were similar. IV prochlorperazine with diphenhydramine is superior to subcutaneous sumatriptan in the treatment of migraine. Copyright 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  11. Survey of patients with acute poisoning seen in the Emergency Department of the University Hospital of Gent between 1983 and 1990.

    Verstraete, A G; Buylaert, W A


    In a prospective study of 4234 patients with acute poisoning in the Emergency Department of the University Hospital of Gent in Belgium between 1983 and 1990, we observed a decline in the number of poisonings from 665 in 1983 to 424 in 1990. This was due to a decrease in the number of deliberate self-poisonings. Fifty-six per cent of patients were female and the most prevalent age group was 20 to 24 years. There was no seasonal variation. The substances most frequently taken were benzodiazepines (55% of the deliberate self-poisonings), ethanol in combination with other substances (35.8%), barbiturates and older hypnotics (18.6%), non-narcotic analgesics (13.3%) and tricyclic antidepressants (11.6%). Carbon monoxide accounted for 65.1% of all the accidental poisonings. With regard to treatment, a reduction in gastric lavage was observed. The patients were transferred to the intensive care unit (29.2%), the psychiatry ward (23.6%) or discharged home (27.8%). Only 0.3% of the patients died in the Emergency Department.

  12. Value of heart-type fatty acid-binding protein (H-FABP) for emergency department patients with suspected acute coronary syndrome.

    Banu, Karakus Yilmaz; Niyazi, Ozüçelik Doğaç; Erdem, Cevik; Dpekçi Afşin, Doğan Hatice; Ozlem, Uzun; Yasemin, Celik; Afsin, Ipekci


    The aim of this study is testing the value of H-FABP in the early diagnosis of ACS alone or with routinely used biomarkers such as myoglobin, CK-MB, and cTn I in patients who admitted to emergency department (ED) with complaint of chest pain and suspected acute coronary syndrome. This prospective and cross-sectional study was performed at the Emergency Department of University hospital between June 2009 and September 2010. Patients who were admitted with chest pain within first 48 hours and suspected ACS were enrolled to the study. Blood samples were taken for CK-MB, myoglobin, cTnI and H-FABP The patients were divided into two groups (ACS and non ACS). Statistical analyse were used for relation of biomarkers with diagnosis of ACS. A 66 patients were included to the study. H-FAPB values were positive in 15.2% patients. When H-FABP was added to routinely used biomarkers in the diagnosis of ACS, increasing was observed in all sensitivity, specificity, PPV and NPV values. However, this increase was not statistically significant. H-FABP did not provide any significant change in early diagnosis and exclusion of ACS diagnosis when used either alone or combination with routinely used biomarkers.

  13. Psychiatric Emergencies in the Elderly.

    Sikka, Veronica; Kalra, S; Galwankar, Sagar; Sagar, Galwankar


    With the increasing life expectancy, the geriatric population has been increasing over the past few decades. By the year 2050, it is projected to compose more than a fifth of the entire population, representing a 147% increase in this age group. There has been a steady increase in the number of medical and psychiatric disorders, and a large percentage of geriatric patients are now presenting to the emergency department with such disorders. The management of our progressively complex geriatric patient population will require an integrative team approach involving emergency medicine, psychiatry, and hospitalist medicine.

  14. 精神科新入职护士心理状况调查分析%Investigation and Analysis of Psychological Status of New Nurses of Psychiatric Department



    目的::了解精神科新入职护士心理状况,为规范职业培训,稳定护士队伍提供必要的信息。方法:采用自行设计问卷对57名入职时间在5年内的精神科护士进行问卷调查,并对入职时间≤1年和>1年的两组人员进行比较分析。结果:精神科工作时间的长短是影响护士心理状况的重要因素,入职时间≤1年的护士85.7%担心被病人攻击受到伤害,71.4%担心独立值班应急处理能力差,66.7%认为自己精神专科疾病知识缺乏,入职时间>1年的护士则对职业规划和社会对精神专科护理工作的支持不够产生担忧。结论:根据精神科新入职护士的心理特点,制定规范的培训计划,开展有针对性的培训学习、临床带教等,帮助他们尽快熟悉工作环境,掌握精神专科护理技能,适应工作角色,为精神病患者提供优质服务。%Objective: To understand the psychological status of new psychiatric nurses and provide necessary information for standardizing professional training and keeping the nurse team stable. Methods:Self-designed questionnaires were used to survey 57 psychiatric nurses with less than 5 years' working experience and two groups of nurses were compared, i.e. nurses with 1 year or less working experience and nurses with over 1 year working experience. Results: How long nurses had worked was an important factor influencing their psychological status. 85.7%of the nurses with 1 year or less working experience were worried about being attacked and hurt by patients, 71.4%were worried about their ability to handle emergencies when working shifts alone, and 66.7%believed they had limited psychiatric knowledge. Nurses with over 1 year working experience were concerned about their career planning and limited social support for psychiatric nursing work. Conclusion:According to new psychiatric nurses' psychological characteristics, standard training plans were developed

  15. Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial


    Introduction This study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting. Methods and analysis A total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain, ankle sprain or primary headache will be recruited by ED physicians. An intravenous or intramuscular injection of analgesics will be provided as the initial st...

  16. Neurobiology of psychiatric disorders

    Đokić Gorica


    Full Text Available Neurobiologically spoken, the supstrate of the mind is formed by neuronal networks, and dysregulated neurocircuitry can cause psychiatric disorders. Psychiatric disorders are diagnosed by symptom clusters that are the result of abnormal brain tissue, and/or activity in specialized areas of the brain. Dysregulated circuitry results from abnormal neural function, or abnormal neural connections from one brain area to another, which leads to neurotransmitter imbalances. Each psychiatric disorder has uniquely dysregulated circuitry and thereby unique neurotransmitter imbalance, such as: prefrontal cortical-limbic pathways in depression or prefrontal cortical-striatal pathways in schizophrenia ie. serotonin-norepinephrin-dopamin imbalance in depression, or dopamine hyperactivity in schizophrenia. Biological psychiatry has completely changed the farmacological treatment of psychiatric disorders, and new foundings in that field are supportive to futher more neuropsychopharmacological and nonpharmacological therapy studies, whish has as a result more safe and effective therapy for psychiatric disorders.

  17. Advanced musculoskeletal physiotherapists are effective and safe in managing patients with acute low back pain presenting to emergency departments.

    Sayer, James M; Kinsella, Rita M; Cary, Belinda A; Burge, Angela T; Kimmel, Lara A; Harding, Paula


    Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners).Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED.Results One thousand and eighty-nine patients with low back pain were seen during AMP service hours (360 in the AMP group, 729 in the non-AMP group). Patients seen by the AMP had a significantly shorter ED wait time (median 13 vs 32min; Pback pain when managed by an AMP compared with patients seen by doctors and nurse practitioners.What is known about the topic? There is a growing body of literature regarding the role of AMPs in the Australian healthcare system in providing clinical services for patients with musculoskeletal conditions, including settings such as the ED. AMPs have proven to be safe and cost-effective, achieving high patient satisfaction and improved patient outcomes. However, there is little to no information regarding their effect on ED metrics, such as ED length of stay, wait time and admission rates for patients presenting to the ED with low back pain.What does this paper add? This paper demonstrates improved ED metrics for patients presenting to the ED with low back pain when seen by an AMP compared with patients seen by doctors and nurse practitioners. The specific improved metrics for these patients were decreased admission rates, decreased ED length of stay and decreased wait time.What are the implications for clinicians? This paper provides evidence that the AMPs effectively discharge patients admitted to the ED in a timely manner, without evidence of

  18. Psychiatric considerations in patients with decreased levels of consciousness.

    Young, James L; Rund, Douglas


    When patients present to the emergency department with changes in behavior and levels of consciousness, psychiatric causes often move to the top of the list of diagnostic considerations. It is important to thoroughly assess such patients for medical causes. Although it is not common for primary psychiatric conditions to present with altered levels of consciousness, severe cases may present in this fashion. Altered mental states may also be caused by adverse reactions to psychiatric medications. In this article, the authors review some of the psychiatric causes of decreased levels of consciousness, as well as certain adverse drug reactions to psychotropic medications. Copyright 2010 Elsevier Inc. All rights reserved.

  19. Psychiatric Advance Directives: Getting Started

    ... More... Home Getting Started National Resource Center on Psychiatric Advance Directives - Getting Started Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments ...

  20. Occupational disability on psychiatric grounds in South African ...

    Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Cape Town, ... in South African teachers with occupational disability on psychiatric grounds. ... The sample comprised 55 (68%) women and 26 (32%) men.

  1. Meta-analysis of Psychological Health of Nurses in Psychiatric Department%1998-2008年精神科护士心理症状研究的Meta分析

    马利军; 徐婕婷


    目的 为全面反映我国精神科护士的心理症状总体状况,对1998-2008年有关精神科护士症状自评量表(Symptom Checklist-90,SCL-90)的研究成果进行Meta分析.方法 采用内容分析法和Meta分析法对所选54篇研究文献进行分析.结果 我国精神科护士SCL-90各因子得分与全国常模相比,人际关系敏感、偏执无差异,其余7个因子合并假设检验差异有统计学意义(P<0.01),但是只有躯体化、焦虑2个因子的效应值偏离常模达到中效应水平,但效应值(d)均偏低;精神科护士与非精神科护士在躯体化、抑郁、焦虑3个因子合并假设检验差异有统计学意义(P<0.01或P<0.05),d值差异有统计学意义,但效应值较低;精神科男、女护士在恐怖因子合并假设检验差异有统计学意义(P<0.05),但是d值差异无统计学意义;30岁以下精神科护士与常模在人际关系敏感、偏执、精神病性3个因子合并假设检验差异有统计学意义(P<0.01或P<0.05),d值差异有统计学意义,但效应值较低.结论 从总体上看,我国精神科护士的SCL-90量表各因子水平与国内常模水平基本相当.%Objective To reveal the mental health status of psychiatric nurses in China with a meta-analysis of their SCL-90 results.Methods Literature review was conducted with content analysis and meta-analysis. Results Compared with those of national norm,nurses' scores of interpersonal sensitivity and paranoid ideation indicated no statistic difference, while hypothesis test on other 7 factors showed statistic difference (P<0.01), and effect size of somatization and anxiety reached middle level, but relatively low. Compared with non-psychiatric nurses, hypothesis test on psychiatric nurses' somatization, depression and anxiety indicated statistic difference as well (P<0.01 or P<0.05). Nurses with different genders showed statistic difference on phobic anxiety, while the difference of d value did not. Nurses

  2. A model for emergency department end-of-life communications after acute devastating events--part I: decision-making capacity, surrogates, and advance directives.

    Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur


    Making decisions for a patient affected by sudden devastating illness or injury traumatizes a patient's family and loved ones. Even in the absence of an emergency, surrogates making end-of-life treatment decisions may experience negative emotional effects. Helping surrogates with these end-of-life decisions under emergent conditions requires the emergency physician (EP) to be clear, making medical recommendations with sensitivity. This model for emergency department (ED) end-of-life communications after acute devastating events comprises the following steps: 1) determine the patient's decision-making capacity; 2) identify the legal surrogate; 3) elicit patient values as expressed in completed advance directives; 4) determine patient/surrogate understanding of the life-limiting event and expectant treatment goals; 5) convey physician understanding of the event, including prognosis, treatment options, and recommendation; 6) share decisions regarding withdrawing or withholding of resuscitative efforts, using available resources and considering options for organ donation; and 7) revise treatment goals as needed. Emergency physicians should break bad news compassionately, yet sufficiently, so that surrogate and family understand both the gravity of the situation and the lack of long-term benefit of continued life-sustaining interventions. EPs should also help the surrogate and family understand that palliative care addresses comfort needs of the patient including adequate treatment for pain, dyspnea, or anxiety. Part I of this communications model reviews determination of decision-making capacity, surrogacy laws, and advance directives, including legal definitions and application of these steps; Part II (which will appear in a future issue of AEM) covers communication moving from resuscitative to end-of-life and palliative treatment. EPs should recognize acute devastating illness or injuries, when appropriate, as opportunities to initiate end-of-life discussions and to

  3. Acute effects of outdoor air pollution on emergency department visits due to five clinical subtypes of coronary heart diseases in shanghai, china.

    Xie, Juan; He, Mingzhen; Zhu, Weiying


    Air pollution can be a contributing cause to the development and exacerbation of coronary heart disease (CHD), but there is little knowledge about the acute effects of air pollution on different clinical subtypes of CHD. We conducted a time-series study to investigate the association of air pollution (particulate matter with an aerodynamic diameter emergency department (ED) visits due to five different subtypes of CHD in Shanghai, China, from 2010 to 2012. We applied an over-dispersed Poisson generalized addictive model to analyze the associations after controlling for the seasonality, day of the week, and weather conditions. We identified a total of 47 523 ED visits for CHD. A 10-µg/m(3) increase in the present-day concentrations of PM10, SO2, and NO2 was associated with respective increases of 1.10% (95% confidence interval [CI] 0.33%-1.87%), 0.90% (95% CI -0.14%-1.93%), and 1.44% (95% CI 0.63%-2.26%) for total ED visits for CHD. These associations varied greatly by clinical type, with strong effects on sudden cardiac death, moderate effects on acute myocardial infarction and angina, weak effects on ischemic cardiomyopathy, and no effect on occult CHD. The associations were stronger among people aged 65 years or more than in younger individuals and in the cool season versus the warm one. Outdoor air pollution may have different effects of air pollution on 5 subtypes of CHD. Our results might be useful for the primary prevention of various subtypes of CHD exacerbated by air pollution.

  4. Oxytocin and Psychiatric Disorders

    Gokce Nur Say


    Full Text Available Oxytocin is a neuropeptide that plays critical role in mother-infant bonding, pair bonding and prosocial behaviors. Several neuropsychiatric disorders such as autism, schizophrenia, affective disorders, anxiety disorders, attention deficit/hyperactivity disorder, alcohol/substance addiction, aggression, suicide, eating disorders and personality disorders show abnormalities of oxytocin system. These findings have given rise to the studies searching therapeutic use of oxytocin for psychi-atric disorders. The studies of oxytocin interventions in psychiatric disorders yielded potentially promising findings. This paper reviews the role of oxytocin in emotions, behavior and its effects in psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 102-113

  5. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

    Cronin, John J; McCoy, Siobhan; Kennedy, Una; An Fhailí, Sinéad Nic; Wakai, Abel; Hayden, John; Crispino, Gloria; Barrett, Michael J; Walsh, Sean; O'Sullivan, Ronan


    In acute exacerbations of asthma in children, corticosteroids reduce relapses, subsequent hospital admission, and the need for ß2-agonist bronchodilators. Prednisolone is the most commonly used corticosteroid, but prolonged treatment course, vomiting, and a bitter taste may reduce patient compliance. Dexamethasone has a longer half-life and has been used safely in other acute pediatric conditions. We examine whether a single dose of oral dexamethasone is noninferior to prednisolone in the emergency department (ED) treatment of asthma exacerbations in children, as measured by the Pediatric Respiratory Assessment Measure (PRAM) at day 4. We conducted a randomized, open-label, noninferiority trial comparing oral dexamethasone (single dose of 0.3 mg/kg) with prednisolone (1 mg/kg per day for 3 days) in patients aged 2 to 16 years and with a known diagnosis of asthma or at least 1 previous episode of ß2-agonist-responsive wheeze who presented to a tertiary pediatric ED. The primary outcome measure was the mean PRAM score (range of 0 to 12 points) performed on day 4. Secondary outcome measures included requirement for further steroids, vomiting of study medication, hospital admission, and unscheduled return visits to a health care practitioner within 14 days. There were 245 enrollments involving 226 patients. There was no difference in mean PRAM scores at day 4 between the dexamethasone and prednisolone groups (0.91 versus 0.91; absolute difference 0.005; 95% CI -0.35 to 0.34). Fourteen patients vomited at least 1 dose of prednisolone compared with no patients in the dexamethasone group. Sixteen children (13.1%) in the dexamethasone group received further systemic steroids within 14 days after trial enrollment compared with 5 (4.2%) in the prednisolone group (absolute difference 8.9%; 95% CI 1.9% to 16.0%). There was no significant difference between the groups in hospital admission rates or the number of unscheduled return visits to a health care practitioner. In

  6. Shrinking inpatient psychiatric capacity: cause for celebration or concern?

    Salinsky, Eileen; Loftis, Christopher


    This issue brief examines reported capacity constraints in inpatient psychiatric services and describes how these services fit within the continuum of care for mental health treatment. The paper summarizes the type and range of acute care services used to intervene in mental health crises, including both traditional hospital-based services and alternative crisis interventions, such as mobile response teams. It reviews historical trends in the supply of inpatient psychiatric beds and explores the anticipated influence of prospective payment for inpatient psychiatric services under Medicare. The paper also considers other forces that may affect the need for and supply of acute mental health services, including key factors that could improve the quality and efficiency of inpatient psychiatric care.

  7. Acute rhabdomyolysis following synthetic cannabinoid ingestion

    Demilade A Adedinsewo


    Full Text Available Context: Novel psychoactive substances, including synthetic cannabinoids, are becoming increasingly popular, with more patients being seen in the emergency room following acute ingestion. These substances have been associated with a wide range of adverse effects. However, identification of complications, clinical toxicity, and management remain challenging. Case Report: We present the case of a young African-American male who developed severe agitation and bizarre behavior following acute K2 ingestion. Laboratory studies revealed markedly elevated serum creatine phosphokinase (CPK with normal renal function. The patient was managed with aggressive intravenous (IV fluid hydration and treatment of underlying psychiatric illness. Conclusion: We recommend the routine evaluation of renal function and CPK levels with early initiation of IV hydration among patients who present to the emergency department following acute ingestion of synthetic cannabinoids to identify potential complications early as well as institute early supportive therapy.

  8. Psychiatric impairment and


    Dec 3, 2002 ... preventing psychiatric disability in the workplace'). An area of .... The employer should create a culture/climate where the affect- ed employee is able to ... (ii) offer praise and positive reinforcement appropriately. 2. Supervisors ...

  9. American Psychiatric Association

    ... Psychiatry? Become an APA Member Learn More Explore APA Psychiatrists Residents & Medical Students Patients & Families About APA ... Psychiatric News Message from President APA Blogs Join APA General Members Residents and Fellows Medical Students International ...

  10. Mathari psychiatric hospital


    Nov 26, 2007 ... burnout among the staff at the Mathari Psychiatric Hospital. Method: This was .... poor relationship with the management staff were quoted as some of the .... Emotional exhaustion and depersonalization as indicators of burnout ...

  11. Hyperthyroidism and psychiatric morbidity

    Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind


    Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity....

  12. Cancer and Psychiatric Disorders

    Gulcan Gulec


    Full Text Available Cancer diagnosis which is used as synonym of “death”, “pain” and “sorrow” leads to a hard-coping period in these patients which requires a rapid intervention. Studies conducted in cancer patients regarding prevalance of psychiatric illnesses reported rates ranging from 9 % to 60%. In many cancer patients, psychiatric disorders can be seen as a reaction to disease or cancer tratment, while in ten precent of cases it can be seen as an aggrevation of premorbid personality disorders or anxiety disorders. Although psychiatric disorders in cancer patients can be treated and by this way, morbidity and mortality of these disorders can be prevented, these disorders are underdiagnosed and not properly treated in many patients. In this article, we briefly reviewed literature about psychiatric disorders and symptoms in cancer patients, their diagnosis and treatment suggestions.

  13. Suicide Risk Assessments: Which Suicide Risk Factors Psychiatric Residents Consider Significant?

    Wang, Sheng-Min; Hwang, Sunyoung; Yeon, Bora; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Kweon, Yong-Sil; Lee, Chung Tai; Lee, Kyoung-Uk


    Objective Patients visiting the emergency department (ED) after a suicide attempt are generally assessed for suicide risk by psychiatric residents. Psychiatric residents' competence in evaluating the risk posed by the patients who attempted suicide is critical to preventing suicide. Methods We investigated factors considered important by psychiatric residents when evaluating suicide risk. This study included 140 patients admitted to the ED after attempting suicide. Psychiatric residents rated...

  14. Nursing human resource allocation status and development countermeasure in psychiatric department%精神科护理人力资源配置现状与发展对策

    邱吉玲; 钟静


    目的:了解精神科护理人力资源配置现状,为加强护理人力资源管理提供借鉴.方法:对我院所有护理人员基本情况及2009年1~12月各临床护理单元护理人力资源配置、床位使用率、床护比的情况进行调查分析.结果:临床在岗护理人员短缺,床护比例失调;高学历、高职称人员缺乏;护理人员闲置的消耗性与临床的需求性相矛盾.结论:护理人力资源配置不足将导致护士身心耗竭,影响护理质量,使安全隐患的风险加剧.因此,应重视护士合理配置,用发展与求实的观点,核定护理工作量,增加护士编制,建立符合精神专科特点的床护比,从而提高精神科护理人力资源配置的有效性、科学性与合理性.%Objective:To know the status quo of psychiatric nursing human resource allocation and provide reference for human resource management. Methods: To survey and analyze the basic information of all the staff as well as human resource allocation of every nursing unit,the utilization rate for the bed and the proportion of nurses with bed during January to December 2009. Results:Lack of clinic nursing staff imbalance between nurses and bed short of well -educated and high title staff contradiction of idle caring nurses with the one needed. Conclusion:The insufficient human resource allocation will cause serious consequerce,such as the burnout of the nurse,thus have bad impact on the nursing quality,and to increase the safe risk, therefore we should pay more atta-tion to the nursing and rehabilitation by the development and realistic point of view add the official appraise criterion. Establish the reasonable rate between nurses and bed in conformity with psychiatry,thereby enhance the efficiency,Science and rationality of the psychiatric human resource allocation.

  15. Psychiatric Disability in Law Enforcement Officers.

    Price, Marilyn


    Law enforcement officers all across the world are exposed to violence, confrontation, and traumatic incidents. They regularly witness death and suffering and are at risk of personal injury. Psychiatric sequelae include an increased risk for trauma-related symptoms, depression, alcohol-use disorders, and stress-related medical conditions. Law enforcement officers have been applying for early disability retirement pensions at an increased rate for stress-related psychiatric and medical conditions. As a result, law enforcement agencies are prematurely losing valuable resources, officers with training and experience. Departments have become proactive in trying to address mental health issues to prevent psychiatric disability by implementing employee wellness plans and stress reduction interventions. Programs have been developed to mitigate the effects of stress on law enforcement personnel. Many law enforcement agencies have developed strategies to encourage early confidential referral for psychiatric treatment. They utilize peer support groups and employee assistance programs and develop alliances with mental health professionals. When these approaches fail, a fitness for duty process can be used to identify impairment in work functioning due to psychiatric factors with the prospect of later returning the officer to full duty. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  16. The Influence of Thyroid Function, Inflammation, and Obesity on Risk Prediction of Acute Kidney Injury by Cystatin C in the Emergency Department

    Moritz Schanz


    Full Text Available Background/Aims: There is a growing role for emergency departments (ED in assessing acute kidney injury (AKI for hospital admissions but there are few studies addressing acute kidney injury biomarkers and confounding factors in the ED. Cystatin C (CysC, a newer renal biomarker, is influenced by thyroid function, inflammation and obesity. This study aims to be the first study to address the impact of these parameters in the ED. Methods: Admitted patients (n=397 were enrolled in the ED at Robert-Bosch-Hospital, Stuttgart, Germany. Daily serum creatinine (sCr was recorded for AKI classification by Kidney Diseases Improves Global Outcome (KDIGO criteria. CysC, thyroid stimulating hormone (TSH, thyroxine (T4, C-reactive protein (CRP and body mass index (BMI were registered at enrollment in the ED. Serum samples were collected at enrollment, after 6 hours and in the following mornings (day 1 to day 3. The correlation of CysC and sCr was studied on a two variable logistic regression model. A linear predictor was computed to predict minimal AKI stage and area under the curve (AUC was calculated. Results: Of 397 patients enrolled for classification by KDIGO AKI criteria, n=152 (38% developed AKI, n=69 (17.4% reached AKI stage I, n=70 (17.6% AKI stage II, and n=13 (3% AKI stage III. Although a correlation between CRP and CysC levels was shown (rho=0.376, this didn't affect the predictive ability for AKI according to our data. We compared receiver operating characteristic (ROC curves (DeLong test of CysC to ROC curves of CysC with the additional variables TSH, BMI, and CRP respectively. Our data shows that addition of CRP, TSH, or BMI does not improve prediction of AKI stage beyond prediction based solely on CysC levels. Conclusions: CysC is known to be influenced by thyroid function, inflammation and obesity, but in our large ED population there was no significant impact of these factors on the diagnostic accuracy of CysC to detect AKI in ED patients.

  17. A fast-track anaemia clinic in the Emergency Department: feasibility and efficacy of intravenous iron administration for treating sub-acute iron deficiency anaemia

    Quintana-Díaz, Manuel; Fabra-Cadenas, Sara; Gómez-Ramírez, Susana; Martínez-Virto, Ana; García-Erce, José A.; Muñoz, Manuel


    Background Clinically significant anaemia, requiring red blood cell transfusions, is frequently observed in Emergency Departments (ED). To optimise blood product use, we developed a clinical protocol for the management of iron-deficiency anaemia in a fast-track anaemia clinic within the ED. Materials and methods From November 2010 to January 2014, patients presenting with sub-acute, moderate-to-severe anaemia (haemoglobin [Hb] <11 g/dL) and confirmed or suspected iron deficiency were referred to the fast-track anaemia clinic. Those with absolute or functional iron deficiency were given intravenous (IV) ferric carboxymaltose 500–1,000 mg/week and were reassessed 4 weeks after receiving the total iron dose. The primary study outcome was the haematological response (Hb≥12 g/dL and/or Hb increment ≥2 g/dL). Changes in blood and iron parameters, transfusion rates and IV iron-related adverse drug effects were secondary outcomes. Results Two hundred and two anaemic patients with iron deficiency (150 women/52 men; mean age, 64 years) were managed in the fast-track anaemia clinic, and received a median IV iron dose of 1,500 mg (1,000–2,000 mg). Gastro-intestinal (44%) or gynaecological (26%) bleeding was the most frequent cause of the anaemia. At follow-up (183 patients), the mean Hb increment was 3.9±2.2 g/dL; 84% of patients were classified as responders and blood and iron parameters normalised in 90%. During follow-up, 35 (17%) patients needed transfusions (2 [range: 1–3] units per patient) because they had low Hb levels, symptoms of anaemia and/or were at risk. Eight mild and one moderate, self-limited adverse drug effects were witnessed. Discussion Our data support the feasibility of a clinical protocol for management of sub-acute anaemia with IV iron in the ED. IV iron was efficacious, safe and well tolerated. Early management of anaemia will improve the use of blood products in the ED. PMID:26674819

  18. Psychiatric Aspects of Infertility

    Hacer Sezgin


    Full Text Available Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict, gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 165-185

  19. Using risk factors to help in the diagnosis of acute myocardial infarction in patients with non-diagnostic electrocardiogram changes in emergency department

    Ali Arhami Dolatabadi


    Full Text Available Objective: This study aimed to determine the association of cardiac risk factors and the risk of Acute Myocardial Infarction (AMI in Emergency Department (ED patients with non-diagnostic ECG changes. Methods: This cross-sectional study was conducted in the ED of Imam Hossein Hospital during a period of one year. In this study, patients with symptoms suggestive of AMI including chest pain, dyspnea, palpitation, syncope, cerebrovascular incidents, nausea, vomitting, dizziness and loss of consciousness were included. The demographic data and risk factors, such as age, gender, history of diabetes, Hypertension (HTN, Hyperlipidemia (HLP, renal failure, positive family history of Coronary Artery Disease (CAD, smoking, substance abuse, alcohol consumption within the past 24 hours and cocaine use within the past 48 hours were recorded. Non-diagnostic ECG included: normal, non-specific, abnormal without ischemic symptoms such as old bundle branch block, Left Ventricular Hypertrophy (LVH, etc. The final diagnosis of AMI was determined by Creatine Phosphokinase-MB (CPK-MB serum markers and Troponin I. The data were analyzed by using SPSS V. 20 and the level of statistical significance was considered to be P< 0.05. Results: HTN, HLP, family history of heart disease were significantly higher in those who had non-diagnostic ECG (P< 0.05. However, the ischemic heart diseases were significantly lower in those with non-diagnostic ECG. History of diabetes, stroke, renal failure, alcohol or opium and menopause showed no significant association with non-diagnostic or diagnostic ECG. Conclusion: Overall, the risk factors are limitedly associated with the occurrence of Myocardial Infarction (MI in cases where ECG is not diagnostic and it is better to use other criteria to diagnose AMI.

