Hipp, Kirsi; Kuosmanen, Lauri; Repo-Tiihonen, Eila; Leinonen, Minna; Louheranta, Olavi; Kangasniemi, Mari
Pro re nata (PRN) medication is widely used and studied in psychiatric care, but our knowledge about patient participation in its administration is fragmented. The aim of this integrative review was to describe and synthesize previous knowledge of patient participation in PRN in psychiatric inpatient settings. We conducted both electronic and manual searches, using the CINAHL, Scopus, PsycINFO, and PubMed databases, and eight scientific journals. Searches were limited to the English language, to the years 2006-2016, and to selected papers using inclusion, exclusion, and quality criteria. We identified 16 relevant papers, and these showed that patient participation included patient-related starting points, including the patients' willingness to participate and their knowledge of the medication. The patients' participation in PRN practices was demonstrated by the opportunity to request PRN and to refuse any PRN that was offered. Patient participation was shown to be linked to certain situations where PRN was recommended. The role that the professionals played in patient participation included interacting with patients, providing counselling and alternatives for PRN. Our results also revealed that coercion was used administering PRN. The existing literature exposed challenges that need to be addressed if patient participation in the use of PRN medication is to be effectively achieved in psychiatric inpatient settings. Equal partnerships between patients, nurses, and physicians are an essential part of this process, and further research into PRN medication is urgently needed, particularly studies that focus on patients' experiences. © 2017 Australian College of Mental Health Nurses Inc.
Kjellin, Lars; Ostman, Margareta
A common concern of psychiatric patients' relatives is that patients might be a danger to themselves or others. The aim of this study was to investigate family burden and relatives' participation in care in relation to physical violence towards others and suicide attempts by psychiatric inpatients before admission. Information concerning violence and suicide attempts by the patients prior to admission was collected from the medical records of 155 acutely voluntarily and involuntarily admitted psychiatric inpatients. Relatives were interviewed a month after admission, using a semi-structured questionnaire. Violence towards other persons and suicide attempts were recorded in 16% and 17% of the cases, respectively. There were no differences between relatives of patients who had been violent and other relatives regarding burden and participation in care. Relatives of patients with suicide attempts more often stated they had been prevented from having own company, worried about suicide attempts by the patient, had mental health problems of their own, and had own need for care and support. It was concluded that violence of acutely admitted psychiatric patients, targeted at other people, was not associated with burden of family, but the results corroborate the need for psychiatric services to involve and support relatives of psychiatric patients with suicidal behaviour.
Bowersox, Nicholas W; Bohnert, Amy S B; Ganoczy, Dara; Pfeiffer, Paul N
This study used factor analysis of a Veterans Health Administration (VHA) survey to identify factors that measure satisfaction with inpatient treatment and to examine the factors' utility in evaluating treatment participation following discharge. The Survey of Healthcare Experiences of Patients (inpatient version) (I-SHEP) was mailed to 34,237 veterans who were discharged from inpatient to outpatient care in the VHA during fiscal year 2009 and was completed by 7,408 patients. A factor analysis of survey responses identified underlying I-SHEP factors and evaluated relationships between the factors, patient characteristics, and attendance at VHA mental health appointments within seven and 30 days of discharge. The factor analysis identified three domains of satisfaction: respect and caring by nurses-overall hospital impression; involvement and information about care; and respect and caring by doctors. These factors demonstrated good internal consistency (Cronbach's α=.93, .90, and .94, respectively) and accounted for a moderate amount of variance in patient responses (r2=.167). Only the care involvement and information factor was associated with participation in follow-up care: increased satisfaction (one standard deviation change in scale score) was associated with improved odds of a mental health visit within seven and 30 days of discharge (odds ratio=1.14 and 1.17, respectively, p<.01). After discharge, persons may not generalize satisfaction about the respect and caring shown by inpatient treatment teams toward their decision to attend outpatient care. Providing patients with information about treatment and involving them in care decisions during inpatient care may help facilitate the transition to outpatient settings.
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...
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.
Erlangsen, Annette; Zarit, Steven H; Tu, Xin
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......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...
Grant, Jon E; Levine, Laura; Kim, Daniel; Potenza, Marc N
The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.
Sæther, Sverre Georg; Schou, Morten; Stoecker, Winfried
Paraneoplastic neurological disorders associated with onconeural antibodies often appear with neuropsychiatric symptoms. To study the prevalence of onconeural antibodies in patients admitted to acute psychiatric inpatient care, the serum of 585 such patients was tested for antibodies targeting MOG......, GLRA1B, DPPX, GRM1, GRM5, DNER, Yo, ZIC4, GAD67, amphiphysin, CV2, Hu, Ri, Ma2, and recoverin. Only one sample was positive (antirecoverin IgG). The present findings suggest that serum onconeural antibody positivity is rare among patients acutely admitted for inpatient psychiatric care. The clinical...