  20. Moving toward comprehensive acute heart failure risk assessment in the emergency department: the importance of self-care and shared decision making.

    Collins, Sean P; Storrow, Alan B


    Nearly 700,000 emergency department (ED) visits were due to acute heart failure (AHF) in 2009. Most visits result in a hospital admission and account for the largest proportion of a projected $70 billion to be spent on heart failure care by 2030. ED-based risk prediction tools in AHF rarely impact disposition decision making. This is a major factor contributing to the 80% admission rate for ED patients with AHF, which has remained unchanged over the last several years. Self-care behaviors such as symptom monitoring, medication taking, dietary adherence, and exercise have been associated with decreased hospital readmissions, yet self-care remains largely unaddressed in ED patients with AHF and thus represents a significant lost opportunity to improve patient care and decrease ED visits and hospitalizations. Furthermore, shared decision making encourages collaborative interaction between patients, caregivers, and providers to drive a care path based on mutual agreement. The observation that “difficult decisions now will simplify difficult decisions later” has particular relevance to the ED, given this is the venue for many such issues. We hypothesize patients as complex and heterogeneous as ED patients with AHF may need both an objective evaluation of physiologic risk as well as an evaluation of barriers to ideal self-care, along with strategies to overcome these barriers. Combining physician gestalt, physiologic risk prediction instruments, an evaluation of self-care, and an information exchange between patient and provider using shared decision making may provide the critical inertia necessary to discharge patients home after a brief ED evaluation.

  1. Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department.

    Mokhtari, Arash; Dryver, Eric; Söderholm, Martin; Ekelund, Ulf


    In the assessment of chest pain patients with suspected acute coronary syndrome (ACS) in the emergency department (ED), physicians rely on global diagnostic impressions ('gestalt'). The aim of this study was to determine the diagnostic value of the ED physician's overall assessment of ACS likelihood, and the values of the main diagnostic modalities underlying this assessment, namely the chest pain history, the ECG and the initial troponin result. 1,151 consecutive ED chest pain patients were prospectively included. The ED physician's interpretation of the chest pain history, the ECG, and the global likelihood of ACS were recorded on special forms. The discharge diagnoses were retrieved from the medical records. A chart review was carried out to determine whether patients with a non-ACS diagnosis at the index visit had ACS or suffered cardiac death within 30 days. The gestalt was better than its components both at ruling in ("Obvious ACS", LR 29) and at ruling out ("No Suspicion of ACS", LR 0.01) ACS. In the "Strong suspicion of ACS" group, 60% of the patients did not have ACS. A positive TnT (LR 24.9) and an ischemic ECG (LR 8.3) were strong predictors of ACS and seemed superior to pain history for ruling in ACS. In patients with a normal TnT and non-ischemic ECG, chest pain history typical of AMI was not a significant predictor of AMI (LR 1.9) while pain history typical of unstable angina (UA) was a moderate predictor of UA (LR 4.7). Clinical gestalt was better than its components both at ruling in and at ruling out ACS, but overestimated the likelihood of ACS when cases were assessed as strong suspicion of ACS. Among the components of the gestalt, TnT and ECG were superior to the chest pain history for ruling in ACS, while pain history was superior for ruling out ACS.

  2. Medical evaluation abnormalities in acute psychotic patients seen at the emergency department of Muhimbili national hospital in Dar es Salaam, Tanzania

    S.G. Yusuf*; M.S. Runyon; V. Mwafongo; T.A. Reynolds


    Prior studies have shown varied rates of medical pathology in patients presenting to acute care settings with psychotic symptoms, and there is almost no literature from the sub-Saharan Africa region. We investigated the yield of physical examination and laboratory testing among patients presenting with acute psychosis to an urban ED in Dar es Salaam. Methods: This was a prospective observational study of patients presenting to the ED at Muhimbili National Hospital with acute psychosis. A s...

  3. 精神科临床实验室危急值的建立与应用%Establishment and Application of Critical Value in Clinical Laboratory of Psychiatric Department



    Tianjin has the largest mental diseases hospital in the north of China which treat with mental illness who has poor ability.When the body appear problem,can't accurate expression.Critical value of the psychiatric clinical laboratory project settings are mainly white blood cell count,platelet count,hemoglobin,blood concentration of calcium,potassium concentration,blood glucose,blood amylase,serum creatinine,creatine kinase and lithium carbonate concentration,blood drug concentration of antipsychotic drugs and the determination of microbial infections has not been widely set critical value of the project.Clinical medical personnel mainly rely on laboratory tests for the determination of value in return for diagnosis and treatment. Especially the inspection items appearring critical value,the measured value is to save patient life and provide very important reference basis.%天津市拥有是华北地区最大规模的精神疾病专科医院,收治的精神疾病患者大多主述能力差,当其躯体出现问题时,不能准确的表述。精神科临床实验室的危急值项目设置主要为白细胞计数、血小板计数、血红蛋白、血钙浓度、血钾浓度、血糖、血淀粉酶、血肌酐、肌酸激酶及碳酸锂浓度,而对抗精神病药物血药浓度、微生物等感染情况的测定还未广泛地设定危急值项目。临床医护人员主要依靠实验室对检查项目的测定值的回报进行诊断和治疗。尤其是检验项目出现危急值时,测定值则对患者生命的挽救提供极其重要的参考依据。

  4. 产科急性心力衰竭28例临床分析%Clinical analysis of acute heart failure in department of obstetrics



    the early manifestations of the heart failure.Most patients' heart function after admission ranked NYHA Ⅰ level or Ⅱ level.Fifteen cases occured before delivery,while the rest happened after dilivery.Eight cases produced by spontaneous vaginal delivery,20 cases of cesarean section,two delivery methods had no significant difference in children asphyxia.Conclusions To reduce the morbidity and mortality of the patients with acute heart failure in the obstetric department,early detection and control is very important,and attention to prenatal care and relative factors is also needed.Treatment emphasizes on the early intervention,and the treatment plan should depends on the patient' s condition.Termination of pregnancy should be performed when it' s necessary.This can improve the patient' s condition and decrease the risks of death.

  5. Perinatal psychiatric episodes

    Munk-Olsen, Trine; Maegbaek, M L; Johannsen, B M


    ). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased...... significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient...

  6. Psychosomatic Medicine for Non-Psychiatric Residents: Video Education and Incorporation of Technology.

    Saunders, J; Gopalan, P; Puri, N; Azzam, P N; Zhou, L; Ghinassi, F; Jain, A; Travis, M; Ryan, N D


    Psychiatric education for non-psychiatric residents varies between training programs, and may affect resident comfort with psychiatric topics. This study's goals were to identify non-psychiatric residents' comfort with psychiatric topics and to test the effectiveness of a video intervention. Residents in various departments were given a survey. They were asked to rank their comfort level with multiple psychiatric topics, answer questions about medical decision making capacity (MDMC), watch a 15-min video about MDMC, and answer a post-test section. In total, 91 Internal Medicine, General Surgery, and Obstetrics and Gynecology residents responded to the study. Of the 91 residents, 55 completed the pre- and post-test assessments. There was no significant difference in correct responses. Residents' comfort levels were assessed, and a significant improvement in comfort level with MDMC was found. This study highlights potential opportunities for psychiatric education, and suggests brief video interventions can increase resident physicians' comfort with a psychiatric topic.

  7. Improving the application of a practice guideline for the assessment and treatment of suicidal behavior by training the full staff of psychiatric departments via an e-learning supported Train-the-Trainer program: study protocol for a randomized controlled trial

    de Beurs Derek P


    Full Text Available Abstract Background In 2012, in The Netherlands a multidisciplinary practice guideline for the assessment and treatment of suicidal behavior was issued. The release of guidelines often fails to change professional behavior due to multiple barriers. Structured implementation may improve adherence to guidelines. This article describes the design of a study measuring the effect of an e-learning supported Train-the-Trainer program aiming at the training of the full staff of departments in the application of the guideline. We hypothesize that both professionals and departments will benefit from the program. Method In a multicenter cluster randomized controlled trial, 43 psychiatric departments spread over 10 regional mental health institutions throughout The Netherlands will be clustered in pairs with respect to the most prevalent diagnostic category of patients and average duration of treatment. Pair members are randomly allocated to either the experimental or the control condition. In the experimental condition, the full staff of departments, that is, all registered nurses, psychologists, physicians and psychiatrists (n = 532, 21 departments will be trained in the application of the guideline, in a one-day small interactive group Train-the-Trainer program. The program is supported by a 60-minute e-learning module with video vignettes of suicidal patients and additional instruction. In the control condition (22 departments, 404 professionals, the guideline shall be disseminated in the traditional way: through manuals, books, conferences, internet, reviews and so on. The effectiveness of the program will be assessed at the level of both health care professionals and departments. Discussion We aim to demonstrate the effect of training of the full staff of departments with an e-learning supported Train-the-Trainer program in the application of a new clinical guideline. Strengths of the study are the natural setting, the training of full staff, the

  8. [Psychiatric treatment sentences.

    Stevens, Hanne; Nordentoft, Merete; Agerbo, Esben


    INTRODUCTION: Previous Danish studies of the increasing number of sentences to psychiatric treatment (SPT) have compared prevalent populations of persons undergoing treatment with incident measures of reported crimes. Examining the period 1990-2006, we studied incident sentences, taking the type...

  9. Aggression in Psychiatric Wards

    Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil


    Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated...

  10. Pathological Gambling: Psychiatric Models

    Westphal, James R.


    Three psychiatric conceptual models: addictive, obsessive-compulsive spectrum and mood spectrum disorder have been proposed for pathological gambling. The objectives of this paper are to (1) evaluate the evidence base from the most recent reviews of each model, (2) update the evidence through 2007 and (3) summarize the status of the evidence for…

  11. Cerebellum and psychiatric disorders

    Baldaçara,Leonardo; Borgio,João Guilherme Fiorani; Lacerda, Acioly Luiz Tavares de [UNIFESP; Jackowski, Andrea Parolin [UNIFESP


    OBJECTIVE: The objective of this update article is to report structural and functional neuroimaging studies exploring the potential role of cerebellum in the pathophysiology of psychiatric disorders. METHOD: A non-systematic literature review was conducted by means of Medline using the following terms as a parameter: "cerebellum", "cerebellar vermis", "schizophrenia", "bipolar disorder", "depression", "anxiety disorders", "dementia" and "attention deficit hyperactivity disorder". The electron...

  12. Cannabis and psychiatric disorders.

    Loga, Slobodan; Loga-Zec, Svjetlana; Spremo, Mira


    There are connection between use of cannabis and many psychiatric disturbances in adolescents, especially "cannabis psychosis", depression, panic attacks and suicide. Negative effects could occur either as a result of a specific pharmacological effect of cannabis, or as the result of stressful experiences during the intoxication of cannabis in young people. Potentially is very dangerous high frequency suicidal ideation among cannabis users.

  13. Obstructive sleep apnea: management considerations in psychiatric patients

    Heck T


    Full Text Available Taryn Heck,1 Monica Zolezzi21Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada; 2Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, QatarAbstract: Psychiatric disorders and obstructive sleep apnea (OSA are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.Keywords: obstructive sleep apnea, psychiatric disorders, comorbidity, psychotropic medications

  14. Depression and sexual desire: an exploratory study in psychiatric patients.

    Lourenço, Mário; Azevedo, Leandra Pinheiro; Gouveia, José Luís


    The purpose of this article was to study the relation between depression and its effect on the sexual desire in psychiatric patients. The sample comprised 89 patients from the Psychiatric and Mental Health Department of Alto Ave's Hospital Center, Entidade Publica Empresarial. The obtained results in this exploratory study revealed that depressive symptomatology severity is directly related with sexual desire. Variables gender, age, and working status, as well as, sociocultural levels indicated important and significant differences between patients.

  15. Psychiatric personnel, risk management and the new institutionalism.

    Hazelton, M


    This article reports the findings of a series of ethnographic research interviews conducted with psychiatric personnel in one region of Tasmania between 1995 and 1997. These interviews formed part of a more wide-ranging project examining changes in the regulatory practices of psychiatric personnel in the light of the professional, media and policy discourses that inform them, especially in relation to the impact of social justice reforms spelt out in recent Australian mental health policy. In discussing the nature of psychiatric work the personnel interviewed returned repeatedly to the themes of safety and risk management. The study presents an analysis of discourses deployed around these themes and argues that concerns over safety and risk are central to the emergence of a new institutionalism in acute in-patient psychiatric services.

  16. Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

    Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael


    Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  17. Usage of psychiatric emergency services by asylum seekers

    Reko, Amra; Bech, Per; Wohlert, Cathrine


    BACKGROUND: Asylum seekers are found to be at high risk of mental health problems. Little is known about the use of acute psychiatric emergency services by asylum seekers. AIM: To describe the usage of an inpatient/outpatient psychiatric emergency service in Denmark by adult asylum seekers......, and discuss clinical implications. METHOD: This descriptive study is based on retrospective data collected from patient charts during a 3-month period. RESULTS: A total of 31 evaluations were made (3.3% of all evaluations), based on 23 asylum seekers. Patients originated from 16 different countries, were...... predominantly male and married. The group consisted primarily (61%) of failed asylum seekers. Most patients (81%) presented with relevant mental health problems. The main reasons for presenting to the acute psychiatric emergency service were suicidal ideation and/or behaviour (60%). The most frequent diagnosis...

  18. Medical evaluation abnormalities in acute psychotic patients seen at the emergency department of Muhimbili national hospital in Dar es Salaam, Tanzania

    S.G. Yusuf*


    Conclusions: In our cohort, history and physical examination findings were not sufficient to rule out serious medical conditions among patients presenting with acute psychosis. The observed rate of laboratory abnormalities was higher than previously published rates from high-resource settings. Based on our findings, patients presenting with psychosis to an acute care facility in this region should be evaluated with physical examination and laboratory studies to rule out serious underlying medical pathology.

  19. Proactive and Reactive Aggression in a Child Psychiatric Inpatient Population

    Fite, Paula J.; Stoppelbein, Laura; Greening, Leilani


    This study examined relations between proactive and reactive aggression and indicators of antisocial behavior (callous/unemotional traits and behavioral consequences) and negative affect (depression and suicidal behavior) in a sample of 105 children admitted to an acute child psychiatric inpatient unit. The majority of the children were male (69%)…

  20. A Clinical Decision Rule to Identify Emergency Department Patients at Low Risk for Acute Coronary Syndrome Who Do Not Need Objective Coronary Artery Disease Testing: The No Objective Testing Rule.

    Greenslade, Jaimi H; Parsonage, William; Than, Martin; Scott, Adam; Aldous, Sally; Pickering, John W; Hammett, Christopher J; Cullen, Louise


    We derive a clinical decision rule for ongoing investigation of patients who present to the emergency department (ED) with chest pain. The rule identifies patients who are at low risk of acute coronary syndrome and could be discharged without further cardiac testing. This was a prospective observational study of 2,396 patients who presented to 2 EDs with chest pain suggestive of acute coronary syndrome and had normal troponin and ECG results 2 hours after presentation. Research nurses collected clinical data on presentation, and the primary endpoint was diagnosis of acute coronary syndrome within 30 days of presentation to the ED. Logistic regression analyses were conducted on 50 bootstrapped samples to identify predictors of acute coronary syndrome. A rule was derived and diagnostic accuracy statistics were computed. Acute coronary syndrome was diagnosed in 126 (5.3%) patients. Regression analyses identified the following predictors of acute coronary syndrome: cardiac risk factors, age, sex, previous myocardial infarction, or coronary artery disease and nitrate use. A rule was derived that identified 753 low-risk patients (31.4%), with sensitivity 97.6% (95% confidence interval [CI] 93.2% to 99.5%), negative predictive value 99.6% (95% CI 98.8% to 99.9%), specificity 33.0% (95% CI 31.1% to 35.0%), and positive predictive value 7.5% (95% CI 6.3% to 8.9%) for acute coronary syndrome. This was referred to as the no objective testing rule. We have derived a clinical decision rule for chest pain patients with negative early cardiac biomarker and ECG testing results that identifies 31% at low risk and who may not require objective testing for coronary artery disease. A prospective trial is required to confirm these findings. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  1. Diagnostic Accuracy of a New Instrument for Detecting Cognitive Dysfunction in an Emergent Psychiatric Population: The Brief Cognitive Screen

    Cercy, Steven P; Simakhodskaya, Zoya; Elliott, Aaron


    .... The authors developed a new cognitive screening instrument, the Brief Cognitive Screen (BCS), with the aim of improving diagnostic accuracy for cognitive dysfunction in the psychiatric emergency department...

  2. [The relation of selected psychiatric disorders to occurrence of suicide attempts among teenage psychiatrically hospitalized patients].

    Krajewska, Katarzyna; Gawlik-Kotelnicka, Oliwia; Gmitrowicz, Agnieszka


    Suicide is the third cause of death globally in the age group 10-19. Multiple risk factors (genetic, psychiatric, psychological, familial, social) increased number of suicide attempts. The aim of this study was to explore whether mental disorders are associated with the number of suicide attempts among psychiatric hospitalized adolescents. Retrospective, chart-based analysis of 119 patients, aged 13-18, treated in 2013-2014 in the Department of Adolescent Psychiatry in Łódź. Inclusion criteria was diagnosis of schizophrenia, schizotypal and delusional disorders, mood disorders, neurotic, stress-related and somatoform disorders, behavioral and emotional disorders according to ICD 10. Exclusion criteria were other psychiatric diagnosis, incomplete information about intention of self-harm behaviors. For statistical analysis used Statistica 9.1. Among psychiatricaly hospitalized patients, 51.2% of people attempted suicide. No relationship was found (p > 0.05) between psychiatric diagnosis and frequency of suicide attempts in adolescents, but the most common suicide attempts related to people with a diagnosis of mood disorders (59.3%) and neurotic disorders (54.6%), and least frequently in patients with a diagnosis of schizophrenia , schizotypal and delusional disorders (40%) and behavioral and emotional disorders (44.4%). There is no relation between the occurrence of suicide attempts and the type of mental disorders among psychiatrically hospitalized adolescents. © 2015 MEDPRESS.

  3. Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period.


    : We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and setting forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. In addition, we are finalizing the provisions of the August 27, 2009 interim final rule that implemented statutory provisions relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. We are making changes affecting the: Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services; and determination of the effective date of provider agreements and supplier approvals under Medicare. We are also setting forth provisions that offer psychiatric hospitals and hospitals with inpatient psychiatric programs increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals and hospitals with inpatient psychiatric programs will have the choice of undergoing a State survey or of obtaining accreditation from a national accrediting organization whose hospital accreditation

  4. 精神科防护性约束失效风险评估与管理对策探讨%The Assessment of The Risk of Failure of Protective Constraint in Psychiatric Department and The Discussion of The Method of Management



    Objective:Discussing about the application effects of the theory of healthcare failure mode and effect analysis during the nursing process of protective constraint in psychiatric department.Methods:Assessing and screening the link of high-risk of failure during the process of protective constraint in terms of The Protective ConstraintFailure Risk Assessment Scale.Analyzing and discussing about the method of improving the security management.Result:The constraint complications reduced to 0,the satisfaction of the family members of patient reached 100% from 95%,as well as the percent of pass of protective constraint reached to 100% after the quality improvement of the nursing process of protective constraint with the application of The Theory of Healthcare Failure Mode and Effect Analysis.conclusion:The management of the process of protective constraint become much more impeccable and optimized with the using of The Theory of Healthcare Failure Mode and Effect Analysis.And the occurrence rate of adverse events in psychiatric department is depressed now because of it.%目的:探讨医疗失效模式与效应分析理论在精神科防护性约束护理流程中的应用效果。方法:运用《防护性约束失效风险评估表》评估筛查防护性约束过程中高失效风险环节,并分析、讨论、制定安全管理改进措施。结果:应用医疗失效模式与效应分析理论对约束护理流程进行持续质量改进后,使约束并发症降为0;家属满意度由95%提高到100%;保护性约束护理合格率100%。结论:医疗失效模式与效应分析理论的应用使精神科防护性约束的过程管理得到进一步的优化和完善,降低了精神科不良事件发生率。

  5. Psychiatric adverse effects of pediatric corticosteroid use.

    Drozdowicz, Linda B; Bostwick, J Michael


    Corticosteroids, highly effective drugs for myriad disease states, have considerable neuropsychiatric adverse effects that can manifest in cognitive disorders, behavioral changes, and frank psychiatric disease. Recent reviews have summarized these effects in adults, but a comprehensive review on corticosteroid effects in children has not been published since 2005. Here, we systematically review articles published since then that, we find, naturally divide into 3 main areas: (1) chronic effects of acute prenatal and neonatal exposure associated with prematurity and congenital conditions; (2) immediate behavioral effects of acute exposure via oncological protocols; and (3) acute behavioral effects of sporadic use in children and adolescents with other conditions. PsycInfo, MEDLINE, Embase, and Scopus were queried to identify articles reporting psychiatric adverse effects of corticosteroids in pediatric patients. Search terms included corticosteroids, adrenal cortex hormones, steroid psychosis, substance-induced psychoses, glucocorticoids, dexamethasone, hydrocortisone, prednisone, adverse effects, mood disorders, mental disorders, psychosis, psychotic, psychoses, side effect, chemically induced, emotions, affective symptoms, toxicity, behavior, behavioral symptoms, infant, child, adolescent, pediatric, paediatric, neonatal, children, teen, and teenager. Following guidelines for systematic reviews from the Potsdam Consultation on Meta-Analysis, we have found it difficult to draw specific conclusions that are more than general impressions owing to the quality of the available studies. We find a mixed picture with neonates exposed to dexamethasone, with some articles reporting eventual deficits in neuropsychiatric functioning and others reporting no effect. In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions

  6. Ingested Sharp Bone Fragment: An Unusual Cause of Acute Bowel Obstruction- Case Report.

    Rangaswamy, Raju; Badai, Samit Kumar; Urugesan, Sadyojata M; Singh, Chabungbam Gyan; Singh, Haobam Manihar


    Acute bowel obstruction due to ingested foreign body (FB) like sharp bone fragment is a rare entity. As preoperative diagnosis was uncertain due to lack of proper history, diagnosis is usually done intraoperatively. Even though it is rare, we should consider it as differential diagnosis in patients with recent dietary history. Herein, we are reporting a 38-year-old man, without any psychiatric illness or previous surgery presenting to emergency department with the features of acute bowel obstruction. CT scan shows high density object in ileum suspicious of foreign body. Patient underwent exploratory laparatomy which reveals dilated small bowel with sharp bony object in ileum, which was retrieved with enterotomy.

  7. Culture and psychiatric diagnosis.

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan


    Since the publication of DSM-IV in 1994, neurobiologists and anthropologists have criticized the rigidity of its diagnostic criteria that appear to exclude whole classes of alternate illness presentations, as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis - composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress - as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning. Copyright © 2013 APA*

  8. Role of the forensic psychiatric nurse.

    Lyons, Tamsen


    Abstract The article clarifies the role of the forensic psychiatric nurse (FPN) and challenges interchangeable terms confusing forensic and correctional nursing. It addresses the varied venues where the FPN may assess the patient (victim or perpetrator) and gather evidence that may influence conviction, sentencing, recidivism, treatment, and prevention. In depth knowledge of medical and psychiatric nursing as well as the criminal justice system is germane to competent advanced practice forensic nursing. An analogy is drawn between the forensic assessment for risk of violence which is commonly performed by psychiatric nurses in Emergency Departments and the collection and preservation of evidence by medical nurses in Emergency Departments. Both instances require evidence-based techniques and a familiarity with forensic procedures and are often performed by nurses who are not specifically trained in these areas. A case analysis demonstrates the value of an in depth and broad assessment of victim and perpetrator. Evidence based training and the application of structured clinical judgment used in the evaluation of victims and perpetrators make it possible for the FNP to provide expert testimony and to make recommendations for treatment.

  9. Automated telehealth for managing psychiatric instability in people with serious mental illness.

    Pratt, Sarah I; Naslund, John A; Wolfe, Rosemarie S; Santos, Meghan; Bartels, Stephen J


    Serious mental illness (SMI) with psychiatric instability accounts for disproportionately high use of emergency room visits and hospitalizations. To evaluate the effectiveness of an automated telehealth intervention supported by nurse health care management for improving psychiatric illness management and reducing acute service use among individuals with SMI and psychiatric instability. Thirty-eight individuals with SMI received the automated telehealth intervention for 6 months. Psychiatric symptoms, illness self-management, and self-reported service use (emergency room visits and hospital admissions) were collected at baseline, 3- and 6-months. Measures of quality of life, health indicators, and subjective health status were also collected. Participants demonstrated improvements in self-reported psychiatric symptoms and illness self-management skills, an 82% decrease in hospital admissions (from 76 to 14 hospitalizations, p manager for people with SMI, and highlight the potential for cost savings through reductions in acute health care utilization.

  10. Prevalence of psychiatric comorbidities in chronic obstructive pulmonary disease patients

    Shyam Chand Chaudhary


    Full Text Available Introduction: Psychiatric disorders, especially anxiety and depression have been reported to have an increased prevalence in chronic obstructive pulmonary disease (COPD patients, but there is a paucity of data from India. Aims and Objectives: Aim of our study is to study the frequency of psychiatric comorbidities in COPD patients and their correlation with severity of COPD, as per global initiative for obstructive lung disease guidelines. Materials and Methods: This study was conducted in outpatient department of a tertiary care hospital (King George's Medical University. A total of 74 COPD patients were included in this study and compared with 74 controls. The diagnosis and severity of COPD were assessed by spirometry. Psychiatric comorbidities were assessed using the Mini International Neuropsychiatric Interview questionnaire. Results: The frequency of psychiatric comorbidities was significantly higher (P < 0.05 in COPD patients (28.4% as compared to controls (2.7%. As regards to severity, the frequency was significantly increased in severe and very severe COPD. The frequency of psychiatric comorbidities in COPD patients increased significantly with the increase in duration of symptoms being present in 67% of patients with duration of symptoms more than 10 years and only 23% of patients with duration of symptoms ≤5 years. Conclusion: The frequency of psychiatric comorbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric comorbidity, if any.

  11. Adolescents and Dual Diagnosis in a Psychiatric Emergency Service.

    Matali, José Luis; Andión, Oscar; Pardo, Marta; Iniesta, Raquel; Serrano, Eduard; San, Luis


    In recent years, both the prevalence of drug use and related child and adolescent psychiatric emergencies have risen sharply. There are few studies about the impact on child and adolescent emergency services. This study has a twofold aim. The first is to describe the prevalence of substance use disorders, mental disorders and dual diagnosis (substance use problems plus mental disorder) in adolescents in psychiatric emergency service. The second is to analyze clinical and healthcare differences between patients with dual diagnosis and patients with a mental disorder without substance use disorder.We retrospectively reviewed 4012 discharge forms for emergencies treated at the psychiatric emergency department during the period 2007-2009. We obtained a sample of 1795 visits. This sample was divided into two groups: the dual diagnosis group (n = 477) and the psychiatric disorder group (n = 1318).The dual diagnosis group accounted for 26.5% of psychiatric emergencies analyzed. Compared to the psychiatric disorder group,the dual diagnosis group had significantly more conduct disorders, social problems, involuntariness in the visit, less hospital admissions and less connection with the healthcare network.Adolescents with a dual diagnosis account for a high percentage of visits at child and adolescent psychiatric emergency services. This patient group requires specialized care both at emergency services and in specific units. Accordingly, these units should play a triple role when handling dual diagnosis: detection, brief treatment and referral to a specialised unit.


    Shrikant B.


    Full Text Available BACKGROUND: Psoriasis is relatively common , chronic inflammatory and hyper - proliferative skin disease that affects 1.4% to 2.0% of the population. Presence of itching , chronic recurrent course of disease and incomplete cure may contribute to great deal of psychiatric co - morbidity in these patients. the most persuasive indications of a link between stress and psoriasis comes from patients themselves , with studies illustrating that the majority of patients believe that stress or psychological distress is a factor in the manifestations of their condition . Depression and anxiety are the most common disorders that are associated with psoriasis , but the proportion of patient also having other psychiatric co - morbid diseases which include social phobia , generalize anxiety disorder , panic disorder , psychotic diso rder , etc. Moreover , symptoms of psoriasis , especially pruritus , are related to depression. OBJECTIVES : To evaluate different psychiatric illnesses their prevalence and severity in psoriasis patients. METHODOLOGY : This was cross - sectional observational stu dy comprised of 70 consecutive patients of psoriasis attending the out - patient department of Dermatology. All the patients were subjected to detailed examinations including the elicitation of dermatological and psychiatric profile after getting written con sent for study . Data was collected using self - developed , pre tested , semi structured Pro format by interview method. RESULTS : The profile of psychiatric diagnoses obtained in the present study depressive disorder 31.4% {18.57% depression , 12.85% Depression with anxiety symptoms} , anxiety disorder 25.7% (7.14% GAD , 8.17% panic disorder , 5.71% social phobia , 4.28 specific phobia. Severity of major depressive disorder was determined with HAM - D score 53.8% had mild depression , 30.7% moderate depression and 15. 5% severe depression. Similarly when HAM - A scale was used to determined severity of generalized

  13. Long term prognosis of acute coronary syndrome with chronic renal dysfunction treated in different therapy units at department of cardiology: a retrospective cohort study.

    Fu, Cong; Sheng, Zulong; Yao, Yuyu; Wang, Xin; Yu, Chaojun; Ma, Genshan


    Coronary care unit is common in hospitals and clinical centers which offer intensive care and therapy for severe coronary artery disease patients. However, if coronary care unit could improve the long term prognosis of acute coronary syndrome patients with renal dysfunction remain unknown. Accordingly, we designed this study to evaluate the differences of incidence of major adverse cardiovascular events for acute coronary syndromes patients with renal dysfunction who treated in coronary care unit or normal unit. The primary end point was all cause mortality. A total of 414 acute coronary syndromes patients with renal dysfunction involved in the study. The results showed that during 12-48 months follow-up, death of any cause occurred in 1.8% patients (4 of 247) in coronary care unit group, as compared with 1.8% in the normal group (3 of 167) (hazard ratio, 1.098; 95% confidence interval, 0.246 to 4.904; P=0.903). Kaplan-Meier survival analysis showed that there were no significant differences between the two groups with respect to the risk of death (P=0.903), revascularization (P=0.948), stroke (P=0.542), heart failure (P=0.198). This trial firstly revealed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit and normal units. Our study showed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit obtained no significant benefits compared with patients in normal units, although there was a declining tendency of the risk of major adverse cardiovascular effectswith patients in coronary care unit.

  14. Long term prognosis of acute coronary syndrome with chronic renal dysfunction treated in different therapy units at department of cardiology: a retrospective cohort study

    Fu, Cong; Sheng, Zulong; Yao, Yuyu; Wang, Xin; Yu, Chaojun; Ma, Genshan


    Coronary care unit is common in hospitals and clinical centers which offer intensive care and therapy for severe coronary artery disease patients. However, if coronary care unit could improve the long term prognosis of acute coronary syndrome patients with renal dysfunction remain unknown. Accordingly, we designed this study to evaluate the differences of incidence of major adverse cardiovascular events for acute coronary syndromes patients with renal dysfunction who treated in coronary care unit or normal unit. The primary end point was all cause mortality. A total of 414 acute coronary syndromes patients with renal dysfunction involved in the study. The results showed that during 12-48 months follow-up, death of any cause occurred in 1.8% patients (4 of 247) in coronary care unit group, as compared with 1.8% in the normal group (3 of 167) (hazard ratio, 1.098; 95% confidence interval, 0.246 to 4.904; P=0.903). Kaplan-Meier survival analysis showed that there were no significant differences between the two groups with respect to the risk of death (P=0.903), revascularization (P=0.948), stroke (P=0.542), heart failure (P=0.198). This trial firstly revealed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit and normal units. Our study showed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit obtained no significant benefits compared with patients in normal units, although there was a declining tendency of the risk of major adverse cardiovascular effectswith patients in coronary care unit. PMID:26770436

  15. Feigning Acute Intermittent Porphyria

    Rania Elkhatib


    Full Text Available Acute intermittent porphyria (AIP is an autosomal dominant genetic defect in heme synthesis. Patients with this illness can have episodic life-threatening attacks characterized by abdominal pain, neurological deficits, and psychiatric symptoms. Feigning this illness has not been reported in the English language literature to date. Here, we report on a patient who presented to the hospital with an acute attack of porphyria requesting opiates. Diligent assessment of extensive prior treatment records revealed thirteen negative tests for AIP.

  16. Acute Mesenteric Ischemia

    ... Side Effects Additional Content Medical News Acute Mesenteric Ischemia By Parswa Ansari, MD, Department of Surgery, Lenox ... Abscesses Abdominal Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of ...

  17. Psychiatric comorbidity : fact or artifact?

    van Loo, Hanna; Romeijn, Jan-Willem


    The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus eit

  18. Treating the disconfirmed psychiatric client.

    Heineken, J


    Frequent disconfirmation behaviors have been documented in psychiatric clients. Individuals who demonstrate maladaptive patterns of disconfirmation can learn to understand and modify this dysfunctional sequence. Through one to one interactions and group discussions, psychiatric nurses can help clients learn more positive communication behaviors. This accomplishment will positively affect the client's interpersonal responsiveness and self-esteem.

  19. College Students with Psychiatric Disabilities

    Singh, Delar K.


    This paper focuses on college students with psychiatric disabilities. It defines and discusses various psychiatric conditions such as mood disorders, anxiety disorders, eating disorders, and personality disorders. It concludes with accommodations that a college professor can make to help these students succeed in higher education. (Contains 1…

  20. Psychiatric aspects of burn

    Dalal P


    Full Text Available Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. The psychological aspects of burn injury have been researched in different parts of the world, producing different outcomes. Studies have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. The concept of allostatic load is presented as a potential explanation for the relationship between acute pain and subsequent psychological outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.

  1. Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators

    Mattsson, Maria Søe; Mattsson, N.; Jørsboe, H. B.


    -square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P ... significantly improved after the reorganization in NFS and HOL (p ...-intervention data were compared for both NFS and HOL (p = 0.024). Conclusions: During the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark...

  2. Establishment and Effects of Nursing Clinic Pathway of Modified Electric Convulsive Therapy in Psychiatric Department%精神科无抽搐电休克治疗临床护理路径的建立与实施效果

    唐春霞; 陈海勤; 徐美英; 潘晓芳; 叶美凤; 徐伟琴


    Objective To explore the effects of clinical pathway on the improvement of the nursing quality of modified electric convulsive therapy (MECT) in psychiatric department. Methods Using convenience sampling, 100 patients undergoing the initial MECT in the hospital between March and August 2011 were enrolled in the study. Two male and female wards were randomly selected as control group(n=50) , while the other two male and female wards were selected as the research group(n= 50). Patients in the control group were treated with the regular nursing care, while patients in the research group were given the clinical pathway. The nursing safety, health education, basic care, complication, nursing writing time and the MECT treatment satisfaction were compared between the two groups with a self-designed nursing quality evaluation form. Results The quality of care and patient satisfaction in the research group were significantly higher than those in the control group,while the recording time and the incidence of complications in the research group were significantly lower than those in the control group(P<0. 05). Conclusion The establishment and implementation of the clinical pathway on the MECT in psychiatric department contributes to standardizing the treatment procedure, saving recording time and improving nursing quality and the satisfaction of patients' families.%目的 探讨临床路径在提高精神科无抽搐电休克治疗(modified electric convulsive therapy,MECT)护理质量中的作用.方法 方便性抽样选择2011年3-8月湖州市第三人民医院普通精神科首次入院进行MECT治疗的患者100例,各抽取男女两个病房作为对照组和观察组,每组50例,对照组采用常规护理,观察组采用临床路径进行护理;应用自制的护理质量评定表比较两组患者治疗前后的护理安全、健康宣教、基础护理、并发症、护理书写时间及MECT治疗满意度.结果 结果表明,观察组的护理质量、患者满

  3. [Psychiatric treatment sentences.

    Stevens, Hanne; Nordentoft, Merete; Agerbo, Esben


    INTRODUCTION: Previous Danish studies of the increasing number of sentences to psychiatric treatment (SPT) have compared prevalent populations of persons undergoing treatment with incident measures of reported crimes. Examining the period 1990-2006, we studied incident sentences, taking the type...... and severity of crime into account. MATERIAL AND METHODS: Using data from Statistics Denmark's national crime statistics, we have compared time-trends of SPT with time-trends of suspended and custodial sentences stratified by type of crime. RESULTS: We found that the rise in SPT is primarily attributable...... to violent offending, and that particularly assaults against public servants have contributed to the development. CONCLUSION: Regarding violent offences against private persons, the time-trends for SPT are parallel to the time-trends for suspended and custodial sentences, which may indicate that the same...

  4. Homocysteine and Psychiatric Disorders

    Vanessa Cavalcante da Silva PhD


    Full Text Available Psychiatric disorders are highly prevalent all over the world with a great impact on public health. Altered homocysteine metabolism is implicated in the pathogenesis of many of these disorders, as it can interfere in normal methylation of subcellular components, promote neuroexcitotoxicity, and induce oxidative stress and inflammation. There are cumulative data implicating these mechanisms in the development of autism, schizophrenia, depression, bipolar disorder, and Alzheimer disease. Altered homocysteine metabolism is multifactorial in its origin. On one hand, genetic factors act as predisposing factors through brain development and function, and on the other hand, environmental factors give the opportunity for nutritional interventions improving metabolic status and possibly also clinical parameters. This article provides a review on the association of 1-carbon metabolism and autism, schizophrenia, depression, bipolar disorder, and dementia and goes through studies on the role of different cofactors and metabolites involved in this pathway.

  5. Emergency Psychiatric Services for Individuals with Intellectual Disabilities: Caregivers' Perspectives

    Weiss, Jonathan A.; Lunsky, Yona; Gracey, Carolyn; Canrinus, Maaike; Morris, Susan


    Background: Strains on the mental health system and inaccessible services for individuals with intellectual disabilities (ID) often force caregivers to bring individuals with ID to the emergency department (ED) when in psychiatric crisis. The purpose of this study was to understand the experience of caregivers and adults with ID and mental health…

  6. Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

    Poremski, Daniel; Lim, Xin Ya; Kunjithapatham, Ganesh; Koh, Doris; Alexander, Mark; Cheng, Lee


    The way service seekers interact with the staff at emergency services has been shown to influence the standard of care, especially in the case of certain psychiatric manifestations. Staff reactions to psychiatric complaints have been linked to their comfort dealing with these types of service users as well as their competencies understanding the illness. It is therefore vital to understand which skills increase confidence in treating psychiatric emergencies. Twenty-six open-ended convergent interviews were conducted with staff working in a psychiatric emergency department. Thematic analysis was used to analyze the data. Participants reported several non-technical skills which developed from exclusively serving people with psychiatric emergencies: 1) Vigilance allowed staff to be sensitive to minor changes in behavior which precede psychiatric emergencies. 2) The ability to negotiate and find tangible solutions was particularly important when dealing with psychiatric complaints which may not have tangible resolutions. 3) The ability to appraise social support networks allowed staff to plan follow-up actions and ensure continuity of care when support was available. 4) The ability to self-reflect allowed participants to learn from their experience and avoid burnout, frustration, and fatigue. Participants also reported several other clinical skills which they gained during training, including teamwork, de-escalating techniques and risk assessment. Tentatively speaking, these skills improve staff's confidence when treating psychiatric emergencies. Certain skills may be generalized to staff working in medical emergency departments who frequently encounter psychiatric complaints.

  7. Psychiatric manifestations of treatable hereditary metabolic disorders in adults.

    Demily, Caroline; Sedel, Frédéric


    Detecting psychiatric disorders of secondary origin is a crucial concern for the psychiatrist. But how can this reliably be done among a large number of conditions, most of which have a very low prevalence? Metabolic screening undertaken in a population of subjects with psychosis demonstrated the presence of treatable metabolic disorders in a significant number of cases. The nature of the symptoms that should alert the clinician is also a fundamental issue and is not limited to psychosis. Hereditary metabolic disorders (HMD) are a rare but important cause of psychiatric disorders in adolescents and adults, the signs of which may remain isolated for years before other more specific organic signs appear. HMDs that present purely with psychiatric symptoms are very difficult to diagnose due to low awareness of these rare diseases among psychiatrists. However, it is important to identify HMDs in order to refer patients to specialist centres for appropriate management, disease-specific treatment and possible prevention of irreversible physical and neurological complications. Genetic counselling can also be provided. This review focuses on three HMD categories: acute, treatable HMDs (urea cycle abnormalities, remethylation disorders, acute intermittent porphyria); chronic, treatable HMDs (Wilson's disease, Niemann-Pick disease type C, homocystinuria due to cystathionine beta-synthase deficiency, cerebrotendinous xanthomatosis); and chronic HMDs that are difficult to treat (lysosomal storage diseases, X-linked adrenoleukodystrophy, creatine deficiency syndrome). We also propose an algorithm for the diagnosis of HMDs in patients with psychiatric symptoms.

  8. CAGE, RAPS4, RAPS4-QF and AUDIT Screening Tests for Men and Women Admitted for Acute Alcohol Intoxication to an Emergency Department: Are Standard Thresholds Appropriate?

    Geneste, J.; Pereira, B.; Arnaud, B.; Christol, N.; Liotier, J.; Blanc,O; Teissedre, F.; Hope, S.; Schwan, R.; P. M. Llorca; Schmidt, J; Cherpitel, C.J.; Malet, L.; G. Brousse


    Aims: A number of screening instruments are routinely used in Emergency Department (ED) situations to identify alcohol-use disorders (AUD). We wished to study the psychometric features, particularly concerning optimal thresholds scores (TSs), of four assessment scales frequently used to screen for abuse and/or dependence, the cut-down annoyed guilty eye-opener (CAGE), Rapid Alcohol Problem Screen 4 (RAPS4), RAPS4-quantity-frequency and AUD Identification Test (AUDIT) questionnaires, particula...

  9. How common are errors in the medication process in a psychiatric hospital?

    Sørensen, Ann Lykkegaard; Mainz, Jan; Lisby, Marianne


    How common are errors in the medication process in a psychiatric hospital? Background and purpose: Medication errors in psychiatric care is a problem in need of attention in Denmark. Studies are sparse and does not investigate all stages of the medication process. There is an urgent need for clar...... education in guidelines related to the medication process. Errors directly related to ward staff constituted 37% of all errors detected and consequently the nurses’ role in improving psychiatric medication safety should be further explored.......How common are errors in the medication process in a psychiatric hospital? Background and purpose: Medication errors in psychiatric care is a problem in need of attention in Denmark. Studies are sparse and does not investigate all stages of the medication process. There is an urgent need...... frequency, type and potential clinical consequences of errors in all stages of the medication process in an inpatient psychiatric setting. Methods and materials: A cross-sectional study in two general psychiatric wards and one acute psychiatric ward. Participants were eligible psychiatric in...

  10. The impact of psychiatric comorbidity on Medicare reimbursement for inpatient medical care.

    Goldberg, R J; Daly, J; Golinger, R C


    Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of psychiatric co-morbidities in Medicare patients on medical services could generate incremental hospital revenue by moving patients from a lower to a higher paying Diagnostic Related Group (DRG). This increased revenue could be used as a means of supporting the psychiatric C-L service. This study documents the financial impact of screening for and documenting psychiatric co-morbidities on a general acute medical service. We clinically assessed 100 consecutive Medicare admissions and found 25 psychiatric co-morbidities in 20 patients. In only one case did the psychiatric diagnosis result in moving the case to a higher DRG. However, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatric diagnoses by the medical team. The authors discuss both the financial and clinical implications of screening medical inpatients for psychiatric co-morbidities and propose directions for further studies in this area.

  11. Improvement of psychiatric symptoms in youth following resolution of sinusitis.

    Mahony, Talia; Sidell, Douglas; Gans, Hayley; Brown, Kayla; Farhadian, Bahare; Gustafson, Melissa; Sherr, Janell; Thienemann, Margo; Frankovich, Jennifer


    Accumulating evidence supports a role for inflammation in psychiatric illness, and the onset or exacerbation of psychiatric symptoms may follow non-CNS infections. Here, we provide the first detailed description of obsessive-compulsive and related psychiatric symptoms arising concurrently with sinusitis. We reviewed the charts of 150 consecutive patients evaluated in our Pediatric Acute-onset Neuropsychiatric Syndromes clinic for documented sinusitis as defined by the American Academy of Pediatrics guidelines. Sinusitis treatments, sinonasal imaging, and neuropsychiatric symptoms before, during, and after sinusitis onset were noted. Patients were included in the final review if they had a clear diagnosis of isolated sinusitis (without concurrent illness and/or immunodeficiency), and were evaluated during an episode of sinusitis. 10/150 (6.6%) patients had isolated sinusitis at the time of their neuropsychiatric deterioration. Eight patients received antibiotics to treat sinusitis, three of whom also received sinus surgery. Neuropsychiatric symptoms improved in all eight patients concurrent with resolution of sinusitis per parent report and clinician assessment. One patient did not follow through with recommended sinus surgery or antibiotics and her psychiatric symptoms persisted. One patient was lost to follow-up. Improvement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study. Identification, treatment, and resolution of underlying infections, including sinusitis, may have the potential to change the trajectory of some neuropsychiatric illnesses. Randomized clinical trials are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Psychiatric morbidity and pattern of dysfunctions in patients with leprosy

    Bhatia M


    Full Text Available BACKGROUND: Leprosy, being a chronic infectious disease with profound social stigma, remains associated with high psychological mortidity. PURPOSES: To find out the pattern of psychiatric morbidity in leprosy patients and the relationship of various factors with the morbidity. METHODS: Ninty patients attending leprosy clinic were randomly chosen for the study group alongwith 40 patients suffering from acute skin problem other than leprosy as control group. The socio-demographic data were recorded in semi-structural proforma; all patients were given Goldbery Health Questioneaire (GHQ. Patients having GHQ score> 2 was assessed by Disability Assessent Questionaire (DAQ. The psychiatric diagnoses was made according to ICD-10 by W ho0 and physical deformity by W ho 0 Disability Scale. FINDINGS: The mean GHQ score of the study grant was 3.44 and that of control group was 1.62. The mean DAQ score was 45.13. Psychiatric disorder was seen in 44.4% and 7.5% of study group and control group respectively. The psychiatric illness was generalised anoxidy disorder (GAD (27.8%. CONCLUSIONS: Leprosis highly associated with psychiatric mobidity. LIMITATIONS: The findings can not be generalised due to small sample size and clinic-based data.

  13. Inpatient Psychiatric Facility PPS

    U.S. Department of Health & Human Services — Since October 1, 1983, most hospitals have been paid under the hospital inpatient prospective payment system (PPS). However, certain types of specialty hospitals and...

  14. Psychiatric Presentations During All 4 Phases of the Lunar Cycle.

    Francis, Omar J; Kopke, Bryan J; Affatato, Anthony J; Jarski, Robert W


    Context • Anecdotal evidence concerning a relationship between human illnesses and a full moon is frequently claimed by as many as 81% of mental health workers. Previous scientific investigations have studied only the full-moon phase and its possible effect on psychiatric presentations. However, information is limited about all 4 phases of the lunar cycle and their effects on different types of psychiatric disorders. Objective • This study primarily intended to evaluate the number of psychiatric presentations to a hospital's emergency department across all 4 phases of the lunar cycle. The secondary objective was to investigate the statistical differences among 5 categories of common mental disorders in relation to the 4 lunar phases. Design • This study was an observational analytic cohort study. Setting • The study took place in the emergency department of a 140-bed, community-teaching hospital. Participants • Participants were 1857 patients who were aged >17 y and who had had a psychiatric component to a visit to the emergency department. Outcome Measures • Data from electronic medical records were collected for 41 consecutive months. The participants were divided into 5 diagnostic groups based on the Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5). The study measured the number of psychiatric presentations for each group during the 4 National Aeronautics and Space Administration (NASA)-defined phases of the lunar cycle, and the study was statistically powered to detect small effects. Results • The following psychiatric presentations occurred: (1) 464 during the new moon; (2) 483 during the first quarter; (3) 449 during the full moon; and (4) 461 during the third quarter (4-group overall χ2, P = .89). Differences between the 5 diagnostic categories across the 4 lunar phases were not statistically significant (4-group overall χ2, P = .85 for the 5 diagnostic categories). Conclusions • Although many traditional and

  15. [Psychiatric comorbidity in pathological gambling].

    Skokauskas, Norbertas; Satkeviciūte, Regina; Burba, Benjaminas


    In this article the peculiarities of psychiatric comorbidity in pathological gambling were investigated. The authors were based both on the data of many foreign scientists and on their own one. Our data on 77 cases of pathological gambling were collected based on interviews of Lithuanian psychiatrists and psychotherapists about their patients with gambling addiction in period from 1991 to 2001. The data that we publish and analyze allows us to make conclusions that pathological gambling can reveal together with very wide spectrum of psychiatric disorders, but more often with alcoholism and depression. The mechanism of psychiatric comorbidity in pathological gambling is very complex.

  16. [Qualitative methods in psychiatric research].

    Sikorski, Claudia; Glaesmer, Heide


    This article addresses the usage of qualitative methods in psychiatric research and presents the qualitative approach in more detail. Recent original empirical work of a German psychiatric journal was systematically reviewed. Methods used to collect and analyse the information are detailed. One third of the articles used a solely qualitative research design. One further article applied a combination of quantitative and qualitative approaches. Three kinds of the qualitative interviews were used (in depth, narrative and problem-focussed interview). Additionally, focus groups (group discussions) and qualitative content analysis were applied by studies. Qualitative approaches are an integral part of psychiatric research. Further work should assure to use adequate sampling strategies.

  17. Psychiatric disorders in myasthenia gravis

    Mariana Inés Ybarra


    Full Text Available OBJECTIVE: To investigate the prevalence of psychiatric disorders in patients with myasthenia gravis (MG. METHOD: Forty-one patients with MG answered to a structured psychiatric interview (MINI-Plus. RESULTS: Eleven (26.1% patients were diagnosed with a depressive disorder and 19 (46.3% were diagnosed with an anxiety disorder. Patients with dysthymia were older (p=0.029 and had longer disease duration (p=0.006. Patients with social phobia also had longer disease duration (p=0.039. CONCLUSION: Psychiatric disorders in MG are common, especially depressive and anxiety disorders.

  18. The cerebellum and psychiatric disorders

    Joseph ePhillips


    Full Text Available The cerebellum has been considered for a long time to play a role solely in motor coordination. However, studies over the past two decades have shown that the cerebellum also plays a key role in many motor, cognitive, and emotional processes. In addition, studies have also shown that the cerebellum is implicated in many psychiatric disorders including attention deficit hyperactivity disorder, autism spectrum disorders, schizophrenia, bipolar disorder, major depressive disorder and anxiety disorders. In this review, we discuss existing studies reporting cerebellar dysfunction in various psychiatric disorders. We will also discuss future directions for studies linking the cerebellum to psychiatric disorders.

  19. Metallurgy Department

    Risø National Laboratory, Roskilde

    The activities of the Metallurgy Department at Risø during 1981 are described. The work is presented in three chapters: General Materials Research, Technology and Materials Development, Fuel Elements. Furthermore, a survey is given of the department's participation in international collaboration...

  20. Care systematization in psychiatric nursing within the psychiatric reform context.

    Hirdes, A; Kantorski, L P


    The aim of this study was to approach care systematization in psychiatric nursing in two psychiatric disorder patients who attended 'Nossa Casa', São Lourenço do Sul, RS, Brazil. Nossa Casa services psychiatric patients in the community, focussing on: (i) permanence in their environment, allowing patients to remain close to their families and social spheres; (ii) integral attendance to meet individual needs; (iii) respecting individual differences; (iv) rehabilitation practices; and (v) social reinsertion. Concepts and assumptions of the psychiatric reform and the Irving's nursing process were used as theoretical-methodological references to elaborate this systematization. A therapeutic project for the psychiatric patient was elaborated, in accordance with the interdisciplinary proposal accepted by Nossa Casa. Interdisciplinary team intervention, guided by a previously discussed common orientation and defined through an individualized therapeutic project, allowed for an effective process of psychosocial rehabilitation. The authors concluded that a therapeutic project based on the mentioned premises leads to consistent, comprehensive, dialectical and ethical assistance in mental health, thereby reinstating the citizenship of psychiatric patients.