Masterton, G; Main, C J; Lever, A F; Lever, R S
Blood pressure recordings in 116 female psychiatric inpatients were analysed. Sixty-nine women had schizophrenia, the remainder a variety of psychiatric conditions. All had been in hospital continuously for more than one year, the average for 19 years continuously. An average of seven recordings of blood pressure per patient had been made during that time. The latest of these compared well with measurements made independently using a sphygmomanometer free from observer bias. On admission to h...
Nijman, H.; Bowers, L.; Oud, N.; Jansen, G.
Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this "Perceptions of Prevalence Of Aggression Scale" (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff
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...
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.
Rifkin, A; Ghisalbert, D; Dimatou, S; Jin, C; Sethi, M
The aim of this study was to replicate reports of a high rate of dissociative identity disorder in psychiatric inpatients. Subjects were 100 randomly selected women, 16-50 years old, who had recently been admitted to an acute psychiatric hospital. Diagnoses were made by two interviewers through use of the Structured Clinical Interview for DSM-IV Dissociative Disorders. One percent (N = 1) of the interviewed subjects had dissociative identity disorder. Contrary to previous studies, the authors found a low rate of dissociative identity disorder, perhaps because of the different methodology used.
Stewart, D; Bowers, L
Nursing staff on psychiatric wards often attribute patient violence and aggression to substance use. This study examined incidents of alcohol and illicit drug use among acute psychiatric inpatients and associations between substance use and violence or other forms of aggression. A sample of 522 adult psychiatric inpatients was recruited from 84 acute psychiatric wards in England. Data were collected from nursing and medical records for the first 2 weeks of admission. Only a small proportion of the sample was reported to have used or been under the influence of alcohol (5%) or drugs (3%). There was no physical violence during a shift when a patient had used alcohol or drugs. Substance using patients were also no more likely than others to behave violently at any point during the study period. However, incidents of substance use were sometimes followed by verbal aggression. Beliefs that substance using patients are likely to be violent were not supported by this study, and could impact negatively on therapeutic relationships between nurses and this patient group. Future studies are needed to examine how staff intervene and interact with intoxicated patients. © 2014 John Wiley & Sons Ltd.
Conclusions: Psychiatric consultation was sought mostly by medical ward that had maximum number of patients presenting with self-poisoning. The commonest diagnosis seen in the referred in-patients was depression and anxiety disorder. Keywords: consultation-liaison psychiatry; in-patient referral; psychiatric morbidity.
Nursing is an occupation that deals with humans and relies upon human relationships. Nursing care, which is an important component of these relationships, involves protection, forbearance, attention, and worry. The aim of this study is to evaluate the ethical beliefs of psychiatric nurses and ethical problems encountered. The study design was descriptive and cross-sectional. RESEARCH CONTEXT: Methods comprised of a questionnaire administered to psychiatric nurses (n=202) from five psychiatric hospitals in Istanbul, Turkey, instruction in psychiatric nursing ethics, discussion of reported ethical problems by nursing focus groups, and analysis of questionnaires and reports by academicians with clinical experience. PARTICIPANTS consist of the nurses who volunteered to take part in the study from the five psychiatric hospitals (n=202), which were selected with cluster sampling method. Ethical considerations: Written informed consent of each participant was taken prior to the study. The results indicated that nurses needed additional education in psychiatric ethics. Insufficient personnel, excessive workload, working conditions, lack of supervision, and in-service training were identified as leading to unethical behaviors. Ethical code or nursing care -related problems included (a) neglect, (b) rude/careless behavior, (c) disrespect of patient rights and human dignity, (d) bystander apathy, (e) lack of proper communication, (f) stigmatization, (g) authoritarian attitude/intimidation, (h) physical interventions during restraint, (i) manipulation by reactive emotions, (j) not asking for permission, (k) disrespect of privacy, (l) dishonesty or lack of clarity, (m) exposure to unhealthy physical conditions, and (n) violation of confidence. The results indicate that ethical codes of nursing in psychiatric inpatient units are inadequate and standards of care are poor. In order to address those issues, large-scale research needs to be conducted in psychiatric nursing with a
Washburn, Stephen; And Others
Seriously ill female psychiatric patients (N=59) were randomly assigned to an inpatient or day service. Data indicate the day treatment is, on the whole, superior to inpatient treatment in subjective distress, community functioning, family burden, total hospital cost, and days of attachment to the hospital program. (Author)
Steer, Robert A.; And Others
Administered Beck Scale for Suicide Ideation (BSI) to 108 adolescent inpatients diagnosed with mixed psychiatric disorders. Examined relationships of Beck Depression Inventory, Anxiety Inventory, and Hopelessness Scale with BSI. Results support use of BSI with adolescent inpatients. Findings indicated that hopelessness was related to suicidal…
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
Molfenter, Todd; Connor, Tim; Ford, James H; Hyatt, John; Zimmerman, Dan
Thirty-day hospital readmission rates have become a quality indicator for many regulators and payers, but published accounts of reducing these rates across a patient population are lacking. This article describes and evaluates the Wisconsin Mental Health Readmissions Project, which aimed to reduce psychiatric inpatient 30-day readmission rates in Wisconsin. Nineteen county human services boards representing 23 of Wisconsin's 72 counties and 61% of the state's residential admissions participated in a statewide quality improvement collaborative from January 1, 2010 to December 31, 2013. Participants applied a standardized organizational change model, called NIATx, in the context of a multicounty quality improvement collaborative to reduce 30-day readmission rates. Readmission rates were tracked through national and state databases, using 2009 as a baseline, and analyzed using a chi-square analysis to test the proportion of means. The study team compared readmission rates of Wisconsin counties that participated in the statewide collaborative with those that did not. Between 2009 and 2013, the 30-day readmission rates in Wisconsin declined significantly for counties that participated in the project when compared to those that did not (2009-2013) [Χ2(4) = 54.503, P < .001], based on a 2.5% decline for participants vs a 0.7% decline for nonparticipants. Reductions to behavioral health inpatient readmission rates beyond individual case examples have been difficult to document. This analysis evaluates a method that Wisconsin behavioral health providers applied as part of a multicounty program addressing readmission rates. The findings highlight quality improvement program design elements and interventions to consider in reducing inpatient behavioral health readmissions, as well as the need for further research on this complex systems issue.