  1. Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography? Results of the Randomized Comparative Effectiveness ROMICAT II Trial.

    Truong, Quynh A; Schulman-Marcus, Joshua; Zakroysky, Pearl; Chou, Eric T; Nagurney, John T; Fleg, Jerome L; Schoenfeld, David A; Udelson, James E; Hoffmann, Udo; Woodard, Pamela K


    Cardiac computed tomography angiography (CCTA) reduces emergency department length of stay compared with standard evaluation in patients with low- and intermediate-risk acute chest pain. Whether diabetic patients have similar benefits is unknown. In this prespecified analysis of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT II) multicenter trial, we randomized 1000 patients (17% diabetic) with symptoms suggestive of acute coronary syndrome to CCTA or standard evaluation. The rate of acute coronary syndrome was 8% in both diabetic and nondiabetic patients (P=1.0). Length of stay was unaffected by the CCTA strategy for diabetic patients (23.9 versus 27.2 hours, P=0.86) but was reduced for nondiabetic patients compared with standard evaluation (8.4 versus 26.5 hours, Pemergency department discharge in both groups (each P≤0.0001, P interaction=0.27). No difference in hospital admissions was seen between the 2 strategies in diabetic and nondiabetic patients (P interaction=0.09). Both groups had more downstream testing and higher radiation doses with CCTA, but these were highest in diabetic patients (all P interaction≤0.04). Diabetic patients had fewer normal CCTAs than nondiabetic patients (32% versus 50%, P=0.003) and similar normalcy rates with standard evaluation (P=0.70). Notably, 66% of diabetic patients had no or mild stenosis by CCTA with short length of stay comparable to that of nondiabetic patients (P=0.34), whereas those with >50% stenosis had a high prevalence of acute coronary syndrome, invasive coronary angiography, and revascularization. Knowledge of coronary anatomy with CCTA is beneficial for diabetic patients and can discriminate between lower risk patients with no or little coronary artery disease who can be discharged immediately and higher risk patients with moderate to severe disease who warrant further workup. URL: Unique identifier: NCT01084239. © 2016 The Authors

  2. [Approaches for suicide prevention in Osaka Psychiatric Medical Center: the importance of multi-disciplinary cooperation and partnerships with other organizations].

    Iwata, Kazuhiko


    Suicide is a very common problem in psychiatric practice today. Therefore, almost all staff of psychiatric hospitals have encountered the suicide of one or more of their patients. Our hospital, Osaka Psychiatric Medical Center, is a public psychiatric hospital in Japan. We provide treatment and support for patients from the acute to chronic phases of psychiatric disorders, and patients range from children to the elderly. Because we accept many patients with severe mental illness from other hospitals, many of our staff are routinely confronted with patients' violence or suicidal attempts. If a patient commits suicide, the relevant staff immediately have a conference to implement measures for preventing a recurrence. At the same time, information about the incident is conveyed to the medical safety management office and made known to all staff in our hospital. This office was established in 2007. Currently, all information about incidents and accidents in our hospital (e.g., suicide, problems between patients, problems with hospital facilities) is aggregated in the office and distributed to all staff members through the hospital intranet. This system makes it possible for staff to consider countermeasures against similar incidents and accidents, even if not involved in the incident. Additionally, we make an effort to develop cooperative relationships with organizations including the police, public health centers, and the fire department. The social welfare council in Hirakata City, where our hospital is located, provides some services to prevent suicide (e.g., telephone counseling, meetings with bereaved family members). Our hospital cooperates with these services by providing lecturers. The partnerships with these organizations help regarding the mental crises of patients in our hospital and fulfill a role to prevent suicide. Multi-disciplinary cooperation and partnerships with community organizations are not special approaches to suicide prevention, but ordinary

  3. Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

    Hubbard, Grace B


    The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed.

  4. Surgery for psychiatric disorders.

    Luigjes, Judy; de Kwaasteniet, Bart P; de Koning, Pelle P; Oudijn, Marloes S; van den Munckhof, Pepijn; Schuurman, P Richard; Denys, Damiaan


    Surgery in psychiatric disorders has a long history and has regained momentum in the past few decades with deep brain stimulation (DBS). DBS is an adjustable and reversible neurosurgical intervention using implanted electrodes to deliver controlled electrical pulses to targeted areas of the brain. It holds great promise for therapy-refractory obsessive-compulsive disorder. Several double-blind controlled and open trials have been conducted and the response rate is estimated around 54%. Open trials have shown encouraging results with DBS for therapy-refractory depression and case reports have shown potential effects of DBS on addiction. Another promising indication is Tourette syndrome, where potential efficacy of DBS is shown by several case series and a few controlled trials. Further research should focus on optimizing DBS with respect to target location and increasing the number of controlled double-blinded trials. In addition, new indications for DBS and new target options should be explored in preclinical research. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Psychiatric disorders in the elderly.

    Skoog, Ingmar


    Recent research has shown that depression, anxiety disorders, and psychosis are more common than previously supposed in elderly populations without dementia. It is unclear whether the frequency of these disorders increases or decreases with age. Clinical expression of psychiatric disorders in old age may be different from that seen in younger age groups, with less and often milder symptoms. Concurrently, comorbidity between different psychiatric disorders is immense, as well as comorbidity with somatic disorders. Cognitive function is often decreased in people with depression, anxiety disorders, and psychosis, but whether these disorders are risk factors for dementia is unclear. Psychiatric disorders in the elderly are often related to cerebral neurodegeneration and cerebrovascular disease, although psychosocial risk factors are also important. Psychiatric disorders, common among the elderly, have consequences that include social deprivation, poor quality of life, cognitive decline, disability, increased risk for somatic disorders, suicide, and increased nonsuicidal mortality.

  6. Modeling psychiatric disorders through reprogramming

    Kristen J. Brennand


    Full Text Available Psychiatric disorders, including autism spectrum disorders and schizophrenia, are extremely heritable complex genetic neurodevelopmental disorders. It is now possible to directly reprogram fibroblasts from psychiatric patients into human induced pluripotent stem cells (hiPSCs and subsequently differentiate these disorder-specific hiPSCs into neurons. This means that researchers can generate nearly limitless quantities of live human neurons with genetic backgrounds that are known to result in psychiatric disorders, without knowing which genes are interacting to produce the disease state in each patient. With these new human-cell-based models, scientists can investigate the precise cell types that are affected in these disorders and elucidate the cellular and molecular defects that contribute to disease initiation and progression. Here, we present a short review of experiments using hiPSCs and other sophisticated in vitro approaches to study the pathways underlying psychiatric disorders.

  7. Suicide among older psychiatric inpatients

    Erlangsen, Annette; Zarit, Steven H; Tu, Xin;


    OBJECTIVE: Older adults have elevated suicide rates, especially in the presence of a psychiatric disorder, yet not much is known about predictors for suicide within this high-risk group. The current study examines the characteristics associated with suicide among older adults who are admitted...... to a psychiatric hospital. METHOD: All persons aged 60 and older living in Denmark who were hospitalized with psychiatric disorders during 1990-2000 were included in the study. Using a case-control design and logistic regression analysis, the authors calculated the suicide risk associated with specific patient...... characteristics. RESULTS: Affective disorders were found to be associated with an almost twofold higher risk of suicide among psychiatric inpatients than other types of disorders (95% confidence interval [CI]: 1.5-2.6). Patients with dementia had a significantly lower risk ratio of 0.2 (95% CI: 0...

  8. Psychiatric genetics in South Africa


    . Psychiatric genetic studies in South Africa seem to involve relatively low-cost methodologies and only a ... Xhosa population shows a significant genetic contribution from ...... Venter M, Warnich L. A pharmacogenetic study of CD4 recovery in.

  9. Acute lymphoblastic leukemia in the Department of Child Health, School of Medicine, University of North Sumatera/Dr. Pirngadi Hospital Medan (1980-1988).

    Arifin, Z; Nasution, F; Sutjipto, A


    A retrospective study on acute lymphoblastic leukemia (ALL) was conducted to assess the pattern of childhood ALL at the Subdivision of Pediatric of Hematology, School of Medicine, University of North Sumatera/Dr. Pirngadi Hospital, Medan, in a period of 8 years (1980-1988). There were 120 cases, consisting of 63 (52.5%) males and 57 (47.5%) females. By the FAB classification (Bennett, 1976) (77.5%) were found as FAB L 1, 25 (20.8%) as FAB L 2, and 2 (1.7%) as FAB L 3. The youngest was 4 months old. The majority of signs and symptoms appeared in the forms of pallor 102 (85%), fever 84 (70%), hemorrhage 52 (43.3%), hepatomegaly 64 (53.3%), splenomegaly 54 (45%) and lymphadenopathy 18 (15%). On first admission, 76 (63.33%) cases were with a leukocyte count of less than 20,000/microliters, and 72 (60%) with Hb content of less than 5 g/dl. Twenty one cases died in the first year. The received cytostatic protocol; 11 (52.38%) were treated regularly and first remission were found in 8 (72.73%) cases. The average of admissions per year for the age group of 2-8 years was higher than the age groups of 0-2 years and 8-16 years (p less than 0.05).

  10. Acute non lymphoblastic leukemia in the Department of Child Health School of Medicine, University of North Sumatera/Dr. Pirngadi Hospital Medan (1983-1988), a preliminary study.

    Nasution, F; Arifin, Z; Sutjipto, A


    A retrospective study on Acute Non Lymphoblastic Leukemia (ANLL) was conducted at the Sub Division of Pediatric Hematology, School of Medicine, University of North Sumatera/Dr. Pirngadi Hospital Medan, in a period of 5 years (1983-1988). There were 18 cases consisted of 14 (77.78%) males and 4 (22.22%) females with the age group of 0-2 years: 6 (30%), 2-8 years: 9 (50%), 8-15 years: 3 (30%). By the FAB classification, they were of FAB M-1: 1 (5.55%). FAB M-2: 1 (5.55%), FAB M-3: 1 (5.55%), FAB M-4: 2 (11.12%) and FAB M-6: 13 (72.23%). Only 7 (38.88%) were treated with cytostatics while the others received only supportive therapy. The result of cytostatic treatment was unsatisfactory: 4 (57.14%) died within the first 2 months of treatment, 3 (42.86%) discontinued their cytostatics treatment.

  11. Can the Preoperative Serum Lactate Level Predict the Extent of Bowel Ischemia in Patients Presenting to the Emergency Department with Acute Mesenteric Ischemia?

    Peter C. Ambe


    Full Text Available Purpose. Early recognition of acute mesenteric ischemia (AMI can be challenging. Extensive bowel necrosis secondary to AMI is associated with high rates of mortality. The aim of this study was to investigate the association between preoperative serum lactate level and the extent of bowel ischemia in patients with AMI. Methods. Data of patients with abdominal pain and elevated serum lactate undergoing emergency laparotomy for suspected AMI within 24 hours of presentation was retrospectively abstracted. The length of the ischemic bowel segment was compared with the preoperative serum lactate level. Results. 36 female and 39 male patients, with median age 73.1 ± 12.3 years, were included for analysis. The median preoperative lactate was 2.96 ± 2.59 mmol/l in patients with ≤50 cm, 6.86 ± 4.08 mmol/l in patients with 51–100 cm, 4.73 ± 2.76 mmol/l in patients with >100 cm ischemic bowel, and 14.07 ± 4.91 mmol/l in the group with multivisceral ischemia. Conclusion. Although elevated serum lactate might permit an early suspicion and thus influence the clinical decision-making with regard to prioritization of surgery in patients with suspected AMI, a linear relationship between serum lactate and the extent of bowel ischemia could not be established in this study.

  12. Can the Preoperative Serum Lactate Level Predict the Extent of Bowel Ischemia in Patients Presenting to the Emergency Department with Acute Mesenteric Ischemia?

    Kang, Kai; Papadakis, Marios; Zirngibl, Hubert


    Purpose. Early recognition of acute mesenteric ischemia (AMI) can be challenging. Extensive bowel necrosis secondary to AMI is associated with high rates of mortality. The aim of this study was to investigate the association between preoperative serum lactate level and the extent of bowel ischemia in patients with AMI. Methods. Data of patients with abdominal pain and elevated serum lactate undergoing emergency laparotomy for suspected AMI within 24 hours of presentation was retrospectively abstracted. The length of the ischemic bowel segment was compared with the preoperative serum lactate level. Results. 36 female and 39 male patients, with median age 73.1 ± 12.3 years, were included for analysis. The median preoperative lactate was 2.96 ± 2.59 mmol/l in patients with ≤50 cm, 6.86 ± 4.08 mmol/l in patients with 51–100 cm, 4.73 ± 2.76 mmol/l in patients with >100 cm ischemic bowel, and 14.07 ± 4.91 mmol/l in the group with multivisceral ischemia. Conclusion. Although elevated serum lactate might permit an early suspicion and thus influence the clinical decision-making with regard to prioritization of surgery in patients with suspected AMI, a linear relationship between serum lactate and the extent of bowel ischemia could not be established in this study. PMID:28261615

  13. Psychiatric aspects of induced abortion.

    Stotland, Nada L


    Approximately one third of the women in the United States have an abortion during their lives. In the year 2008, 1.21 million abortions were performed in the United States (Jones and Koolstra, Perspect Sex Reprod Health 43:41-50, 2011). The psychiatric outcomes of abortion are scientifically well established (Adler et al., Science 248:41-43, 1990). Despite assertions to the contrary, there is no evidence that abortion causes psychiatric problems (Dagg, Am J Psychiatry 148:578-585, 1991). Those studies that report psychiatric sequelae suffer from severe methodological defects (Lagakos, N Engl J Med 354:1667-1669, 2006). Methodologically sound studies have demonstrated that there is a very low incidence of frank psychiatric illness after an abortion; women experience a wide variety of feelings over time, including, for some, transient sadness and grieving. However, the circumstances that lead a woman to terminate a pregnancy, including previous and/or ongoing psychiatric illness, are independently stressful and increase the likelihood of psychiatric illness over the already high baseline incidence and prevalence of mood and anxiety disorders among women of childbearing age. For optimal psychological outcomes, women, including adolescents, need to make autonomous and supported decisions about problem pregnancies. Clinicians can help patients facing these decisions and those who are working through feelings about having had abortions in the past.

  14. Reorganisation of acute referral to an emergency department resulted in fewer admissions for chronic obstructive pulmonary disease but in higher rates of non-invasive ventilation

    Titlestad, Ingrid Louise; Bryde, Jonas; Oberg-Hansen, Bo


    .3%) compared with 2010 (36 admissions; 4.5%), but no referrals to the intensive care unit or deaths were registered during the hospitalisation in either of the groups, but one patient died within 30 days after admission from the DEM. FUNDING: This project was funded by an Odense University Hospital research...... medical records were retrieved from two COPD cohorts: 1) all patients admitted to DEM between 1 July and 31 December 2012 and 2) all patients admitted to the Medical Emergency Ward, Odense University Hospital (MEW) in 2010. RESULTS: There were 300 eligible admissions comprising 236 unique patients in DEM......INTRODUCTION: We performed an audit on all admissions with chronic obstructive pulmonary disease (COPD) in ex-acerbation to the Department of Emergency Medicine, Odense University Hospital (DEM) in the second half of 2012 to evaluate if an organisational change had altered visitation, treatment...

  15. [Schizophrenia spectrum disorders in elderly patients : Analysis of reasons for admission to a department of geriatric psychiatry].

    Jagsch, C; Dietmaier, G; Jagsch, M; Roller, R E


    The aim of this study was to analyze the possible reasons for acute admission to a department for geriatric psychiatry. The reasons for hospitalization, the psychiatric and somatic comorbidities of the patients over 65 years old with schizophrenia, schizoaffective disorder and delusional disorder were examined to identify patterns and risk profiles. A retrospective analysis was carried out using paper and electronic patient records of a department of acute care for geriatric psychiatry and psychotherapy. During the assessment period 206 successive patients over 65 years old were included in the study. The patient cohort included 64 patients with schizophrenia according to the international classification of diseases 10 (ICD-10, category F20), 78 patients with persistent delusional disorder (ICD-10, F22) and 64 patients with schizoaffective disorder (ICD-10, F25). The reason for admission for one third of the patients in all three groups was aggressive behavior, whereas delusions and hallucinations were more frequent in the groups of F20 and F22 patients than in patients with schizoaffective disorders (F25). Somatic comorbidities were seen significantly more often in the group of F22 patients than in the other two groups. Acute admission was essentially due to acute psychiatric symptoms. Additional somatic comorbidities and psychosocial influencing factors played only a minor role in this study. The patients examined in this study constituted a special group within the acute treatment of inpatient psychiatry because they showed distinctive psychopathological productive symptoms but were relatively healthy from a somatic point of view. Patients with the diagnosis of schizophrenia (F20) or schizoaffective disorder (F25) were significantly different from patients classified into the group of delusional disorders (F22).

  16. Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection

    Canas Nuno


    Full Text Available Abstract Background Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm. Case report We describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation. Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids. Conclusion This is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis.

  17. A study of psychiatric morbidity in patients of peptic ulcer diseases

    Jagpal Singh Klair


    Full Text Available Aims and Objectives: To study the prevalence of psychiatric morbidity among patients of peptic ulcer disease and to study the patients of peptic ulcer disease with psychiatric morbidity in comparison to patients of peptic ulcer disease without psychiatric morbidity on following variables: sociodemographic variables and attributes/risk factors of peptic ulcer disease. Materials and Methods: Fifty cases of clinically proven acid peptic diseases and 30 cases of the control group were screened in department of General Medicine, outdoor as well as indoor patients. Instruments applied for the purpose of the study were Personal Bio-data Performa (Appendix-I, (SCL- 80 (Appendix-II, Hamilton rating scale for anxiety and depression, (P.S.L.E.; clinical diagnosis of psychiatric disorders was made as per ICD- 10 criteria. Data collected shall be subjected to statistical analysis. Results and Findings: The psychiatric morbidity was significantly (P10 years, compared to 23.80% in patients without psychiatric morbidity. Lastly, 48.27% of patients with psychiatric morbidity had significantly (P<0.01 stronger family history of acid peptic disease compared to 9.52% in patients without psychiatric morbidity. Conclusions: There is a significant relationship between the peptic ulcer disease and the various psychiatric morbidity factors as illustrated from the findings of this study.

  18. Prevalence of psychiatric morbidity among cancer patients – hospital-based, cross-sectional survey

    Mohan Roy Gopalan


    Full Text Available Aim: To study the prevalence of Psychiatric disorders in cancer patients and to find out the factors associated with Psychiatric disorders in Cancer Patients. Settings and Design: Department of Radiotherapy, Medical College, Thiruvananthapuram, cross sectional survey design was used. Methods and Material: Adult patients (18 years of age and above, having a diagnosis of carcinoma were selected by consecutive sampling method.A questionnaire which included back ground data, socio economic variables, treatment variables like type of malignancy, exposure to radiation & chemotherapy prior to the evaluation and current treatment, co occurring medical illness & treatment and past & family history of psychiatric illness was used to collect data. Delirium rating scale and MINI International neuropsychiatric interview were used to assess Psychiatric disorders and delirium. Statistical Analysis Used: Chi square and logistics regression tests were used for analysis. Results: Of the 384 assessed, 160(41.7% had psychiatric disorders. Adjustment disorders were seen in 22.6%. 10.9% of subjects had major depressive disorder. Thus a total of 33.5% of patients had a diagnosis of either anxiety or depressive disorder. Proportion of patients having delirium was 6.5%. Hypomania was seen in small (1.6% of patients. Multivariate analysis for various parameters for psychiatric disorders showed that age, past history of chemotherapy, past history of radiotherapy, & surgical treatment of carcinomas are significant predictors of psychiatric disorders. Conclusions: Psychiatric disorders are seen in a significant proportion of Psychiatric patients.

  19. Effect of light pressure stroking massage with sesame (Sesamum indicum L.) oil on alleviating acute traumatic limbs pain: A triple-blind controlled trial in emergency department.

    Nasiri, Morteza; Farsi, Zahra


    Due to adverse effects of common medications used for traumatic pain management, it is crucial to use complementary methods to alleviate this pain. Present study aimed to assess the effect of light pressure stroking massage with topical sesame oil on pain severity of patients with limbs trauma. This triple-blinded randomized trial was conducted on 40 patients with upper or lower extremities trauma in emergency department of Busheher Amir Al-Momenian Hospital, Busheher, Iran, in 2015-2016. Patients received a 5min massage with either liquid paraffin (placebo) or sesame oil on trauma site twice a day for 9days duration. Pain severity was assessed by visual analogue scale in first day (baseline), 3th, 6th and 9th days of intervention in the both groups. Mean changes of pain severity between two groups was significant in the 6th (-0.20±1.36; P=0.036) and 9th (-0.36±1.12; PMassage with topical sesame oil was associated with significant reduction in pain severity of patients with limbs trauma. Therefore, it is suggested to use this oil on complementary medicine for pain relief due to low cost, easy usage and lack of adverse effects. Copyright © 2017. Published by Elsevier Ltd.

  20. Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging.

    Feuchtner, Gudrun Maria; Plank, Fabian; Pena, Constantino; Battle, Juan; Min, James; Leipsic, Jonathon; Labounty, Troy; Janowitz, Warren; Katzen, Barry; Ziffer, Jack; Cury, Ricardo C


    To determine whether evaluation of resting myocardial CT perfusion (CTP) from coronary CT angiography (CTA) datasets in patients presenting with chest pain (CP) to the emergency department (ED), might have added value to coronary CTA. 76 Patients (age 54.9 y±13; 32 (42%) women) presenting with CP to the ED underwent coronary 64-slice CTA. Myocardial perfusion defects were evaluated for CTP (American Heart Association 17-segment model) and compared with rest sestamibi single-photon emission CT myocardial perfusion imaging (SPECT-MPI). CTA was assessed for >50% stenosis per vessel. CTP demonstrated a sensitivity of 92% and 89%, specificity of 95% and 99%, positive predictive value (PPV) of 80% and 82% and negative predictive value (NPV) of 98% and 99% for each patient and for each segment, respectively. CTA showed an accuracy of 92%, sensitivity of 70.4%, specificity of 95.5%, PPV 67.8%, and NPV of 95% compared with SPECT-MPI. When CTP findings were added to CTA the PPV improved from 67% to 90.1%. In patients presenting to the ED with CP, the evaluation of rest myocardial CTP demonstrates high diagnostic performance as compared with SPECT-MPI. Addition of CTP to CTA improves the accuracy of CTA, primarily by reducing rates of false-positive CTA.

  1. Utilization Patterns at a Specialized Children's Comprehensive Psychiatric Emergency Program.

    Gerson, Ruth; Havens, Jennifer; Marr, Mollie; Storfer-Isser, Amy; Lee, Mia; Rojas Marcos, Carolena; Liu, Michelle; Horwitz, Sarah McCue


    Most youths experiencing a psychiatric crisis present to emergency departments (EDs) that lack the specialized staff to evaluate them, so youths are often discharged without appropriate mental health assessment or treatment. To better understand the needs of this population, this study described clinical details and disposition associated with visits for psychiatric emergencies to a specialized ED staffed 24/7 by child psychiatrists. Through retrospective chart review, 1,180 visits to the ED during its first year of operation were reviewed for clinical characteristics, prior service utilization, and demographic characteristics. Bivariate analyses (chi-square test and Wilcoxon rank sum test) compared differences in disposition (evaluate and release, brief stabilization, and inpatient psychiatric admission) associated with characteristics of the children's first visit (N=885). Measures with bivariate association of p<.10 were further assessed by using multinomial logistic regression analyses. For most visits (59%), children were evaluated and released, 13% were briefly stabilized, and 28% were admitted for psychiatric treatment. Youths with mood or psychotic disorders were more likely to be admitted, as were those with current suicidality or aggression. Many youths who presented with aggression were also identified as having suicidality or self-harm. Clinical factors, especially suicidality, predicted psychiatric admission. Admission rates for youths with suicidality were significantly higher in this study than previously reported, suggesting the availability of child psychiatrists in this ED allowed greater ascertainment of suicide risk (and thus hospitalization to mitigate that risk) than occurs in EDs without such staffing.

  2. Who’s Boarding in the Psychiatric Emergency Service?

    Scott A. Simpson


    Full Text Available Introduction: When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described. Methods: We electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student’s t-tests and multivariate regression. Results: 521 of 5363 patient encounters (9.7% resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/ seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis. Conclusion: Boarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients. [West J Emerg Med. 2014;15(6:669-674


    Mirela Batta


    Full Text Available Background. Huntington disease occurrs rarely, it can be encountered not only by neurologists and psychiatrists but also by other medical practitioners. Its characteristic features are involuntary movements, cognitive disorders and gradual development of dementia. Diagnosis is given on the basis of these clinical features, positive familial anamnesis, with the laboratory exclusion of other neuropsychiatric diseases and with the help of neuroimaging methods (in particular NMR. The disease can be only confirmed by means of genetic analysis.Patients and methods. In this article, four cases of patients with Huntington disease and diverse psychiatric disorders that were hospitalised at the psychiatric department of the Maribor General Hospital between October 2002 and March 2003 are described. All the patients fulfilled the valid criteria for the diagnosis of Huntington disease. However, they differed according to their accompanying psychiatric psychopathology, age and social problems.Conclusions. The purpose of this article is to draw attention to different psychiatric symptoms and clinical manifestations of Huntington disease that are often misleading in the diagnostic process. In addition, exigency of early diagnostics, guidelines for referrals to genetic testing and psychiatric monitoring of these patients are emphasised.

  4. Correlation between Anger and Job Motivation among Psychiatric Nurses in Kashan Psychiatric Hospital

    Kouchaki E.


    Full Text Available Abstract Aims: In general, nurses who work in department of psychiatric are in fact interacting with emotional disorders of patients once providing their care services. higher levels of job motivation and satisfaction can markedly foster service improvement. The aim of this study was to evaluate the correlation between anger and job motivation in nurses of a psychiatric hospital. Instrument & Methods: In this cross-sectional descriptive research in 2014, all 50 psychiatry nurses working at Kargarnejad Hospital of Kashan City, Iran, were entirely studied. A demographical questionnaire, the Anger Multiple Scale and the Job Motivation Scale were used for data gathering. Data were analyzed by SPSS 19 software using Pearson correlation coefficient. Findings: The mean score of anger was 3.01±0.36 and of job motivation was 1.70±0.86. There was a significant relationship between job motivation and the number of family members and conditions of employment of nurses (p=0.001. There was a significant inverse relationship between scores of anger and job motivation of psychiatry nurses of the hospital (r=-0.712; p=0.001. Conclusion: There is a relationship between anger and job motivation in nurses of Kashan Psychiatric hospital.

  5. External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

    Díez-Manglano, Jesús; Cabrerizo García, José Luis; García-Arilla Calvo, Ernesto; Jimeno Saínz, Araceli; Calvo Beguería, Eva; Martínez-Álvarez, Rosa M; Bejarano Tello, Esperanza; Caudevilla Martínez, Aránzazu


    The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

  6. Automated Computer-Assisted Diagnosis of Obstructive Coronary Artery Disease in Emergency Department Patients Undergoing 256-Slice Coronary Computed Tomography Angiography for Acute Chest Pain.

    Hashoul, Sharbell; Gaspar, Tamar; Halon, David A; Lewis, Basil S; Shenkar, Yuval; Jaffe, Ronen; Peled, Nathan; Rubinshtein, Ronen


    A 256-slice coronary computed tomography angiography (CCTA) is an accurate method for detection and exclusion of obstructive coronary artery disease (OBS-CAD). However, accurate image interpretation requires expertise and may not be available at all hours. The purpose of this study was to evaluate the usefulness of a fully automated computer-assisted diagnosis (COMP-DIAG) tool for exclusion of OBS-CAD in patients in the emergency department (ED) presenting with chest pain. Three hundred sixty-nine patients in ED without known coronary disease underwent 256-slice CCTA as part of the assessment of chest pain of uncertain origin. COMP-DIAG (CorAnalyzer II) automatically reported presence or exclusion of OBS-CAD (>50% stenosis, ≥1 vessel). Performance characteristics of COMP-DIAG for exclusion and detection of OBS-CAD were determined using expert reading as the reference standard. Seventeen (5%) studies were unassessable by COMP-DIAG software, and 352 patients (1,056 vessels) were therefore available for analysis. COMP-DIAG identified 33% of assessable studies as having OBS-CAD, but the prevalence of OBS-CAD on CCTA was only 18% (66 of 352 patients) by standard expert reading. However, COMP-DIAG correctly identified 61 of the 66 patients (93%) with OBS-CAD with 21 vessels (2%) with OBS-CAD misclassified as negative. In conclusion, compared to expert reading, automated computer-assisted diagnosis using the CorAnalyzer showed high sensitivity but only moderate specificity for detection of obstructive coronary disease in patients in ED who underwent 256-slice CCTA. The high negative predictive value of this computer-assisted algorithm may be useful in the ED setting.

  7. The HEART score for early rule out of acute coronary syndromes in the emergency department: a systematic review and meta-analysis.

    Van Den Berg, Patricia; Body, Richard


    The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome. For the 12 studies meeting inclusion criteria, study characteristics and diagnostic accuracy measures were systematically extracted and study quality assessed using the QUADAS-2 tool. After quality assessment, nine studies including data from 11,217 patients were combined in the meta-analysis applying a generalised linear mixed model approach with random effects assumption (Stata 13.1). In total, 15.4% of patients (range 7.3-29.1%) developed major adverse cardiac events after a mean of 6 weeks' follow-up. Among patients categorised as 'low risk' and suitable for early discharge (HEART score 0-3), the pooled incidence of 'missed' major adverse cardiac events was 1.6%. The pooled sensitivity and specificity of the HEART score for predicting major adverse cardiac events were 96.7% (95% confidence interval (CI) 94.0-98.2%) and 47.0% (95% CI 41.0-53.5%), respectively. Patients with a HEART score of 0-3 are at low risk of incident major adverse cardiac events. As 3.3% of patients with major adverse cardiac events are 'missed' by the HEART score, clinicians must ask whether this risk is acceptably low for clinical implementation.

  8. Clinical Observation of Acute Respiratory Distress Syndrome After Operation in Department of Thoracic Surgery%胸外科术后急性呼吸窘迫综合征的临床观察



    目的:探讨胸外科术后急性呼吸窘迫综合征的临床防治措施及其临床效果。方法选取近期来我院行胸外科手术治疗,且术后并发急性呼吸窘迫综合征患者80例,患者一经确诊为急性呼吸窘迫综合征,转入ICU病房,给予呼吸机辅助呼吸,增强吸氧浓度;积极对症处理患者的原发疾病;严格控制患者入水量,确保胸腔引流通畅;给予敏感抗生素抗感染;加强营养支持。结果80例患者经临床治疗后,其PaO2、PaCO2、RR、HR、MAP及BH等各项临床指标均得到了显著的改善,P<0.05比较差异具有统计学意义。80例患者经临床治疗后,70例痊愈(97.5%),10例死亡(12.5%)。结论综合疗法是目前治疗胸外科术后急性呼吸窘迫综合征最为有效的方式。%Objective To investigate the clinical control measures and clinical effect of acute respiratory distress syndrome after operation in Department of thoracic surgery.Methods In recent years, our hospital thoracic surgery, and postoperative acute respiratory distress syndrome in 80 cases, patients were diagnosed as acute respiratory distress syndrome into ICU, ventilator assisted breathing, oxygen concentration enhancement, active symptomatic treatment of patients with primary disease, strictly control the patient into the water to ensure drainage unobstructed, give sensitive antibiotic resistance to infection and nutritional support.Results After clinical treatment, 80 cases of patients with PaO2, PaCO2, RR, HR, MAP and BH and other clinical indicators have been significantlyimproved,P<0.05 comparison has statistical significance. After clinical treatment, 70 cases were cured (97.5%), 10 cases died (12.5%).Conclusion Comprehensive therapy is the most effective method for the treatment of acute respiratory distress syndrome.

  9. Addressing psychiatric comorbidity.

    Woody, G E; McLellan, A T; O'Brien, C P; Luborsky, L


    Research studies indicate that addressing psychiatric comorbidity can improve treatment for selected groups of substance-abusing patients. However, the chances for implementing the necessary techniques on a large scale are compromised by the absence of professional input and guidance within programs. This is especially true in public programs, which treat some of the most disadvantaged, disturbed, and socially destructive individuals in the entire mental health system. One starting point for upgrading the level of knowledge and training of staff members who work in this large treatment system could be to develop a better and more authoritative information dissemination network. Such a system exists in medicine; physicians are expected to read appropriate journals and to guide their treatment decisions using the data contained in the journals. Standards of practice and methods for modifying current practice are within the tradition of reading new facts, studying old ones, and comparing treatment outcome under different conditions with what is actually being done. No such general system of information-gathering or -sharing exists, particularly in public treatment programs. One of the most flagrant examples of this "educational shortfall" can be found among those methadone programs that adamantly insist on prescribing no more than 30 to 35 mg/day for all patients, in spite of the overwhelming evidence that these dose levels generally are inadequate. In some cases, program directors are unaware of studies that have shown the relationship between dose and outcome. In other cases, they are aware of the studies but do not modify their practices accordingly. This example of inadequate dosing is offered as an example of one situation that could be improved by adherence to a system of authoritative and systematic information dissemination. Many issues in substance abuse treatment do not lend themselves to information dissemination as readily as that of methadone dosing

  10. Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

    Chiriac A


    Full Text Available Anca Chiriac,1 Liliana Foia,2 Cristina Birsan,1 Ancuta Goriuc,2 Caius Solovan3 1Department of Dermatology, Nicolina Medical Center, Iaşi, Romania; 2Surgical Department, Grigore T Popa University of Medicine and Pharmacy, Iaşi, Romania; 3Department of Dermatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania Background: The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods: Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results: The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion: These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to

  11. Headache attributed to psychiatric disorders.

    Guidetti, Vincenzo; Galli, Federica; Sheftell, Fred


    The association between psychiatric illness and headache is widely recognized. "Headache attributed to psychiatric disorder" is a new category of secondary headache introduced in the 2004 revision of the International Classification of Headache Disorders (ICHD-II) (Headache Classification Subcommittee of the International Headache Society, 2004). It represents a new, but not conclusive, step toward a better systematization of the topic "headache and psychological factors." From the early 1990s the involvement of psychological factors in headache disorders has been clearly identified as "psychiatric comorbidity." The current conceptualization of the term implies an association, more than casual, but likely not causal, between an index disease or disorder and one or more coexisting physical or psychological pathologies. Additionally, clarifying the direction, meaning, and weight of comorbidities has pathophysiological, nosological, course, and treatment implications. However, the study of comorbidity may present a series of difficulties related to the current understanding of the etiology and pathophysiology of diseases at the center of our attention. Sometimes, as happens in the subject of headache, we proceed against a background where many issues need to be clarified. In this chapter, we analyze the past and current literature, tracing the line from "migraine personality" to "psychiatric comorbidity" to "headache attributed to psychiatric disorders." Questions related to etiology, pathophysiology, and treatment options are discussed for different headache subtypes.

  12. Visceral Pain and Psychiatric Disorders.

    Felice, Valeria D; Moloney, Rachel D; Cryan, John F; Dinan, Timothy G; O'Mahony, Siobhain M


    The high comorbidity existing between visceral pain and psychiatric disorders such as depression and anxiety is well documented and it is gaining increasing interest among scientists. When visceral pain and psychiatric disorders are comorbid, they present a more debilitating condition than each disorder alone, impacting significantly on the quality of life of these patients. Despite several groups having shown that an overlapping pathophysiology exists between visceral pain and stress-related disorders the link between them is not clear yet. Moreover, it still remains to be elucidated if psychiatric conditions predispose the individual to develop visceral hypersensitivity or vice versa. The brain-gut-microbiome axis is the bidirectional communication between the CNS and the gastrointestinal tract. Alterations at different levels of this axis have been implicated in both visceral hypersensitivity and psychiatric disorders. Here we give an overview of what it is known about comorbid visceral pain and psychiatric disorders and provide evidence of potential overlapping pathophysiological mechanisms involved. Preclinical models of comorbid visceral pain and stress-related disorders are also discussed. © 2015 S. Karger AG, Basel.

  13. Department of



    Aug 27, 2014 ... Ethiopian Journal of Environmental Studies & Management 7(5): 468 – 477, 2014 ... Department of Planning, Kwame Nkrumah University of Science and Technology .... Anglican and Presbyterian schools have all been mined; exposing school children to dust and .... the district office of the National Disaster.

  14. Acute psychological stress reduces working memory-related activity in the dorsolateral prefrontal cortex.

    Qin, S.; Hermans, E.J.; Marle, H.J.F. van; Luo, J.; Fernandez, G.S.E.


    BACKGROUND: Acute psychological stress impairs higher-order cognitive function such as working memory (WM). Similar impairments are seen in various psychiatric disorders that are associated with higher susceptibility to stress and with prefrontal cortical dysfunctions, suggesting that acute stress

  15. Family violence and psychiatric disorder.

    Bland, R; Orn, H


    The relationship between family violence and psychiatric disorders was examined using standardized diagnostic interviews of 1200 randomly selected residents of a large Canadian city. The results showed that higher than expected proportions of those exhibiting violent behavior had a psychiatric diagnosis and the rate of violent behaviors in those with diagnoses (54.4%) significantly (p less than .0001) exceeds the rate in the remainder of the sample (15.5%). Particularly high rates of violence are found in those where alcoholism is combined with antisocial personality disorder and/or recurrent depression (80-93%). Also at high risk for violence are those who have made suicide attempts (over 50%) and those who have been arrested for non-traffic offences (two-thirds). These data suggest that psychiatric disorders have a strong relationship to violent behavior, and are not in agreement with the predominantly sociological explanations of family violence.

  16. [Movement disorders is psychiatric diseases].

    Hidasi, Zoltan; Salacz, Pal; Csibri, Eva


    Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.

  17. Psychiatric Adverse Effects of Dermatological Drugs

    Mine Özmen


    Full Text Available Dermatological drugs, mostly corticosteroids and isotretinoin, cause different psychiatric adverse effects. During steroid therapy, a wide range of psychiatric conditions, from minor clinical symptoms like insomnia and anxiety to serious psychiatric syndromes like psychosis and delirium might be seen. In medical literature, a causal connection is usually suggested between “isotretinoin”, which is used for treatment of acne vulgaris and depression and suicide attempts. However, there are no statistically significant double-blind randomized studies that support this connection. Clinicians must know patient’s psychiatric history before using any dermatological treatment known as causing psychiatric adverse effects, and psychiatric consultation should be established whenever necessary.

  18. The nature of psychiatric disorders.

    Kendler, Kenneth S


    A foundational question for the discipline of psychiatry is the nature of psychiatric disorders. What kinds of things are they? In this paper, I review and critique three major relevant theories: realism, pragmatism and constructivism. Realism assumes that the content of science is real and independent of human activities. I distinguish two "flavors" of realism: chemistry-based, for which the paradigmatic example is elements of the periodic table, and biology-based, for which the paradigm is species. The latter is a much better fit for psychiatry. Pragmatism articulates a sensible approach to psychiatric disorders just seeking categories that perform well in the world. But it makes no claim about the reality of those disorders. This is problematic, because we have a duty to advocate for our profession and our patients against other physicians who never doubt the reality of the disorders they treat. Constructivism has been associated with anti-psychiatry activists, but we should admit that social forces play a role in the creation of our diagnoses, as they do in many sciences. However, truly socially constructed psychiatric disorders are rare. I then describe powerful arguments against a realist theory of psychiatric disorders. Because so many prior psychiatric diagnoses have been proposed and then abandoned, can we really claim that our current nosologies have it right? Much of our current nosology arose from a series of historical figures and events which could have gone differently. If we re-run the tape of history over and over again, the DSM and ICD would not likely have the same categories on every iteration. Therefore, we should argue more confidently for the reality of broader constructs of psychiatric illness rather than our current diagnostic categories, which remain tentative. Finally, instead of thinking that our disorders are true because they correspond to clear entities in the world, we should consider a coherence theory of truth by which disorders

  19. Optogenetics in psychiatric animal models.

    Wentz, Christian T; Oettl, Lars-Lennart; Kelsch, Wolfgang


    Optogenetics is the optical control of neuronal excitability by genetically delivered light-activated channels and pumps and represents a promising tool to fuel the study of circuit function in psychiatric animal models. This review highlights three developments. First, we examine the application of optogenetics in one of the neuromodulators central to the pathophysiology of many psychiatric disorders, the dopaminergic system. We then discuss recent work in translating functional magnetic resonance imaging in small animals (in which optogenetics can be employed to reveal physiological mechanisms underlying disease-related alterations in brain circuits) to patients. Finally, we describe emerging technological developments for circuit manipulation in freely behaving animals.

  20. Quinolones: review of psychiatric and neurological adverse reactions.

    Tomé, Ana M; Filipe, Augusto


    of reports, while for ofloxacin and pefloxacin, the number of reports may be over-representative. A total of 232 ADRs were identified from the selected articles, with 206 of these related to psychiatric and/or neurological ADRs. The other 26 were related to other body systems but were reported together with the reactions of interest. Mania, insomnia, acute psychosis and delirium were the most frequently reported psychiatric adverse events; grand mal convulsion, confusional state, convulsions and myoclonus were the most frequently reported neurological adverse events. Several aspects should be taken into account in the development of CNS adverse effects, such as the pharmacokinetics of quinolones, chemical structure and quinolone uptake in the brain. These events may affect not only susceptible patients but also 'healthy' patients.

  1. Do locked doors in psychiatric hospitals prevent patients from absconding?

    Undine E. Lang

    Full Text Available Background and Objectives: In the acute treatment of acute psychiatric patients coercive measures are often required and therapeutic relationships can be affected by such measures. In this study we assessed whether opening the entrance door of an acute psychiatric ward influences absconding behaviour. Methods: An acute psychiatric ward was primarily closed (91.4% for six months and primarily open (75.6% for six months over the time period of one year. In this one year period, 337 patients were treated (206 male, age: 40 ± 16 years: 60.2% of the patients had schizophrenia, 13.6% had affective disorders, 11.6% suffered from addiction and 14.5% displayed other diagnoses. Results: In terms of age (t = 0.026, df = 335, p = 0.979, gender (chi² = 1.6, df = 1, p = 0.13, diagnoses (chi² = 7.337, df = 1, p = 0.062 and duration of stay (t = -0.90, df = 335, p = 0.928, we found no significant differences between the patients admitted in the closed and those admitted in the open ward period. Absconding (df = 1, chi² = 5.107, p = 0.029, aggressive incidents (chi² = 4.46, df = 1, p = 0.050 and coercive medications (chi² = 4.646, df = 1, p = 0.037 were observed significantly more often in the closed door period. Moreover, the duration up to readmission was reduced in the closed time period (t = 2.314, df = 54, p = 0.025. Conclusions: We hypothesize that open doors reduce patient's discomfort, improve ward atmosphere and aggressive acts and do not appear to increase the risk of absconding.

  2. Department of internal medicine, emergency treatment of acute abdominal pain and clinical features in patients with diagnostic method%内科急诊急性腹痛患者诊断方法和临床特点



    Objective To analyze the diagnosis and clinical characteristics of patients with acute abdominal pain in emergency department of internal medicine.Methods 60 cases of hospital emergency treatment of acute abdominal pain were divided into observation group and control group with 30 cases in each group,the observation group uses the conventional combined examination of laboratory diagnosis, clinical analysis of characteristics of the patients with such.Results Accurate diagnosis rate was 98%, the misdiagnosis rate was 2%; the control group the accurate diagnosis rate of \\74%, the misdiagnosis rate was 26%, the difference was significant. Conclusion Emergency with acute abdomen, diagnosis method combined with laboratory routine diagnostic applications, not only can improve the accurate diagnosis rate, and effectively reduce the rate of misdiagnosis, missed diagnosis rate.%目的:分析内科急诊急性腹痛患者诊断及临床特点。方法将我院60例急诊急性腹痛患者分为观察组和对照组各30例,对照组常规诊断;观察组采用常规联合实验室检查诊断,分析此类患者临床发病特点。结果急性腹痛患者显示具有发病急、进展快、病情重的特点;观察组采用实验室检查诊断,准确诊断率98%,误诊率2%;对照组准确诊断率为74%,误诊率26%,差异显著。结论急诊急性腹痛患者中,应用常规诊断联合实验室检查诊断方法,不仅可以提高准确诊断率,同时有效减少误诊率、漏诊率。

  3. Family ties of crack cocaine users cared for in a psychiatric emergency department Vínculo familiar de usuarios de crack atendidos en una unidad de emergencia psiquiátrica Vínculo familiar de usuários de crack atendidos em uma unidade de emergência psiquiátrica

    Maycon Rogério Seleghim


    Full Text Available This study characterizes the family ties of crack cocaine users cared for in a psychiatric emergency department in southern Brazil. It is a qualitative study with a series of cases carried out in the city of Maringá, PR, Brazil from April to June 2010. Data were collected through semi-structured interviews, analyzed using content analysis, and organized into two categories: family ties as facilitators in the use of crack cocaine and other drugs; and fragmented family ties of crack users. Loss of relational bonds with family and social milieu was observed among the ten studied users in addition to the presence of drugs and violence in the family sphere. Further studies addressing the use of crack and its interface with the family are encouraged, taking into consideration that families have an essential role in the initiation and continuity of drug use.El objetivo del estudio fue conocer el vínculo familiar de usuarios de crack atendidos en una Unidad de Emergencia Psiquiátrica del Sur de Brasil. Se trata de una investigación cualitativa, con delineamiento de serie de casos, realizada en el municipio de Maringá, en Paraná, en el período de abril a junio de 2010. Para la recolección de datos se utilizó un guión semiestructurado de entrevista. Los datos fueron analizados siguiendo la técnica de análisis de contenido y organizados en dos categorías: el vínculo familiar como facilitador del uso de crack y otras drogas, y el vínculo familiar fragmentado de los usuarios de crack. Entre los diez usuarios investigados, se evidenció: pérdida de los vínculos relacionales con la familia y con el medio social y, presencia de drogas y violencia en el ambiente familiar. La realización de investigaciones sobre el uso de crack y su interfaz con la familia deben ser estimuladas, ya que las familias poseen un papel fundamental en la iniciación y continuidad del uso de drogas.O objetivo deste estudo foi conhecer o vínculo familiar de usu

  4. Biofeedback for psychiatric disorders: a systematic review

    Schoenberg, P.L.; David, A.S.


    Biofeedback potentially provides non-invasive, effective psychophysiological interventions for psychiatric disorders. The encompassing purpose of this review was to establish how biofeedback interventions have been used to treat select psychiatric disorders [anxiety, autistic spectrum disorders, dep

  5. Biofeedback for psychiatric disorders: a systematic review

    Schoenberg, P.L.; David, A.S.


    Biofeedback potentially provides non-invasive, effective psychophysiological interventions for psychiatric disorders. The encompassing purpose of this review was to establish how biofeedback interventions have been used to treat select psychiatric disorders [anxiety, autistic spectrum disorders,

  6. Skin disorders in chronic psychiatric illness

    Mookhoek, E. J.; van de Kerkhof, P. C. M.; Hovens, J. E. J. M.; Brouwers, J. R. B. J.; Loonen, A. J. M.


    Background Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. Objective To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. Methods Ninety-one randomly chosen patients of the

  7. A retrospective analysis of 1198 patients with acute heart failure treated in emergency department%1198例急性心力衰竭患者急诊抢救的回顾性分析

    李小宇; 秦俭; 梁潇; 华琦


    目的 对急性心力衰竭(心衰)患者的急诊抢救进行流行病学分析.方法 选择2005年1月~2011年12月我院急诊抢救室的15408例急诊患者中,急性心衰患者1198例的临床资料进行回顾性分析.结果 急性心衰患者占所有急诊抢救患者的7.8%.≥80岁高龄患者比例29.1%.急诊病死率12月份最高.急诊抢救好转出院或自动离院212例(17.7%),急诊住院580例(48.4%),继续急诊留院227例(18.9%),转院64例(5.3%),死亡115例(9.6%);每年急性心衰病死率无明显下降趋势;13.9%在入抢救室2h内死亡,63.5%在24 h内死亡.2010、2011年24 h内死亡比例较2008年以前明显下降(P<0.05).患者在抢救室滞留时间逐年延长.结论 急性心衰占急诊抢救患者的比例有逐年增加趋势,应重视并采取有效措施进一步降低急诊病死率,并减少急诊滞留时间.%Objective To provide the evidence for prevention and treatment of acute heart failure (AHF) by analyzing its epidemiology. Methods Clinical data about 1198 AHF patients admitted to our department from January 2005 to December 2011 were respectively analyzed. Results The AHF patients accouted for 7. 8% of the 1198 patients treated in emergency department. The proportion of elderly AHF patients has been increasing year by year. The hightest morbidity and mortality of AHF patients were observed in December. 212(17. 7%)returned to their home or left hospital voluntarily after treatment,580(48. 4%)were transfered to emergency wards,227(18. 9%) stayed in emergency department for observation, 64(5. 3%) were transferred to other hospitals, and 115(9. 6%)died. The mortality of AHF patients did not reduce significantly. Of the died patients,13. 9% died within 2 h and 63. 5% died within 24 h after they were admitted to emergency department. The 24 h mortality in 2011 and 2012 was significantly lower than in 2008 or before (P<0. 05). The stay time of AHF patients in emergency department has been

  8. Mental health related Internet use among psychiatric patients


    Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by comple...

  9. 预见性护理在产科急性弥漫性血管内凝血中的运用体会%Application experience of predictive nursing for acute disseminated intravascular coagulation in department of obstetrics



    目的 探讨预见性护理在产科急性弥漫性血管内凝血中的运用效果.方法 102例弥漫性血管内凝血患者, 随机分成对照组和观察组, 各51例.对照组给予常规护理干预, 观察组在常规护理的基础上给予预见性护理干预.观察比较两组的总有效情况.结果 观察组患者的治疗成功率、转院率、死亡率及平均输血量情况明显优于对照组, 差异具有统计学意义(P<0.05).结论 预见性护理可以显著提高产科急性弥漫性血管内凝血的治疗成功率, 提高母婴的安全, 值得临床推广应用.%Objective To investigate application effect by predictive nursing for acute disseminated intravascular coagulation in department of obstetrics.Methods A total of 102 patients with disseminated intravascular coagulation were randomly divided into control group and observation group, with 51 cases in each group. The control group received conventional nursing intervention, and the observation group received additional predictive nursing intervention. Total effectiveness of the two groups were observed and compared. Results The observation group had obviously better treatment success rate, hospital transfer rate, mortality rate, and average blood transfusion volume than the control group. Their differences all had statistical significance (P<0.05).Conclusion Predictive nursing can remarkably improve treatment success rate for acute disseminated intravascular coagulation in department of obstetrics, along with maternal and infant safety. It is worth clinical promotion and application.

  10. Community Psychiatric Rehabilitation in Israel.

    Levy, Amihay; Neumann, Micha


    This paper describes the development of community-based rehabilitation services for persons with mental illness in Israel. It focuses on occupational, social, and residential community psychiatric rehabilitation services. The paper argues that service development has been slow and out of step with the philosophy and objectives of community…

  11. Paraphilias in adult psychiatric inpatients.

    Marsh, Patrick J; Odlaug, Brian L; Thomarios, Nick; Davis, Andrew A; Buchanan, Stephanie N; Meyer, Craig S; Grant, Jon E


    The goal of the present study was to examine the prevalence of paraphilias in an adult inpatient psychiatric population. One hundred twelve consecutive, voluntarily admitted, adult male psychiatric inpatients were administered the Structured Clinical Interview for DSM-IV, Sexual Disorders Module, Male Version, to assess the rates of DSM-IV paraphilias. Fifteen patients (13.4%) reported symptoms consistent with at least one lifetime DSM-IV paraphilia. The most common paraphilias were voyeurism (n = 9 [8.0%]), exhibitionism (n = 6 [5.4%]), and sexual masochism (n = 3 [2.7%]). Patients who screened positive for a paraphilia had significantly more psychiatric hospitalizations (P = .006) and, on a trend level, were more likely to have attempted suicide. In addition, patients with paraphilias were significantly more likely to report having been sexually abused than patients without a paraphilia (P = paraphilia. Paraphilias appear to be more common in adult male psychiatric inpatients than previously estimated. The study also demonstrated that these disorders were not screened for by the treating physician and thus may go untreated. Further, larger-scale studies are necessary in order to further examine the rates of these disorders in the general population.

  12. Dyspepsia in chronic psychiatric patients

    Mookhoek, E.J.; Meijs, V.M.M.; Loonen, A.J.M.; Leufkens, H.G.M.