Uhlmann, C; Flammer, E; Pfiffner, C; Grempler, J; Längle, G; Eschweiler, G-W; Spießl, H; Steinert, T
In the S3 treatment guidelines psychotherapy is recommended in all psychological disorders. Therefore, outpatient or inpatient psychotherapy should be recommended by therapists in most cases. On the other hand, it is well known that waiting periods for psychotherapeutic treatment are considerable, which raises the question how the recommendation for psychotherapy is presented in psychiatric hospitals in Germany. The article deals with the question of how frequent the recommendation of psychotherapeutic treatment is made after psychiatric inpatient stay or day care, and if there are differences between hospitals and patient groups. In four psychiatric hospitals in southern Germany the frequency of recommendation for psychotherapy in psychiatric patients was registered and compared to the number of all patients treated in the equivalent time. For this purpose, we analyzed data of the basic documentation in the four participating hospitals. Overall, 9.6 % of the patients received a recommendation of psychotherapeutic treatment. In the psychiatric university hospital a subsequent psychotherapeutic treatment was recommended somewhat more often. Differences between hospitals were present but marginal. Over all participating hospitals, psychotherapy was recommended markedly less frequently in patients with an F2 diagnosis in comparison with patients with F3 or F4 diagnoses. Psychotherapeutic treatment after psychiatric inpatient stay is recommended cautiously. Probably therapists anticipate the fact that the growing demand for psychotherapeutic treatment in general reduces the chances for persons after psychiatric inpatient treatment.
Marthoenis, M; Aichberger, Marion; Puteh, Ibrahim; Schouler-Ocak, Meryam
A vast majority of psychiatric medication causes weight gain, however the rate of obesity in psychiatric patients has yet to be thoroughly studied in Indonesia. The present study aims to assess the prevalence of obesity among psychiatric inpatients in Indonesia. This cross sectional study was conducted in Banda Aceh Psychiatric Hospital, Indonesia from December 2012 to January 2013. The Body Mass Index (BMI) and blood pressure of a total 242 inpatients was measured, and data on their demographic information and medication were collected from the patient's chart. The prevalence rate of obesity among psychiatric inpatients was 5% (95% CI = 2.6-8.5%), and overweight was 8% (95% CI = 5.1-12.4). The mean BMI was 21.44 kg/m² (SD: 3.43). Stage I hypertension and stage II hypertension was found among 7% (95% CI = 4.1-11), and 2% (95% CI = 0.9-5.3%) inpatients, respectively. The findings suggest that the rate of overweight, obesity and hypertension in the present study population was relatively low compared to rates of the general population. The inpatients have limited access to food and only eat meals that are provided to them by the hospital.
Full Text Available Introduction Cigarette smoking is the single largest preventable cause of death and disability in the industrialized world and it causes at least 85% of lung cancers, chronic bronchitis and emphysema. In addition smokers are at a higher risk from psychiatric co-morbid illness such as depression and completed suicide. Methods We conducted a cross-sectional survey in which we targeted all patients with serious mental illness (SMI who were admitted in Razi mental health Hospital in Tehran, Iran. We recruited 984 participants, who were receiving services from Razi mental health Hospital and hospitalized for at least two days between 21 July to 21 September, 2010. Nine hundred and fifty patients out of this figure were able to participate in our study. Results The final study sample (n = 950 consisted of 73.2% males and 26.8% females. The mean age was 45.31 (SD=13.7. A majority of participants (70% was smoker. A history of never smoking was present for 25.2% of the study sample; while 4.8% qualified