    Introduction: We report on dyspeptic complaints among patients hospitalized in the long-stay ward of a general psychiatric hospital. Methods: A representative sample of the patients was interviewed using a structured questionnaire. Results: Eighty percent of the patients reported one or more symptom

  13. Job satisfaction in psychiatric nursing.

    Ward, M; Cowman, S


    In recent years, mental health services across Europe have undergone major organizational change with a move from institutional to community care. In such a context, the impact of change on the job satisfaction of psychiatric nurses has received little attention in the literature. This paper reports on the job satisfaction of psychiatric nurses and data were collected in 2003. The population of qualified psychiatric nurses (n = 800) working in a defined geographical health board area was surveyed. Methodological triangulation with a between-methods approach was used in the study. Data were collected on job satisfaction using a questionnaire adopted from the Occupational Stress Indicator. A response rate of 346 (43%) was obtained. Focus groups were used to collect qualitative data. Factors influencing levels of job satisfaction predominantly related to the nurses work location. Other factors influencing job satisfaction included choice of work location, work routine, off duty/staff allocation arrangements, teamwork and working environment. The results of the study highlight to employers of psychiatric nurses the importance of work location, including the value of facilitating staff with choices in their working environment, which may influence the recruitment and retention of nurses in mental health services.

  14. Attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments.

    Shaoling, Zhong; Jun, Wang; Graham, Mellsop; Chen, Chen; Simei, Zhang; Qiguang, Li; Qun, Wang; Jiansong, Zhou; Xiaoping, Wang


    The aim of this study was to investigate the attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. A questionnaire designed to record attitudes toward the current forensic psychiatric assessment procedures and the disposal of mentally ill offenders was developed and distributed via a mobile App. A total of 134 community members and 132 psychiatrists voluntarily completed the questionnaire. Most of responders agreed that the department of public-security has the right to apply for a forensic psychiatric assessment but should not be held solely by that department. Community members were less significantly confident in the validation of forensic psychiatric opinions than were the psychiatrists. A significantly higher proportion of community members than psychiatrists considered that offenders judged Not Criminally Responsible on Account of Mental Disorder (NCRMD) should be punished as would be sane people. In addition, only a minority of responders supported that NCRMD should not be held criminally responsible. Our results indicate that both groups have comments on the current distribution of right of startup of forensic psychiatric assessments. Compared to psychiatrists, community members have lower confidence in the validation of forensic psychiatric assessment and have stricter attitudes toward the disposal of offenders with psychiatric disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Restless Legs Syndrome and Psychiatric Disorders.

    Mackie, Susan; Winkelman, John W


    There are strong epidemiologic ties between restless legs syndrome (RLS) and a wide array of psychiatric conditions. Although the mechanism of this association is not fully understood, there are likely bidirectional cause-and-effect relationships. Appreciation of psychiatric comorbidity is an essential component of the treatment of RLS. Clinicians should be prepared to facilitate appropriate psychiatric treatment and consider the complex interactions between psychiatric medications, RLS medications, and the clinical course of both illnesses.

  16. Dilemmas in private psychiatric practice

    Nanasaheb M Patil


    Full Text Available Background: A practicing psychiatrist faces dilemmas on a number of occasions, in deciding the best course of action he/she needs to undertake while treating a patient. At times, this choice may not be in accordance with the ethical and moral principles and may in fact appear to violate patient′s autonomy and rights. Aim: To study the nature of psychiatric practice by the practicing psychiatrist in the areas of admission, discharge, consent, physical restraint, electroconvulsive therapy (ECT, certification, treatment, suicide and psychotherapy. Settings and Design: Cross-sectional observational study. Materials and Methods: Forty-eight psychiatrists gave consent to participate in the study. A special proforma was prepared, which addresses the common dilemmas in the clinical psychiatric practice. All the psychiatrists were given specially designed profoma and were requested to fill the proforma with appropriate answers. Statistical analysis was done using SPSS software. Results: There were 42 male and 6 female psychiatrists. The age of the psychiatrists ranged from 28 to 65 years with a mean of 43.08 years. The mean duration of practice of these psychiatrists was 14.81΁11.07 years. Question and answers related to admission, discharge, consent, physical restraint, ECT, certification, treatment, suicide and psychotherapy are discussed. Conclusions: The present standard and practice especially in private psychiatric set-up does not confirm to the rules, recommendations, and regulations suggested by Mental Health Act 1987, Mental Health Authorities and various guidelines of practice. Indian Psychiatric Society and other professional bodies need to take steps to prepare guidelines for a good psychiatric practice.


    Saxena, Shekar; Wig, N.N.


    SUMMARY A brief review of literature on psychiatric morbidity associated with migration is presented, with particular emphasis on the problems of political refugees. Initial experiences with 152 Afghan nationals attending the psychiatric outpatient department of a general hospital in Delhi during a period of 18 months are described supported by retrospective data from the records. Problems encountered in adequate assessment and management of these patients are highlighted. Need for prospective and longitudinal research on this group of patients is pointed out. PMID:21847250

  18. Neurological and Psychiatric Conditions: Hand in Hand in the Emergency Room – Neurologist’s Perspective

    Cristina Costa


    Full Text Available Both neurologists and psychiatrists work under complex circumstances in the emergency department; these conditions may hinder diagnostic management of patients, especially when neurological and psychiatric disorders coexist. These two specialties frequently complement each other in their clinical approaches. In this paper, we will first address the psychiatric manifestations of neurological disorders, then the functional symptoms which mimic neuro- logical diseases. This latter group of symptoms constitutes the greatest challenge for the neurologist in the emergency room. 

  19. Predicting psychiatric symptoms among homeless people.

    Calsyn, R J; Morse, G A


    Multiple regression was used to predict psychiatric symptoms among homeless people. The following variables were significant predictors of psychiatric symptoms: current life satisfaction, previous psychiatric hospitalization, the number of stressful life events, social support, problem drinking, and childhood unhappiness. The results are discussed in terms of their policy and practice implications, particularly the need for crisis intervention services and for dual-diagnosed clients.

  20. The psychoactive effects of psychiatric medication: the elephant in the room.

    Moncrieff, Joanna; Cohen, David; Porter, Sally


    The psychoactive effects of psychiatric medications have been obscured by the presumption that these medications have disease-specific actions. Exploiting the parallels with the psychoactive effects and uses of recreational substances helps to highlight the psychoactive properties of psychiatric medications and their impact on people with psychiatric problems. We discuss how psychoactive effects produced by different drugs prescribed in psychiatric practice might modify various disturbing and distressing symptoms, and we also consider the costs of these psychoactive effects on the mental well-being of the user. We examine the issue of dependence, and the need for support for people wishing to withdraw from psychiatric medication. We consider how the reality of psychoactive effects undermines the idea that psychiatric drugs work by targeting underlying disease processes, since psychoactive effects can themselves directly modify mental and behavioral symptoms and thus affect the results of placebo-controlled trials. These effects and their impact also raise questions about the validity and importance of modern diagnosis systems. Extensive research is needed to clarify the range of acute and longer-term mental, behavioral, and physical effects induced by psychiatric drugs, both during and after consumption and withdrawal, to enable users and prescribers to exploit their psychoactive effects judiciously in a safe and more informed manner.


    Lakshimi Borgohain


    Full Text Available BACKGROUND Electroconvulsive Therapy (ECT among adolescent psychiatric patient is rarely used and studies in this regard are also rare, while its need is of great importance. Aim of this study was to study the prevalence of ECT in common psychiatric illnesses among adolescent age group, where it is indicated and outcome of ECT in those psychiatric patients. MATERIALS AND METHODS All data were collected retrospectively from the chart review for those adolescents aged between 12 to 18 years who received ECT during the period of 2008 - 2012. During the study period a total of 554 patients received ECT, among whom 104 were adolescents. RESULTS Adolescent patients were 18.77% in the whole ECT sample; the average age of the adolescents was 16.33 years and number of patients were more with older age. Among all the patients, 48.08% had positive family history of mental illness and 81.73% were from lower Socioeconomic Class. The use of ECT was more with schizophrenia (n= 63, 60.57% and acute and transient psychotic disorder (n= 30, 28.85%. The most common indication was agitation and aggression (n= 29, 27.88% followed by poor medication response (n= 19, 18.27%. Good response is found in most of the cases (n= 88, 84.62%, only a few percentage of cases showed minor and transient adverse event. CONCLUSION The result of our study suggests that prevalence of ECT among adolescent psychiatric patients is quite high and ECT is a safe and effective method of treatment in the adolescent psychiatric patients, especially those patients who are severely ill and poorly responding to medication.

  2. Psychiatric morbidity in dermatology patients: Frequency and results of consultations

    Seyhan Muammer


    Full Text Available BACKGROUND: Dermatological patients quite commonly depict psychiatric morbidity. PURPOSES: To study the psychiatric morbidity among skin patients of our clinic. METHODS: In the present study, the patients who were treated in the Dermatology Clinic of Inonu University Medical Faculty were evaluated retrospectively. The age, gender, marital status, habits, dermatological and systemic diseases, previously used drugs, current therapy and psychiatric diagnosis of each patient were recorded. FINDINGS: Of 636 patients involved in the study, 15.3% had psychopathological problems, which were depression (32.0%, adjustment difficulty (15.5%, anxiety (13.4%, psychosomatic disorders (10.3%, obsessive-compulsive disorder and conversion (5.1%, dysthymic disorder (4.1%, attention deficit and hyperactivity disorder (2.1%, panic attack (1.0%, premenstrual syndrome, schizophrenia, somatization disorder, insomnia, alcohol dependency, bipolar affective disorder, mental retardation, agoraphobia, social phobia and dementia. The dermatological diseases defined for the patients with psychopathology diagnosis were chronic urticaria (25.8%; psoriasis (15.5%; alopecia areata, totalis and iniversalis (11.3%; acute urticaria, neurodermatitis and Behcet′s disease (5.1%; atopic dermatitis and drug eruptions (4.1%; pemphigus (3.1%; angioedema, contact dermatitis and generalized pruritus (2.1%; folliculitis and the others (1.0%. CONCLUSIONS: Psychiatric morbidity has an affect on the course of dermatological diseases. When required, psychiatric consultation should be sought by dermatology clinics and patients should be followed with the cooperation of dermatologists and psychiatrists. LIMITATION: The indoor-based study had not included any control group and any domicillary patient.

  3. Psychiatric Aspects of Childhood Epilepsy

    Raman Deep PATTANAYAK


    of children with epilepsy. J Child Neurol 1997;12(3:187-92.44. Pavlou E, Gkampeta A. Learning disorders in children with epilepsy. Childs Nerv Sys 2011;27(3:373-9.45. Fastenau PS, Shen J, Dunn DW, Perkins SM, Hermann BP, Austin JK. Neuropsychological predictors of academic underachievement in pediatric epilepsy: moderating roles of demographic, seizure, and psychosocial variables. Epilepsia 2004;45(10:1261-72.46. Austin JK, Caplan R. Behavioral and psychiatric comorbidities in pediatric epilepsy: toward an integrative model. Epilepsia 2007;48(9:1639-51.47. Austin JK, McNelis AM, Shore CP, Dunn DW, Musick B. A feasibility study of a family seizure management program ‘Be seizure smart’. J Neurosci Nurs 2002;34:30-7.48. Ronen GM, Streiner DL, Rosenbaum P. Health-related quality of life in childhood epilepsy: Moving beyond ‘seizure control with minimal adverse effects’. Health Qual Life Outcomes 2003;1:36.49. Smith K, Siddarth P, Zima B, Sankar R, Mitchell W Gowrinathan R, et al. Unmet mental health needs in pediatric epilepsy: insights from providers. Epilepsy Behav 2007;11(3:401-8.50. Goldstein J, Plioplys S, Zelko F, Mass S, Corns C, Blaufuss R, et al. Multidisciplinary approach to childhood epilepsy: exploring the scientific rationale and practical aspects of implementation. J Child Neurol 2004;19(5:362-78.51. Achenbach TM. Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, VT: Univ. of Vermont Department of Psychiatry; 1991.52. Gadow KD, Sprafkin J. Child symptom inventory-4 norms manual. Stony Brook, NY: Checkmate Plus; 1997.53. Sabaz M, Cairns DR, Lawson JA, Nheu N, Bleasel AF, Bye AM. Validation of a new quality of life scale for children with epilepsy. Epilepsia 2000;41(6:765-74.54. Camfield C, Breau L, Camfield P. Impact of pediatric epilepsy on the family: a new scale for clinical and research use. Epilepsia 2001;42(1:104-12.55. Lewis MA, Salas I, de la Sota A, Chiofalo N, Leake B. Randomized trial of

  4. Hypernatremia in the Emergency Department

    Neslihan YÜCE


    Full Text Available INTRODUCTION: To determine the symptoms, clinical characteristics, prevalence and outcome of patients with hypernatremia who presented at the emergency department. MATERIAL and METHODS: We retrospectively studied patients who presented at the emergency department with hypernatremia (Na>148 meq/l from January 2008 to December 2008. RESULTS: A total of 25.545 cases presented at the Emergency Department and hypernatremia was seen in 86 patients. The prevalence of hypernatremia was 0.34%. The mean age was 69.5±15.2 (20- 96, median age: 75 years and 51 of them (59% were male. Forty percent of the patients died. There were no significant differences according to age, gender and admission Na levels. A comorbid disease were seen 99% of patients. Cerebrovascular disease(CVD, dementia/Alzheimer and hypertension were the most common co-morbid diseases (respectively, 34%, 34%,and 27%. Central neurological system disorders (such as thrombotic or hemorrhagic CVD, Alzheimer, etc. were seen in 72% of the cases. Fifty patients had acute infection at the time of admission. Acute urinary infection, pneumonia and acute CVD were the most common acute illnesses. CONCLUSION: Hypernatremia is usually seen in the geriatric population and associated with a high mortality and morbidity rate and the majority of patients with hypernatremia have a comorbid disease. The prevalence of hypernatremia was 0.34% in our emergency department.

  5. A Q fever outbreak in a psychiatric care institution in The Netherlands

    Koene, R.P.M.; Schimmer, B.; Rensen, H.; Biesheuvel, M.; Bruin, A. de; Lohuis, A.; Horrevorts, A.; Lunel, F.V.; Delsing, C.E.; Hautvast, J.L.A.


    In May 2008 the Nijmegen Municipal Health Service (MHS) was informed about an outbreak of atypical pneumonia in three in-patients of a long-term psychiatric institution. The patients had been hospitalized and had laboratory confirmation of acute Q fever infection. The MHS started active case finding

  6. The relationship between substance use and exit security on psychiatric wards

    Simpson, A.; Bowers, L.; Allan, T.; Haglund, K.; Muir-Cochrane, E.; Nijman, H.L.I.; Merwe, M. van der


    Aim. In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Background. Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming

  7. Occurrence of comorbid substance use disorders among acute ...

    some patients, the mental disorder and substance use might ... Therefore, this study was conducted to examine the prevalence of SUD among acute adult psychiatric inpatients at Stikland Hospital .... Substance induced anxiety disorders. 0.

  8. Recollected experiences of first hospitalisation for acute psychosis ...

    psychiatric hospital admission for acute psychosis of people diagnosed with schizophrenia. ..... having his basic needs met by others. Note that .... participants have strong emotional requirements of the nursing staff. The nurse-patient ...

  9. Bilateral thalamic infarction with psychiatric symptoms: case report

    Betül Tekin Güveli


    Full Text Available Introduction: Thalamus is a mass of gray matter, which plays a role in the transmission of sensory and motor information to the primary sensory and motor centers of the cerebral cortex, cerebellum and basal ganglia. Vascular lesions of thalamus may occur in different syndromes depending on the affected nuclei. In this report, a case with acute evolving personality and behavior changes and detected bilateral thalamic infarction will be presented. Case: A 40-year-old male patient was brought to the psychiatric ER with complaints of acute excessive sleep and behavioral changing. His neurological examination was normal except for limited cooperation and dysarthria. There was hyperintensity in bilateral paramedian thalamic regions in diffusion MRI and hypointensity in the right side in the ADC. During clinical observation the patient occasionally had visual hallucinations and attempted suicide. The psychiatrist diagnosed the patient with psychotic disorder due to his general medical condition and olanzapine 10 mg / day was prescribed. Etiological tests were normal. The patient was discharged after clinical improvement on the tenth day of hospitalization. Conclusion: Bilateral thalamic infarcts are very rare in all ischemic cerebrovascular diseases and typically result in changing of consciousness, gaze palsy and memory. The most common etiological cause of bilateral thalamic infarct is cardioembolism and the prognosis is generally good. Thalamic infarcts have a clinical spectrum varying according to the location of the lesion and may even just be present with psychiatric symptoms. In acute or subacute personality and behavior changes in a patient with no history of psychiatric disorders, thalamic lesions should be considered.

  10. Hypoglycemia in Emergency Department

    Yu-Jang Su; Chia-Jung Liao


    Objective:To study the epidemiology, etiologies and prognostic factors of hypoglycemia. Methods:A retrospective chart review of hypoglycemic cases from December, 2009 to February, 2012 was conducted to gather the following patient data: age, gender, vital signs at triage, white blood cell count, serum glucose, C-reactive protein, glutamic oxaloacetic transaminase, creatinine, sodium, potassium, past history of liver cirrhosis, uremia, concomitant infection, concomitant cancer/malignancy, length of stay, lack of recent meal, status of acute renal failure and concomitant stroke. A total of 186 cases were enrolled in our study. We analyzed the data using commercial statistics software (SPSS for Windows, version 11.0, SPSS Inc., Chicago, IL). We used the Student's t-test andχ2 test for the statistical analyses, and significance was set at a P value less than 0.05. Results: Hypoglycemia is related to several co-morbidities. In total, 10.2%of the patients had liver cirrhosis and 7.0% had uremia. More than half (55.4%) were bacterial infection during hospitalization. Acute renal failure accounted for 26.3%of the hypoglycemic episodes. In addition to the etiology of infection, the lack of a recent meal accounted for 44.6%hypoglycemic episodes. A total of 2.2%of the cases resulted from an acute cerebrovascular accident. Approximately 8.6%were concomitant with malignancy. Conclusions: When hypoglycemic patients present in the emergency department, physicians should pay attention to the presence of infection, malignancy, liver diseases (liver cirrhosis and biliary tract infection), and acute renal failure.

  11. Catatonia in the emergency department.

    Jaimes-Albornoz, Walter; Serra-Mestres, Jordi


    Disturbances of the level of awareness are a frequent motive of attendance to emergency departments where the initial assessment and management will determine the direction of their outcome. The syndrome of catatonia must be taken into consideration and although it is normally associated with psychiatric diagnoses, it is also very often found in a great variety of neurological and medical conditions. Due to the clinical complexity of catatonia, there are still difficulties in its correct identification and initial management, something that leads to diagnostic delays and increased morbidity and mortality. In this article, a review of the literature on catatonia is presented with the aim of assisting emergency department doctors (and clinicians assessing patients in emergency situations) in considering this condition in the differential diagnosis of stupor due to its high frequency of association with organic pathology.

  12. [Ketamine: psychiatric indications and misuses].

    Delimbeuf, N; Petit, A; Karila, L; Lejoyeux, M


    Ketamine or -ketamine hydrochloride- is used as an anesthesic and a painkiller. It may also, in some indications, be prescribed in psychiatry and addictology. A literature review was conducted from 2003 to 2013, in PubMed, Google Scholar, Embase, and Psyclnfo, using the following key words (alone or combined): "ketamine", "abuse", "addiction", "dependence" and "misuse". Various studies have shown the benefit of kétamine in some psychiatric conditions such as major depressive episodes and electroconvulsive therapy. Others have demonstrated beneficial effects in alcohol or opiate abstinence maintenance. Ketamine seems to be a promising molecule in psychiatry and in the treatment of addictions, despite the absence of marketing approval for those specific uses. Being a strong psycho-stimulant, ketamine can be the source of abuse and dependence with somatic, psychiatric and cognitive complications.

  13. Perinatal psychiatric disorders: an overview.

    Paschetta, Elena; Berrisford, Giles; Coccia, Floriana; Whitmore, Jennifer; Wood, Amanda G; Pretlove, Sam; Ismail, Khaled M K


    Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed. Copyright © 2014 Mosby, Inc. All rights reserved.

  14. Imaging genetics and psychiatric disorders.

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M


    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-Omethyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of largescale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders.

  15. Postgraduate psychiatric training in Thailand.

    Ratta-Apha, Woraphat; Sitdhiraksa, Nantawat; Saisavoey, Nattha; Lortrakul, Manote; Udomratn, Pichet


    In Thailand, after medical students graduated from medical schools, the general practitioners have to work for the government for at least three years. Then, they can enroll in postgraduate training program. Postgraduate training usually takes three to four years. All of the psychiatric training programs are supervised and monitored by the board of education of the Royal College of Psychiatrists of Thailand (RCPsychT). One of the missions of all training institutes is to prepare residents to be the high qualified psychiatrists to serve the mental well-being of Thai people. Additionally, they should teach the learners to be the leaders in academic and research fields in psychiatry. Currently, there are nine psychiatric training institutions in Thailand, most of which are running by university programs. The training program core curriculum composes of the compulsory rotations such as general psychiatry, child and adolescent psychiatry, neurology, consultation-liaison psychiatry, mental hospital psychiatry and addiction psychiatry. Moreover, the residents also have three months for elective in each program. The learning process includes practicing in an out-patient and in-patient unit under psychiatric staff supervision, individual and group supervision, case conference, journal club, book club and grand round etc. Research in field of psychiatry and social sciences is also compulsory for board examination. The RCPsychT approved two Certificate Diplomas including Diploma of Thai Board of Psychiatry, and Diploma of Thai Board of Child and Adolescent Psychiatry. There are only nine psychiatric training institutes and only thirty to forty residents enrolled in these programs in each year. The compact and collaboration of all training institutes bring about the benefits in efficiency programs management by regular meeting of representatives from each institute. They keep the standard of training program to progress in the same vision and direction. Furthermore, residents

  16. Dissociative Experiences in Psychiatric Inpatients

    Ali Firoozabadi; Nooshin Reza Alizadeh


    Dissociative disorders are conditions that involve disruptions of memory, awareness, identity, or perception. Data collected in diverse geographic locations underline the consistency in clinical symptoms of dissociative disorders. In this cross-sectional descriptive study, prevalence of dissociative experiences has been screened in hospitalized patients in psychiatric wards of Shiraz University of Medical Sciences in Iran. One hundred and sixty patients in two hospitals entered the study. Our...

  17. Imaging Genetics and Psychiatric Disorders

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M


    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-O-methyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of large-scale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders. PMID:25732148

  18. Psychiatric Thoughts in Ancient India

    Ravi Abhyankar


    Full Text Available A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry.

  19. The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital

    Barfod Charlotte


    Full Text Available Abstract Background Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1 to describe the formation and design of the 'Acute Admission Database', and 2 to characterize the cohort included. Methods All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1 Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2 Blood sample results taken at admission, including a venous acid-base status, and 3 Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission. Results In primary triage, patients were categorized as red (4.4%, orange (25.2%, yellow (38.7% and green (31.7%. Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%, saturation of peripheral oxygen (9.2%, Glasgow Coma Score (6.6% and respiratory rate (4.8%. A venous acid-base status was obtained in 43% of all patients. The majority (78% had a pH within the normal range (7.35-7.45, 15% had acidosis (pH 7.45. Median length of stay was 2 days (range 1-123. The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0, 1.8% (95% CI 1.5-2.2 died within 7 days, and 4.2% (95% CI 3.7-4.7 died within 28 days after admission

  20. Psychiatric nursing: an unpopular choice.

    Jansen, R; Venter I


    Research studies in the United States, the United Kingdom, New Zealand and Australia suggest that students do not consider psychiatric nursing as a popular career option. According to this research, there is a widespread concern about the nursing shortages in psychiatry. The demand for mental health services continues to grow and there is a need for strategies to recruit nurses for this specialized field. The purpose of this study was to identify the factors preventing undergraduate nursing students in South Africa (SA) from choosing psychiatric nursing as a career. A qualitative research design that aimed to explore and describe was used. Data were collected through the Nominal Group Technique. A sample of convenience of 27 final year nursing students from the School of Nursing at the University of the Free State as well as the Free State School of Nursing, situated in Bloemfontein (SA), voluntarily participated in this research. The following categories emerged from the content analysis of the data: personal factors, working environment, unprofessional behaviour, learning environment and the unclassified category. Psychiatric nursing as a career choice is in a predicament and nursing schools need to implement practical strategies to recruit future nurses for this field.

  1. Dissociative Experiences in Psychiatric Inpatients

    Ali Firoozabadi


    Full Text Available Dissociative disorders are conditions that involve disruptions of memory, awareness, identity, or perception. Data collected in diverse geographic locations underline the consistency in clinical symptoms of dissociative disorders. In this cross-sectional descriptive study, prevalence of dissociative experiences has been screened in hospitalized patients in psychiatric wards of Shiraz University of Medical Sciences in Iran. One hundred and sixty patients in two hospitals entered the study. Our tool to screen the prevalence of dissociative experiences was Dissociative Experience Scale (DES. Linear regression analysis shows that gender and age are predictors of high DES scores to some extent while psychiatric disorders are not good predictors. Age, gender and psychiatric disorders are poor predictors (almost 7% of high DES scores in this study (R square=0.69. In this study, patients with Borderline Personality Disorder had higher dissociative experiences based on DES score (Mean: 56.44, followed by Schizophrenic patients (Mean: 28.22 and patients with Bipolar Personality Disorder (Mean: 25.18. This study showed that we might be able to create a new category in psychological disorders based on dissociative experiences. As age, gender and psychological disorders were poor predictors of dissociative experiences, stronger predictors such as positive childhood psychological traumas could be responsible for dissociative disorders.

  2. TRP channels and psychiatric disorders.

    Chahl, Loris A


    Depression and schizophrenia are major psychiatric disorders that cause much human suffering. Current treatments have major limitations and new drug targets are eagerly sought. Study of transient receptor potential (TRP) channels in these disorders is at an early stage and the potential of agents that activate or inhibit these channels remains speculative. The findings that TRPC6 channels promote dendritic growth and are selectively activated by hyperforin, the key constitutent of St John's wort, suggest that TRPC6 channels might prove to be a new target for antidepressant drug development. There is now considerable evidence that TRPV1 antagonists have anxiolytic activity but there is no direct evidence that they have antidepressant activity. There is also no direct evidence that TRP channels play a role in schizophrenia. However, the findings that TRPC channels are involved in neuronal development and fundamental synaptic mechanisms, and that TRPV1 channels play a role in central dopaminergic and cannabinoid mechanisms is suggestive of potential roles of these channels in schizophrenia. Investigation of TRP channels in psychiatric disorders holds the promise of yielding further understanding of the aetiology of psychiatric disorders and the development of new drug treatments.

  3. Psychiatric aspects of air pollution.

    Lundberg, A


    Psychological and toxic effects of air pollution can lead to psychiatric symptoms, including anxiety and changes in mood, cognition, and behavior. Increased levels of some air pollutants are accompanied by an increase in psychiatric admissions and emergency calls and, in some studies, by changes in behavior and a reduction in psychological well-being. Numerous toxic pollutants interfere with the development and adult functioning of the nervous system. Manifestations are often insidious or delayed, but they can provide a more sensitive indicator of toxic effects than cancer rates or mortality data. Other medical effects of air pollution, such as asthma, can indirectly affect psychological health. The sick building syndrome and multiple chemical sensitivity are conditions with toxicologic and psychiatric aspects. Psychosocial stress can cause symptoms similar to those of organic mental disorders. Reactions to stress depend on cultural, individual, and situational variables. We must understand these factors to be able to alleviate and prevent the consequences of environmental trauma. Expanded research is recommended in three main areas: (1) how people perceive and cope with environmental health risks, (2) the effects of air pollution on behavior and neuropsychological functioning, and (3) neurotoxicologic evaluation of air pollutants with both behavioral and in vitro studies.

  4. [The psychiatric illness of Vincent van Gogh].

    Strik, W K


    Vincent van Gogh's illness has been the object of much speculation. Explanations as disparate as acute intermittent porphyria, epilepsy and schizophrenia have been proposed. Many of the diagnostic hypotheses, however, are based on partial or incomplete consideration of the biography and of the reports of his subjective experience in his letters to his brother. Karl Leonhard showed, in a detailed analysis of Vincent's biography, that both the course and symptoms of the disorder were consistent with the diagnosis of a cycloid psychosis (anxiety-elation psychosis). In the present paper, the diagnostic judgement of Leonhard is described and discussed in the light of independent research on van Gogh's letters, his works and biography. The bibliographical sources were investigated for information consistent with a cycloid psychosis, but also for information that might contradict this hypothesis. The course and symptoms of the disorder are presented as comprehensively and systematically as possible and are documented with the respective citations. Furthermore, the most important diagnoses proposed in the literature are critically discussed. Based on this investigation, it was possible to show that only the diagnosis of a cycloid psychosis allowed us to connect all the available information to a typical psychiatric syndrome.

  5. Musical hallucinations - a challenge for psychiatric therapeutical management. Case report.

    Focseneanu, B E; Marian, G


    Background. Musical hallucinations occur in individuals with and without mental illness, and many patients tend to have intact reality testing. Although literature on musical hallucinations is limited, they have been associated with hearing abnormalities, adverse effects of pharmacological agents, female gender, advances in age and psychiatric illness. Aim. To present the psychiatric management of a case of an old female patient, who suddenly developed verbal and musical hallucinations with a pervasive impact on her daily activities. Method. Female, 71 years old, developed verbal and musical hallucinations 6 months before that have intensified later. She was known with bilateral hypoacusia starting with the age of 45, and magnetic resonance imaging performed 1 year before proved multiple lacunar infarcts. Because of the persistence, most of the time of these auditory hallucinations, the patient experienced pervasive difficulties with her major areas of activities. She was referred to a psychiatric department for evaluation and treatment. Results. The psychiatric consult revealed neither a depressive relapse, nor a mild cognitive impairment, and obsessive-compulsive disorder was suspected with intrusive obsessions. Patient received, as antiobsessional augmentation escitalopram 10mg/ day, an atypical antipsychotic, risperidone, which at 3 mg/ day induced extrapyramidal symptoms and cognitive impairment. Therefore, the dose of risperidone was reduced, extrapyramidal symptoms disappeared, and 300mg/ day of acidum valproicum was initiated. Discussion. Our patient presented with diminished sensory input to the auditory cortex, and it was hard to make a differential diagnosis between an organic and a mental etiology. Conclusion. The integration of musical hallucinations into a psychiatric disorder may be a difficult task, and, their treatment represents a challenge.

  6. EMTALA and patients with psychiatric emergencies: a review of relevant case law.

    Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T


    Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  7. Ambient Particulate Matter (PM2.5/PM10) Exposure and Emergency Department Visits for Acute Myocardial Infarction in Chaoyang District, Beijing, China During 2014: A Case-Crossover Study

    Zhang, Qian; Qi, Weipeng; Yao, Wei; Wang, Mei; Chen, Yiyong; Zhou, Yujie


    Background Epidemiology studies have shown a consistently increased risk of acute myocardial infarction (AMI) correlated with particulate matter (PM) exposure. However, little is known about the association with specific AMI subtypes. In this work, we investigated the association between short-term PM exposure and emergency department visits (EDVs) for AMI, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). Methods We based this case-crossover study on 2749 patients from Chaoyang District hospitalized with AMI in Anzhen Hospital during 2014. Meteorological and air pollution data were collected during this period. We used a time-stratified case-crossover design with lag model, adjusted for meteorological conditions and/or other gaseous pollutants, to estimate risk of EDVs for AMI, STEMI, and NSTEMI. We conducted stratified analyses by gender, age, season, and comorbid conditions to examine potential effect modification. Results We found that each 10 µg/m3 increment of PM2.5 concentration (1-day lagged) was associated with an increased risk of EDVs for STEMI (OR 1.05; 95% CI, 1.00–1.11). We found no association of PM2.5 concentration with overall AMI or NSTEMI. No effect modification was found when stratified by gender, season, or comorbid conditions, even though the effect size was larger in patients who were male, smokers, and comorbid with hypertension. Patients aged ≥65 years showed a significantly increased risk of STEMI associated with PM2.5 in the previous day than those aged <65 years. Conclusions Our study indicated a transient effect of short-term PM2.5 exposure on EDVs for STEMI. Patients aged ≥65 years appeared to be particularly susceptible. Our findings suggest that studies of the association between PM exposure and AMI should consider AMI subtypes, lag times, and individual characteristics. PMID:27064131

  8. Heart-type fatty acid binding protein (H-FABP) in patients in an emergency department setting, suspected of acute coronary syndrome: optimal cut-off point, diagnostic value and future opportunities in primary care.

    Willemsen, Robert T A; van Severen, Evie; Vandervoort, Pieter M; Grieten, Lars; Buntinx, Frank; Glatz, Jan F C; Dinant, Geert Jan


    Most patients presenting chest complaints in primary care are referred to secondary care facilities, whereas only a few are diagnosed with acute coronary syndrome (ACS). The aim is to determine the optimal cut-off value for a point-of-care heart-type fatty acid binding protein (H-FABP) test in patients presenting to the emergency department and to evaluate a possible future role of H-FABP in safely ruling out ACS in primary care. Serial plasma H-FABP (index test) and high sensitivity troponin T (hs-cTnT) (reference test) were determined in patients with any new-onset chest complaint. In a receiver operating characteristic (ROC) curve, the optimal cut-off value of H-FABP for ACS was determined. Predictive values of H-FABP for ACS were calculated. For 202 consecutive patients (prevalence ACS 59%), the ROC curve based on the results of the first H-FABP was equal to the ROC curve of hs-cTnT (AUC 0.79 versus 0.80). Using a cut-off value of 4.0 ng/ml for H-FABP, sensitivity for ACS of the H-FABP (hs-cTnT) tests was 73.9% (70.6%). Negative predictive value (NPV) of H-FABP for ACS in a population representative for primary care (incidence of ACS 22%) thus could reach 90.8%. In patients presenting chest pain, plasma H-FABP reaches the highest diagnostic value when a cut-off value of 4 ng/ml is used. Diagnostic values of an algorithm combining point-of-care H-FABP measurement and a score of signs and symptoms should be studied in primary care, to learn if such an algorithm could safely reduce referral rate by GPs.

  9. [Development of Human Resources to Solve Psychiatric Issues].

    Ozaki, Norio


    Psychiatric research is important to answer daily clinical questions, clarify the etiopathology, and develop diagnostic methods and treatments based on the etiopathology. Therefore, the goal of departments of psychiatry in universities is to train the next generation of leaders in psychiatry who can promote innovative and personalized care for patients. In terms of the development of research-oriented human resources, it is necessary to emphasize the importance of prioritizing patients' demands and education regarding the following points:1) After the critical appraisal of papers, we have to elucidate what we know and what we do not know to clearly determine the purpose of research (Social or scientific value). 2) We have to use accepted methods, including statistical techniques, to produce reliable and valid data (Scientific validity). In addition, we should introduce ethical considerations into clinical research, including informed consent. The development of research-oriented human resources is indispensable for future research focused on the needs of psychiatric patients and their families.

  10. Psychiatric disorders are overlooked in patients with drug abuse

    Kruckow, Line; Linnet, Kristian; Banner, Jytte


    Introduction: Psychiatric disease is overlooked in drug users. Patients with both drug abuse and a psychiatric disease – dual diagnosis – suffer decreased compliance to treatment and decreased life expectancy compared with single-diagnosis patients. Identifying the patients among ­either drug...... addicts or mentally ill patients is difficult. Methods: All drug addicts autopsied at the Department of Forensic Medicine, University of Copenhagen, Denmark, in the years 1992, 2002 and 2012 were included. The group was divided into two subpopulations of possible dual diagnosis patients either according...... to police reports stating mental illness or to psychotropics found in the toxicology screening after autopsy. Results: We found a rise in possible mental illness in both subpopulations in the study period. Drug addicts with psychotropics in the blood at the time of death increased from 3.1% in 1992 to 48...

  11. Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department Validez de las pruebas diagnósticas realizadas a pacientes con dolor abdominal agudo en un servicio de urgencias hospitalario

    J. A. Navarro Fernández


    Full Text Available Objective: to determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain. Methods: a retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient's final diagnosis. Results: our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%, followed by cholecystitis (10%. We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%. Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy's sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively. Conclusions: a anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b ultrasound scans offer a low diagnostic agreement index for appendicitis; and c laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.Objetivo: determinar la importancia real que en sí tienen la anamnesis, la exploración física y las diferentes pruebas complementarias en la valoraci

  12. Usage of psychiatric emergency services by asylum seekers: Clinical implications based on a descriptive study in Denmark.

    Reko, Amra; Bech, Per; Wohlert, Cathrine; Noerregaard, Christian; Csillag, Claudio


    Asylum seekers are found to be at high risk of mental health problems. Little is known about the use of acute psychiatric emergency services by asylum seekers. To describe the usage of an inpatient/outpatient psychiatric emergency service in Denmark by adult asylum seekers, and discuss clinical implications. This descriptive study is based on retrospective data collected from patient charts during a 3-month period. A total of 31 evaluations were made (3.3% of all evaluations), based on 23 asylum seekers. Patients originated from 16 different countries, were predominantly male and married. The group consisted primarily (61%) of failed asylum seekers. Most patients (81%) presented with relevant mental health problems. The main reasons for presenting to the acute psychiatric emergency service were suicidal ideation and/or behaviour (60%). The most frequent diagnosis given at the initial evaluation was ICD-10 F43.9 "reaction to severe stress, unspecified" (50%). Evaluations were made primarily by non-psychiatrists. No standardized screening or diagnostic instrument was used. This first description of the use of an acute psychiatric emergency service by asylum seekers in Denmark shows some of the acute mental health needs asylum seekers present with. The findings of high levels of suicidal ideation and possible diagnostic difficulties are discussed, as well as possible improvements of the referral and psychiatric evaluation processes.

  13. Mitochondrial dysfunction in psychiatric morbidity: current evidence and therapeutic prospects

    Toker L


    Full Text Available Lilach Toker,1 Galila Agam2,3 1Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; 2Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 3Mental Health Center, Beer-Sheva, Israel Abstract: Cumulating evidence for the involvement of mitochondrial dysfunction in psychiatric disorders leaves little to no doubt regarding the involvement of this pathology in mood disorders. However, mitochondrial abnormalities are also observed in a wide range of disorders spanning from cancer and diabetes to various neurodegenerative and neurodevelopmental disorders such as Parkinson’s, Alzheimer’s, Huntington’s, autism, and amyotrophic lateral sclerosis. The apparent lack of specificity questions the role of mitochondrial dysfunction in psychiatric disorders, in general, and in mood disorders, in particular. Is mitochondrial dysfunction a general phenomenon, simplistically rendering brain cells to be more vulnerable to a variety of disease-specific perturbations? Or is it an epiphenomenon induced by various disease-specific factors? Or possibly, the severity and the anatomical region of the dysfunction are the ones responsible for the distinct features of the disorders. Whichever of the aforementioned ones, if any, is correct, “mitochondrial dysfunction” became more of a cliché than a therapeutic target. In this review, we summarize current studies supporting the involvement of mitochondrial dysfunction in different psychiatric disorders. We address the question of specificity and causality of the different findings and provide an alternative explanation for some of the aforementioned questions. Keywords: bipolar disorder, psychiatric disorders, schizophrenia, Stanley Foundation Brain Collection

  14. The paediatric psychiatric emergency population in a university teaching hospital in Belgium (2003-2008).

    Cuypers, Pieter J V; Danckaerts, Marina; Sabbe, Marc; Demyttenaere, Koen; Bruffaerts, Ronny


    In the last few decades, there has been a remarkable increase in the number of children and adolescents presenting with psychiatric complaints to the emergency department in the USA. In Europe, however, less is known about the paediatric psychiatric emergency population. This study provides a clinical and demographic profile of this population and its service use in a European context. From 2003 to 2008, we registered 989 paediatric psychiatric patients consulting the psychiatric emergency services (PES) of a large university hospital in Belgium. During this period the number of patients increased more than three-fold. Patients were predominantly female (57.3%) and adolescent (83.3%) and mostly referred for hostility and violence towards others (18.5%) and suicidal ideation (17.8%). For about 1/4 of the patients, PES was the first ever mental health treatment contact. PES could serve as a place for early detection and intervention and as an entry point to mental health services.

  15. Sociodemographic characteristics and frequency of psychiatric disorders in Turkish pilgrims attended to psychiatry outpatient clinics during Hajj

    Şakir Özen


    Full Text Available Objectives: The psychiatric problems of pilgrims fromnon-Arabic speaking countries have not been investigatedsufficiently. The aim of this study was to investigate thefrequency of psychiatric disorders and socio-demographiccharacteristics of Turkish pilgrims in psychiatry departmentof Turkish Mecca Hospital.Methods: A detailed psychiatric interview was performedon 294 Turkish Pilgrims who attended the outpatient clinicof the psychiatric unit at the Turkish hospital in Mecca,Saudi Arabia, during 2008 Hajj period. Information wascollected by using a semi-structured form and the patients’diagnoses were done according to the DSM-IV-TRcriteria.Results: The study group consisted of 175 women (59.5% and 119 men (40.5 % with the mean age of 53.0±13years. A total of 71 % patients had not traveled abroadpreviously, and 60% had received a former psychiatrictreatment. The commonest disorders were found asdepression (26.5%, adjustment disorder with anxiety(16.3% and panic disorder (14% in the patients. Anxietydisorders alone or co-morbid with any other psychiatricdisorder were found in 49% of the patients. Nine percentof the patients had symptoms of acute psychosis, schizophrenia,dementia or mania which could prevent pilgrimsfrom performing Hajj rituals. Suicide attempt, alcohol andillicit drug use were not detected.Conclusions: Previous psychiatric admission and absenceof any foreign travel experience were commonamong Turkish pilgrims who had sought psychiatric helpduring the Hajj. Psychiatric disorders seems to be relatedwith older age, low educational level, and having previousmedical and psychiatric problems.

  16. Acute myocardial infarction with multiple coronary thromboses in a young addict of amphetamines and benzodiazepines

    Mohammed A. Al Shehri


    Full Text Available A 35-year-old man of average build and a smoker, with a background of a psychiatric disorder, was brought by his neighbor to the emergency department after an hour of severe chest pain. Upon arrival at the hospital he had cardiac arrest, was resuscitated, and moved to the catheterization laboratory with inferior, posterior, and lateral myocardial infarction. Coronary angiography showed an unusual thrombosis in multiple coronary branches. Toxicology report showed high levels of amphetamines and benzodiazepines in the patient’s original blood sample. The patient was kept under ventilation for 18 days, with difficult recovery due to severe withdrawal manifestations, ventilation acquired pneumonia, and rhabdomyolysis inducing acute renal failure. The patient regained near normal left ventricular function after baseline severe regional and global dysfunction. We postulate a relationship between the use of amphetamines, potentiated by benzodiazepines, and occurrence of acute thrombosis of multiple major coronary arteries.

  17. Literature-based recommendations for suicide assessment in the emergency department: a review.

    Ronquillo, Linda; Minassian, Arpi; Vilke, Gary M; Wilson, Michael P


    Suicidal ideation and attempted suicide are important presenting complaints in the Emergency Department (ED). The Joint Commission established a National Patient Safety Goal that requires screening for suicidal ideation to identify patients at risk for suicide. Given the emphasis on screening for suicidal ideation in the general hospital and ED, it is important for Emergency Physicians to be able to understand and perform suicide risk assessment. A review of literature was conducted using PubMed to determine important elements of suicide assessment in adults, ages 18 years and over, in the ED. Four typical ED cases are presented and the assessment of suicide risk in each case is discussed. The goal of an ED evaluation is to appropriately determine which patients are at lowest suicide risk, and which patients are at higher or indeterminate risk such that psychiatry consultation is warranted while the patient is in the ED. Emergency clinicians should estimate this risk by taking into account baseline risk factors, such as previous suicide attempts, as well as acute risk factors, such as the presence of a suicide plan. Although a brief screening of suicide risk in the ED does not have the sensitivity to accurately determine which patients are at highest risk of suicide after leaving the ED, patients at lowest risk may be identified. In these low-risk patients, psychiatric holds and real-time psychiatric consultation while in the ED may not be needed, facilitating more expeditious dispositions from the ED. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. The structure of psychiatric science.

    Kendler, Kenneth S


    This essay addresses two interrelated questions: What is the structure of current psychiatric science and what should its goals be? The author analyzed all studies addressing the etiology of psychiatric disorders in the first four 2013 issues of 12 psychiatry and psychology journals. He classified the resulting 197 articles by the risk factors examined using five biological, four psychological, and three environmental levels. The risk factors were widely dispersed across levels, suggesting that our field is inherently multilevel and already practicing empirically based pluralism. However, over two-thirds of the studies had a within-level focus. Two cross-level patterns emerged between 1) systems neuroscience and neuropsychology and 2) molecular or latent genetic factors and environmental risks. The author suggests three fundamental goals for etiological psychiatric research. The first is an eclectic effort to clarify risk factors regardless of level, including those assessed using imaginative understanding, with careful attention to causal inference. An interventionist framework focusing on isolating causal effects is recommended for this effort. The second goal is to clarify mechanisms of illness that will require tracing causal pathways across levels downward to biological neuroscience and upward to social factors, thereby elucidating the important cross-level interactions. Here the philosophy of biology literature on mechanisms can be a useful guide. Third, we have to trace the effects of these causal pathways back up into the mental realm, moving from the Jasperian level of explanation to that of understanding. This final effort will help us expand our empathic abilities to better understand how symptoms are experienced in the minds of our patients.

  19. Martyrs of the psychiatric hospitals

    Serra Paolo


    Full Text Available This article is based on the history of an Italian psychiatric hospital (Arezzo that closed in 1989 and was turned into a university. The illegal and inhumane treatment in asylum-type institutions is condemned. In particular the treatment of those patients who, according to the analysis, hospital directors referred to as “social cases.” These individuals did not stay in hospital because of health problems but only due to the lack of social care by the state. AS a consequence they are condemned to be “prisoners” without committing any crimes.

  20. Psychiatric specialty training in Greece.

    Margariti, M; Kontaxakis, V; Ploumpidis, D


    The reform and development of psychiatric services require, in addition to financial resources, reserves in specialized human resources. The role of psychiatrists in this process, and at reducing the consequences of mental morbidity is evident. Psychiatrists are required to play a multifaceted role as clinicians, as experts in multidisciplinary team environments and as advisors in the recognition of public needs in mental health issues, as teachers and mentors for students and other health professionals, as researchers in order to enrich our knowledge in the scientific field of psychiatry, and as public health specialists in the development of the mental health services system. This multifaceted role requires the continuous education of modern psychiatrists, but above all a broad, substantial and comprehensive training regime in the initial stage of their professional career, that is to say during specialization. Training in Psychiatry, as indeed has happened in all other medical specialties, has evolved considerably in recent decades, both in the content of education due to scientific advances in the fields of neurobiology, cognitive neuroscience, genetics, psychopharmacology, epidemiology and psychiatric nosology, and also because of advances in the educational process itself. Simple apprenticeship next to an experienced clinician, despite its importance in the clinical training of young psychiatrists, is no longer sufficient to meet the increased demands of the modern role of psychiatrists, resulting in the creation of educational programs defined by setting and pursuing minimum, though comprehensive educational objectives. This development has created the global need to develop organizations intended to supervise training programs. These organizations have various forms worldwide. In the European Union, the competent supervising body for medical specialties is the UEMS (European Union of Medical Specialities) and particularly in the case of the psychiatric

  1. Volatile substance abuse: a review of possible long-term neurological, intellectual and psychiatric sequelae.

    Ron, M A


    The possibility that chronic abuse of volatile substances can cause permanent neurological, psychiatric, and intellectual sequelae is critically reviewed. Toluene, present in the commonly used adhesives, is most often implicated in 'glue sniffing'; this review focuses on its potential long-term effects. Many criticisms--particularly poor matching of control samples and inability to distinguish between acute and chronic effects--can be levelled at the available studies, while no adequate follow-up studies have been performed. In the light of present knowledge, the possibility that permanent structural brain damage, with accompanying psychiatric manifestations, results from solvent abuse remains inconclusive.

  2. Psychiatric sequelae of traumatic brain injury

    Suprakash Chaudhury


    Full Text Available Almost half of the people suffering traumatic brain injury (TBI may later be diagnosed with psychiatric disorders. The literature (PubMed, IndMed of past 30 years on psychiatric disturbances associated with TBI is reviewed. The authors highlight the close link between head injury and psychiatry and provide an overview of the epidemiology, risk-factors, and mechanisms of psychiatric sequelae including, cognitive deficits, substance abuse, psychoses, mood disorders, suicide, anxiety disorders, dissociative disorders, post-concussion syndrome, and personality changes following head injury. The various psychiatric sequelae are briefly discussed.

  3. [Mental capacity of psychiatric patients].

    Wu, Kevin Chien-Chang


    Nearly every society maintains legal norms that define those members of society qualified to participate in social affairs. Mental capacity and legal competence are deemed necessary conditions for legal actions to have legal validity. On Nov. 23, 2009, newly revised adult guardianship provisions came into effect in Taiwan. However, there has been lack of discussion with regard to how assessments of mental capacity and legal competence should be conducted on psychiatric patients. This paper reviewed relevant overseas literature on this subject and followed common practice in separating legal mental capacity into causal and functional components. The causal component predicates the diseases and illnesses that render the disability, while the functional component represents legally substantial impairments in terms of cognition, emotion and behavior. The paper explored functional component contents, including finance management, individual health care, independence in daily life, interpersonal relationships and communing. Findings pointed out that in setting up competence standards, a trade-off between respect for autonomy and beneficence is unavoidable. As Taiwan does not have rich empirical data on competence assessments and decisions, collaboration between the legal and psychiatric professions is recommended to engage in relevant research to enhance legal consistencies and the science of competence assessment.

  4. Psychiatric rehabilitation education for physicians.

    Rudnick, Abraham; Eastwood, Diane


    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination ( Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011).

  5. [Adoption and its psychiatric aspects].

    Burgeois, M


    Adoption has changed in history, in different cultures, in law, in its goals, its functions, its modalities. The study of the adoptive condition is worthwhile for theoretical research (psychopathology, genetics, etc.) and for clinical practice (prevention, selection and motivation analysis of adopting parents). It is dangerous and too simple to explain pathology by adoption. However, there is a specific psychopathology of adoptees : 1. by maternal deprivation and abandonnement pathology (more frequent and more important), 2. by the adoptive situation condition itself. We review some hypotheses, particularly the concept of "Family romance". The adopted child undergoes more frequent examinations, both pediatric and psychiatric, than the ordinary child (this may be explained by parental anxiety and child acting out behavior). Certain American statistics on this appear to be significant. On the other hand, there is a silent pathology (the majority ?) : we found it frequently in the youngest children in France. We discuss the problem of psychiatric selection of adoptive parents and adoptive children, its legitimacy, its methodes ; psychopathology and motivations of the adoptive patents ; the problem of the revelation of adoption to the child ; the problem of sterility (it is often incompletely explored and treated). Adoption may not be the best solution for most of the abandonned children and sterile couples.

  6. Time Perception and Psychiatric Disorders

    Hatice Ceviz


    Full Text Available Time perception is an ability which we use in every moment of daily life, that guides the formation and continuation of our behaviors and from an evolutionary perspective ensures survival. Internal clock models help us to understand time perception. Time perception is known to vary between individuals and particular situations. This variability is explained with the mechanisms which is associated with the processes related to attention, the speed of the internal clock and the memory unit. It is suggested that time perception is mainly associated with the activities of dopamine and acetylcholine. Some dopaminergic psychoactive substances like cocaine and amphetamine have all been shown to change time perception by increasing the speed of internal clock while on the other hand some antipsychotic drugs make an opposite change in time perception by descreasing the speed of the clock. Similarly, time perception is affected in some psychiatric disorders and an ethiopathological relationship between time perception disturbances and psychiatric disorders is suggested. In this article time perception changes in schizophrenia, attention deficit/hyperactivity syndrome, depression, anxiety disorders and personality disorders are briefly reviewed.

  7. [Compulsive buying and psychiatric comorbidity].

    Mueller, Astrid; Mühlhans, Barbara; Silbermann, Andrea; Müller, Ulrike; Mertens, Christian; Horbach, Thomas; Mitchell, James E; de Zwaan, Martina


    Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

  8. Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder

    William P. Nash, MD


    Full Text Available This article summarizes the recommendations of the Department of Veterans Affairs (VA/Department of Defense (DOD VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress that pertain to acute stress and the prevention of posttraumatic stress disorder, including screening and early interventions for acute stress states in various settings. Recommended interventions during the first 4 days after a potentially traumatic event include attending to safety and basic needs and providing access to physical, emotional, and social resources. Psychological first aid is recommended for management of acute stress, while psychological debriefing is discouraged. Further medical and psychiatric assessment and provision of brief, trauma-focused cognitive-behavioral therapy are warranted if clinically significant distress or functional impairment persists or worsens after 2 days or if the criteria for a diagnosis of acute stress disorder are met. Follow-up monitoring and rescreening are endorsed for at least 6 months for everyone who experiences significant acute posttraumatic stress. Four interventions that illustrate early intervention principles contained in the VA/DOD Clinical Practice Guideline are described.

  9. Differences in maladaptive schemas between patients suffering from chronic and acute posttraumatic stress disorder and healthy controls

    Ahmadian A


    Full Text Available Alireza Ahmadian,1,2 Jafar Mirzaee,1 Maryam Omidbeygi,1 Edith Holsboer-Trachsler,3 Serge Brand3,41Department of Psychology, Kharazmi University, 2Sadr Psychiatric Hospital, Janbazan Medical and Engineering Research Center (JMERC, Tehran, Iran; 3Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, 4Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland Background: War, as a stressor event, has a variety of acute and chronic negative consequences, such as posttraumatic stress disorder (PTSD. In this context, early maladaptive schema-based problems in PTSD have recently become an important research area. The aim of this study was to assess early maladaptive schemas in patients with acute and chronic PTSD.Method: Using available sampling methods and diagnostic criteria, 30 patients with chronic PTSD, 30 patients with acute PTSD, and 30 normal military personnel who were matched in terms of age and wartime experience were selected and assessed with the Young Schema Questionnaire-Long Form, Beck Depression Inventory second version (BDI-II, the Beck Anxiety Inventory (BAI, and the Impact of Events Scale (IES.Results: Both acute and chronic PTSD patients, when compared with normal military personnel, had higher scores for all early maladaptive schemas. Additionally, veterans suffering from chronic PTSD, as compared with veterans suffering from acute PTSD and veterans without PTSD, reported more impaired schemas related, for instance, to Self-Control, Social Isolation, and Vulnerability to Harm and Illness.Discussion: The results of the present study have significant preventative, diagnostic, clinical, research, and educational implications with respect to PTSD. Keywords: veterans, PTSD, depression, anxiety 

  10. Gluten encephalopathy with psychiatric onset: case report

    Costantini Chiara


    Full Text Available Abstract Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15% gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders. A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.

  11. Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF).

    Craig, Louise E; McInnes, Elizabeth; Taylor, Natalie; Grimley, Rohan; Cadilhac, Dominique A; Considine, Julie; Middleton, Sandy


    Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED. Studies of any design, conducted in ED, where barriers or enablers based on primary data were identified for one or more of these six clinical behaviours. Major biomedical databases (CINAHL, OVID SP EMBASE, OVID SP MEDLINE) were searched using comprehensive search strategies. The barriers and enablers were categorised using the theoretical domains framework (TDF). The behaviour change technique (BCT) that best aligned to the strategy each enabler represented was selected for each of the reported enablers using a standard taxonomy. Five qualitative studies and four surveys out of the 44 studies identified met the selection criteria. The majority of barriers reported corresponded with the TDF domains of "environmental, context and resources" (such as stressful working conditions or lack of resources) and "knowledge" (such as lack of guideline awareness or familiarity). The majority of enablers corresponded with the domains of "knowledge" (such as education for physicians on the calculated risk of haemorrhage following intravenous thrombolysis [tPA]) and "skills" (such as providing opportunity to treat stroke cases of varying complexity). The total number of BCTs assigned was 18. The BCTs most frequently assigned to the reported enablers were "focus on past success" and "information about health consequences." Barriers and enablers for the delivery of key evidence-based protocols in an emergency setting have

  12. How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

    Meltem Çoban Ağca


    Full Text Available Objective: We aimed to investigate the success rate of non-invasive ventilation (NIV in wards and the predictors of failure in cases of chronic obstructive pulmonary disease (COPD-related acute hypercapnic respiratory failure (AHRF. Methods: The was a retrospective study conducted in a tertiary teaching hospital between May 2011 and 2013. Patients who were admitted to the emergency department (ED because of COPD with AHRF were evaluated; 544 patients who initially received NIV in ED and were transferred to wards were included. Patient characteristics, baseline and follow-up pH values, and partial arterial carbon dioxide (PaCO2 values were recorded. Baseline pH values were categorized as severe (pH<7.26, moderate (pH≥7.26–7.30, and mild (pH≥7.30 acidosis. According to the in-hospital outcome, patients were classified in 2 groups: Group 1: home discharge, Group 2: death or intensive care unit transfer. Results: Treatment resulted in success in 477 (88% patients. Albumin levels were significantly low and the mean Charlson index (CI score was significantly high in Group 2. Admission pH and PaCO2 values did not affect the treatment outcome. Patients in Group 2 had higher PaCO2 and lower pH values as well as a lower level of decrease in PaCO2 values within 2 hours of treatment in ED. Similarly, higher PaCO2 and lower pH values at the end of the first day in wards were indicative of NIV failure (p<0.05. Conclusion: The success rate of NIV in wards in cases of AHRF is high. Patients with low albumin levels and higher CI scores have worse response to treatment. pH or PaCO2 values after a few hours of treatment and not the baseline pH or PaCO2 values are better predictors than the baseline pH and PaCO2 values.

  13. Short-term reconsultation, hospitalisation, and death rates after discharge from the emergency department in patients with acute heart failure and analysis of the associated factors. The ALTUR-ICA Study.

    Miró, Òscar; Gil, Víctor; Martín-Sánchez, Francisco Javier; Herrero, Pablo; Jacob, Javier; Sánchez, Carolina; Xipell, Carolina; Aguiló, Sira; Llorens, Pere


    The aim of this study was to define the following in patients with acute heart failure (AHF) discharged directly from accident and emergency (A&E): rates of reconsultation to A&E and hospitalisation for AHF, and all-cause death at 30 days, rate of combined event at 7 days and the factors associated with these rates. The study included patients consecutively diagnosed with AHF during 2 months in 27 Spanish A&E departments who were discharged from A&E without hospitalisation. We collected 43 independent variables, monitored patients for 30 days and evaluated predictive factors for adverse events using Cox regression analysis. We evaluated 785 patients (78±9) years, 54.7% women). The rates of reconsultation, hospitalisation, and death at 30 days and the combined event at 7 days were: 26.1, 15.7, 1.7 and 10.6%, respectively. The independent factors associated with reconsultation were no endovenous diuretics administered in A&E (HR 2.86; 95% CI 2.01-4.04), glomerular filtration rate (GFR)<60ml/min/m(2) (1.94; 1.37-2.76) and previous AHF episodes (1.48; 1.02-2.13); for hospitalisation these factors were no endovenous diuretics in A&E (2.97; 1.96-4.48), having heart valve disease (1.61; 1.04-2.48), blood oxygen saturation at arrival to A&E<95% (1.60; 1.06-2.42); and for the combined event no endovenous diuretics in A&E (3.65; 2.19-6.10), GFR<60ml/min/m(2) (2.22; 1.31-3.25), previous AHF episodes (1.95; 1.04-3.25), and use of endovenous nitrates (0.13; 0.02-0.99). This is the first study in Spain to describe the rates of adverse events in patients with AHF discharged directly from A&E and define the associated factors. These data should help establish the most adequate approaches to managing these patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  14. Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point-of-care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta-analysis.

    Benabbas, Roshanak; Hanna, Mark; Shah, Jay; Sinert, Richard


    Acute appendicitis (AA) is the most common surgical emergency in children. Accurate and timely diagnosis is crucial but challenging due to atypical presentations and the inherent difficulty of obtaining a reliable history and physical examination in younger children. The aim of this study was to determine the utility of history, physical examination, laboratory tests, Pediatric Appendicitis Score (PAS) and Emergency Department Point-of-Care Ultrasound (ED-POCUS) in the diagnosis of AA in ED pediatric patients. We performed a systematic review and meta-analysis and used a test-treatment threshold model to identify diagnostic findings that could rule in/out AA and obviate the need for further imaging studies, specifically computed tomography (CT) scan, magnetic resonance imaging (MRI), and radiology department ultrasound (RUS). We searched PubMed, EMBASE, and SCOPUS up to October 2016 for studies on ED pediatric patients with abdominal pain. Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality and applicability of included studies. Positive and negative likelihood ratios (LR+ and LR-) for diagnostic modalities were calculated and when appropriate data was pooled using Meta-DiSc. Based on the available literature on the test characteristics of different imaging modalities and applying the Pauker-Kassirer method we developed a test-treatment threshold model. Twenty-one studies were included encompassing 8,605 patients with weighted AA prevalence of 39.2%. Studies had variable quality using the QUADAS-2 tool with most studies at high risk of partial verification bias. We divided studies based on their inclusion criteria into two groups of "undifferentiated abdominal pain" and abdominal pain "suspected of AA." In patients with undifferentiated abdominal pain, history of "pain migration to right lower quadrant (RLQ)" (LR+ = 4.81, 95% confidence interval [CI] = 3.59-6.44) and presence of "cough/hop pain" in the physical

  15. Tempo de chegada do paciente com infarto agudo do miocárdio em unidade de emergência Time of arrival of patients with acute myocardial infarction to the emergency department

    Alessandra Soler Bastos


    Full Text Available OBJETIVO: Caracterizar o perfil das pessoas com infarto agudo do miocárdio (IAM atendidas em um serviço de emergência e verificar o tempo de chegada (delta T. Identificar como o paciente foi transportado e correlacionar o delta T com o tratamento e prognóstico do mesmo. MÉTODOS: Pesquisa transversal, incluindo 52 pacientes admitidos na Unidade de Emergência de um Hospital de Ensino com diagnóstico de IAM, no período de julho a dezembro de 2010. A coleta de dados foi realizada por meio do prontuário e entrevista. RESULTADOS: A maioria dos pacientes era do gênero masculino, com idade média de 62,35 ± 14,66 anos, casada, poucos anos de estudo, histórico familiar de doença cardíaca, hipertensão arterial, dislipidemia e sedentarismo. Os sintomas apresentados foram dor no tórax, região epigástrica ou desconforto torácico associado à dispneia e/ou sudorese súbita. A maioria dos pacientes foi transportada por ambulância e submetida a cateterismo cardíaco, seguido de angioplastia. O delta T encontrado foi 9h54min ± 18h9min. A letalidade global do estudo foi de 3,85%. CONCLUSÃO: O reconhecimento dos sinais e sintomas do IAM pelo paciente foi fator determinante para a procura de atendimento especializado e aqueles com menor delta T apresentaram melhor prognóstico.OBJECTIVES: To characterize the profile of patients with acute myocardial infarction (AMI treated at the emergency department and to verify the time of arrival of each patient (ΔT. Identify how the patient was transported and to correlate Delta-T (ΔT with the treatment and the prognosis of each patient. METHODS: Cross-sectional survey involving 52 patients with AMI admitted to the Emergency Department of a Teaching Hospital took part in the study from July to December 2010. Data collection was performed using medical records and interviews. RESULTS: The majority of the patients were male with a mean age of 62.35 ± 14.66 years. The participants were married, with low

  16. [The onset of psychiatric disorders and Wilson's disease].

    Benhamla, T; Tirouche, Y D; Abaoub-Germain, A; Theodore, F


    Wilson's disease is an infrequent, autosomic recessive pathology, resulting from a loss of function of an adenosine triphosphatase (ATP7B or WDNP), secondarily to a change (more than 60 are described currently), insertion or deletion of the ATP7B gene located on the chromosome 13q14.3-q21.1, which involves a reduction or an absence of the transport of copper in the bile and its accumulation in the body, notably the brain. Wilson's disease is transmitted by an autosomic recessive gene located on the long arm of chromosome 13. The prevalence of the heterozygote is evaluated at 1/90 and the homozygote at 1/30,000. Consanguinity, frequent in the socially geographically isolated populations, increases the prevalence of the disease. The toxic quantities of copper, which accumulate in the liver since early childhood and perhaps before, remain concentrated in the body for years. Hence, cytological and histological modifications can be detected in the biopsies, before the appearance of clinical or biological symptoms of hepatic damage. The accumulation of copper in the liver is due to a defect in the biliary excretion of metal and is accompanied invariably by a deficit in ceruloplasmin; protein synthesized from a transferred ATP7B gene, which causes retention of the copper ions in the liver. The detectable cellular anomalies are of two types: hepatic lesions resulting in acute hepatic insufficiency, acute hepatitis and finally advanced cirrhosis and lesions of the central nervous system responsible for the neurological and psychiatric disorders. In approximately 40-50% of the patients, the first manifestation of Wilson's disease affects the central nervous system. Although copper diffuses in the liver towards the blood and then towards other tissues, it has disastrous consequences only in the brain. It can therefore cause either a progressive neurological disease, or psychiatric disorders. Wilson's disease begins in the form of a hepatic, neurological, or psychiatric




    Full Text Available OBJECTIVE: To estimate prevalence of psychiatric co - morbidity and its effect on quality of life in persons with Hansen’s disease. METHOD: The study was conducted on around 80 persons above 18 year age with Hansen’s disease in out - patient department dermatology and i n leprosy home. Participants were diagnosed cases of Hansen’s disease, selected randomly and were evaluated with socio demographic questionnaire, Duke’s general health questionnaire, DSM - 5 self rated level 1 cross cutting symptom measure – adult and WHO - QO L - BREF. The period of data collection was from October 2014 to March 2015. RESULTS: The assessment showed that prevalence of at least one psychiatric co morbidity was 83.75% (67/80 patients and of these 67 patients 18(26.86% have one diagnosis, 26(38.80% have two diagnoses and 23(34.32% have 3 or more psychiatric diagnoses. Among all depression was most prevalent (28.35% mental disorder; followed by anxiety disorder (23.88%. Quality of life was significantly impaired in almost all persons with Hansen’ s disease. CONCLUSION: Persons with Hansen’s disease have significantly high prevalence of mental disorders which have much impact on their quality of life which were under diagnosed and thus remained untreated

  18. [Review of the psychiatric aspects of anti-NMDA (N-methyl-D-aspartic acid) receptor encephalitis, case report, and our plans for a future study].

    Herman, Levente; Zsigmond, Ildiko Reka; Peter, Laszlo; Rethelyi, Janos M


    Anti-NMDAR (N-methyl-D-aspartic acid receptor) encephalitis, first described in 2007, is a rare, autoimmune limbic encephalitis. In half of the cases anti-NMDAR antibodies are paraneoplastic manifestations of an underlying tumor (mostly ovarian teratoma). In the early stage of the disease psychiatric symptoms are prominent, therefore 60-70% of the patients are first treated in a psychiatric department. In most of the cases, typical neurological symptoms appear later. Besides the clinical picture and typical symptoms, verifying presence of IgG antibodies in the serum or CSF is necessary to set up the diagnosis. Other diagnostic tools, including laboratory tests, MRI, lumbar puncture or EEG are neither specific, nor sensitive enough. Therapy is based on supportive care, plasma exchange and immune suppression, intensive care administration can be necessary. If there is an underlying tumor, tumor removal is the first-line treatment. The disease can cause fatal complications in the acute phase but with adequate therapy long-term prognosis is good, although rehabilitation can last for months. In the past few years besides the typical clinical picture and illness course an increasing number of case reports described no typical neurological symptoms, only psychiatric symptoms, including psychosis, disorganized behavior, and catatonic symptoms. Immune suppressive treatment was still effective in most of these cases. Such cases present a difficult diagnostic challenge. These patients may receive unnecessary antipsychotic treatment because of the suspected schizophrenia, although they often suffer from serious extrapyramidal side effects. A few years ago there was a hypothesis that a small part of the patients who are treated with therapy-resistant schizophrenia may suffer from anti-NMDAR encephalitis, so they require a different kind of medication. Evidence from the latest publications did not confirm this hypothesis, although the connection between anti-NMDAR antibodies and

  19. Cultural Issues in Psychiatric Administration and Leadership.

    Aggarwal, Neil Krishan


    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation's largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges.

  20. Stress levels of psychiatric nursing staff

    Looff, P.C. de; Kuijpers, E.; Nijman, H.L.I.


    During a total of 30 shifts, the arousal levels of 10 psychiatric nurses were assessed while working on a (forensic) psychiatric admissions ward. Arousal was assessed by means of a small device (wristband) by which the Skin Conductance Level (SCL) of the participating nurses was monitored. Each nurs

  1. Stress levels of psychiatric nursing staff

    Looff, P.C. de; Kuijpers, E.; Nijman, H.L.I.


    During a total of 30 shifts, the arousal levels of 10 psychiatric nurses were assessed while working on a (forensic) psychiatric admissions ward. Arousal was assessed by means of a small device (wristband) by which the Skin Conductance Level (SCL) of the participating nurses was monitored. Each

  2. Psychiatric disorders of patients seeking obesity treatment

    Lin Hung-Yen


    Full Text Available Abstract Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.

  3. Wang Shufen,A Psychiatric Nurse


    WANG Shufen, a cheerful 26, has been a nurse at a psychiatric hospital for seven years. However, when asked about her profession, she still says "I’m a nurse," omitting "in a psychiatric hospital." Wang wanted to become a nurse after she left middle school. She applied to several nurse training schools, and was

  4. Perceived sleep quality of psychiatric patients

    de Niet, G. J. (Gerrit); Tiemens, B. G. (Bea); Lendemeijer, H. H. G. M. (Bert); Hutschemaekers, G. J. M. (Giel)

    This paper aims at acquiring knowledge about the quality of sleep of adult and elderly psychiatric patients who receive clinical or outpatient nursing care, and identifying key factors in perceiving a sleep problem. To do so, a sample of 1699 psychiatric patients were asked whether they perceived a

  5. Psychiatric disorders and urbanization in Germany

    Dekker, J.J.M.; Peen, J.; Koelen, J.A.; Smit, H.F.E.; Schoevers, R.A.


    Abstract Background Epidemiological studies over the last decade have supplied growing evidence of an association between urbanization and the prevalence of psychiatric disorders. Our aim was to examine the link between levels of urbanization and 12-month prevalence rates of psychiatric disorders in

  6. Teaching Creative Writing in a Psychiatric Setting.

    Press, Simone N.

    This paper reports the results of creative writing workshops in various psychiatric hospitals that have demonstrated that individuals in psychiatric settings have particular needs, affinities, and receptivities to the means of self-expression and communication available through creative writing. The purgative effect of Emily Dickinson's poetry and…

  7. Teaching Creative Writing in a Psychiatric Setting.

    Press, Simone N.

    This paper reports the results of creative writing workshops in various psychiatric hospitals that have demonstrated that individuals in psychiatric settings have particular needs, affinities, and receptivities to the means of self-expression and communication available through creative writing. The purgative effect of Emily Dickinson's poetry and…

  8. [Psychiatric aid during the Great Patriotic War].


    The article presents an observe of questions of organization of psychiatric aid during the Great Patriotic War, main disadvantages of the first period of war, their dependence from circumstances of prewar period, ignoring of experience of last war. There was marked the role of famous native psychiatrists in organization of psychiatric aid to military servicemen in theatre of combat actions.

  9. Smartphone apps as a new psychiatric treatment

    Dalum, Anette Ellegaard; Arnfred, Sidse Marie


    Søg 1 - 1 ud af 1 Smartphone apps as a new psychiatric treatment. Anette Ellegaard Dalum, Sidse Arnfred, 2014, vol. 176, nummer 34, 2014. Ugeskrift for laeger Artikel Importer Fjern......Søg 1 - 1 ud af 1 Smartphone apps as a new psychiatric treatment. Anette Ellegaard Dalum, Sidse Arnfred, 2014, vol. 176, nummer 34, 2014. Ugeskrift for laeger Artikel Importer Fjern...

  10. Psychiatric consultation of patients with hyperemesis gravidarum.

    Kim, Deborah R; Connolly, K R; Cristancho, Pilar; Zappone, Mark; Weinrieb, Robert M


    The request for a psychiatric examination of patients with hyperemesis gravidarum (HG) is a unique challenge for the psychiatric consultant. Unfortunately, there are little data in the psychosomatic medicine literature to guide diagnostic evaluations and treatment of patients with HG. In this article, we summarize the existing literature and propose a practical approach to such patients based on the literature and our clinical experience.

  11. Psychiatric disorders in women with fertility problems

    Baldur-Felskov, Birgitte; Kjaer, S K; Albieri, V;


    Do women who don't succeed in giving birth after an infertility evaluation have a higher risk of psychiatric disorders compared with women who do?......Do women who don't succeed in giving birth after an infertility evaluation have a higher risk of psychiatric disorders compared with women who do?...

  12. [Use of social media by psychiatric in-patients : Case report and further perspectives].

    Czech, O M; Podoll, K; Schneider, F


    Communication by means of social networks and messenger programs as well as the use of smartphones have rapidly increased during recent years and are constantly present in everyday life. We report about a 25-year-old patient with a diagnosis of borderline personality disorder who posted photographs of acute self-injuries to a group of fellow patients by means of a messenger app while on weekend leave during psychiatric hospital treatment. The implications about possible effects of the use of social media by psychiatric in-patients on treatment and group dynamics are discussed. Furthermore, social media communication by patients is focused on in general and potential consequences for psychiatric, psychotherapeutic and psychosomatic treatment are discussed.

  13. Cardiovascular Disease and Psychiatric Comorbidity: The Potential Role of Perseverative Cognition

    Britta A. Larsen


    Full Text Available The high comorbidity between psychiatric disorders and cardiovascular disease has received increasing attention, yet little is known about the processes linking the two. One plausible contributing mechanism is the tendency of those with psychiatric disorders to ruminate on stressful events. This phenomenon, sometimes called perseverative cognition, can extend the psychological and physiological effects of stress, which could contribute to cardiovascular disease etiology. In this paper, we discuss the potential role of perseverative cognition in mediating the relationship between psychiatric illness and cardiovascular disease. Rumination can delay physiological recovery from acute stress, which in turn has been found to predict future cardiovascular health. This delayed recovery could act as a mechanism in the longitudinal link between worry and cardiovascular health. The cognitive inflexibility that characterizes mood and anxiety disorders may then contribute to disease not by producing greater reactivity, but instead through extending activation, increasing the risks for cardiovascular damage.

  14. Psychiatric diagnosis: the indispensability of ambivalence

    Callard, Felicity


    The author analyses how debate over the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has tended to privilege certain conceptions of psychiatric diagnosis over others, as well as to polarise positions regarding psychiatric diagnosis. The article aims to muddy the black and white tenor of many discussions regarding psychiatric diagnosis by moving away from the preoccupation with diagnosis as classification and refocusing attention on diagnosis as a temporally and spatially complex, as well as highly mediated process. The article draws on historical, sociological and first-person perspectives regarding psychiatric diagnosis in order to emphasise the conceptual—and potentially ethical—benefits of ambivalence vis-à-vis the achievements and problems of psychiatric diagnosis. PMID:24515564

  15. Tackling nonadherence in psychiatric disorders: current opinion

    Farooq S


    Full Text Available Saeed Farooq,1,2 Farooq Naeem3 1Staffordshire University, Staffordshire, UK; 2Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan; 3Department of Psychiatry, Queen's University, Kingston, Ontario, Canada Abstract: Nonadherence to treatment is a major challenge in all fields of medicine, and it has been claimed that increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments. However, despite widespread use of terms such as adherence and compliance, there is little agreement on definitions or measurements. Nonadherence can be intermittent or continuous, voluntary or involuntary, and may be specific to single or multiple interventions, which makes reliable measurement problematic. Both direct and indirect methods of assessment have their limitations. The current literature focuses mainly on psychotic disorders. A large number of trials of various psychological, social, and pharmacologic interventions has been reported. The results are mixed, but interventions specifically designed to improve adherence with a more intensive and focused approach and interventions combining elements from different approaches such as cognitive-behavioral therapy, family-based, and community-based approaches have shown better outcomes. Pharmacologic interventions include careful drug selection, switching when a treatment is not working, dose adjustment, simplifying the treatment regimen, and the use of long-acting injections. The results for the most studied pharmacologic intervention, ie, long-acting injections, are far from clear, and there are discrepancies between randomized controlled trials, nationwide cohort studies, and mirror-image studies. Nonadherence with treatment is often paid far less attention in routine clinical practice and psychiatric training. Strategies to measure and improve adherence in clinical practice are based more

  16. [Complex expertise on the psychiatric health of a criminal].

    Gierowski, Józef Krzysztof


    The development of psychiatry and psychology has brought about a situation in need of newer evaluation of the surroundings in which the justice department tries to use specialist knowledge of the processes governing human psychic life and health. The lacking of clear criteria between the competencies of psychiatrists and psychologists is a certain standard in dealing with the disturbed or mentally ill persons. This is a result of the application of a multidisciplinary approach towards the patient in the area of diagnosis, therapy and rehabilitation. The advancing psychiatric and psychological knowledge has a difficulty in findings its way to forensic psychiatry and psychology. However, owing to the fact that current legal regulations require complex psychiatric-psychological opinions to be formulated, it is worthy to take a closer look at the issue. The fore-mentioned model has its benefits and its flaws. The compiling of the complex opinion may bring about the risk of "mixing up" of the contents as used by the various experts and cause certain methodological problems. From another perspective it would appear that it is impossible to refrain from applying the newly developing interdisciplinary links. Positive experiences with the DSM classification give a strong argument to the sensibility of this approach. The author analyses the bases for cooperation between the psychiatric-psychological expertise which arises from the rules and regulations of the penal law and the code of penal conduct. They pertain to the rules of being able in body and mind and the application of the so called security measures. The model of psychiatric-psychological cooperation taken up by the law-giver does not pertain fully to the essential competencies of psychiatry and psychology and is not a compact consequential solution.

  17. Choking risk among psychiatric inpatients

    Nagamine T


    Full Text Available Takahiko Nagamine1Division of Psychiatric Internal Medicine, Seiwakai-Kitsunan Hospital, Suzenji, JapanChoking is a life-threatening and not infrequent occurrence in psychiatric hospitals. There is, however, little information available about the risk factors or methods to prevent choking. We conducted a retrospective analysis of the 8 patients who had a cardiopulmonary arrest due to choking and received resuscitation at our hospital during the 6-year period from April 2005 to March 2011. The study involved 6 males and females, all of whom were patients with schizophrenia taking antipsychotics orally. They were aged from 56 to 79 (mean ± SD: 69.0 ± 7.5 years, with the duration of illness from 28 to 54 years (39.9 ± 7.9 years. In 6 of the 8 cases, choking was diagnosed immediately on the basis of the situation at the time of cardiopulmonary arrest. In the remaining 2 cases, cardiopulmonary arrest was initially unexplained, and choking was only diagnosed subsequently. Choking was caused by bread in all cases. Tracheal intubation was carried out in all cases and resulted in successful resuscitation, causing no subsequent change in functions compared with the prechoking condition. All 8 patients had been receiving multiple antipsychotics before the event (mean number of drugs used 2.5 ± 0.7, with a total dose level ranging from 600 to 1800 mg/day chlorpromazine equivalents (mean 1113 ± 341 mg/day. Seven of the 8 patients had mild to moderate involuntary movements, and 5 patients were diagnosed with antipsychotic-induced tardive dyskinesia. During the 5-year period before the choking event, 7 of the 8 patients had at least 1 treatment interruption, and some patients had up to 4 interruptions.

  18. Emergency Psychiatric Service Use by Individuals with Intellectual Disabilities Living with Family

    Lunsky, Yona; Tint, Ami; Robinson, Suzanne; Khodaverdian, Alin; Jaskulski, Christine


    The purpose of this study was to describe the experiences of individuals with intellectual disabilities (ID) and their families in the emergency department (ED). Hospital chart audits were conducted on a sample of 20 individuals with ID living with family who had visited the ED for a psychiatric crisis. Individuals had a combined total of 44 ED…

  19. 42 CFR 485.647 - Condition of participation: psychiatric and rehabilitation distinct part units.


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: psychiatric and rehabilitation distinct part units. 485.647 Section 485.647 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS...

  20. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.


    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR...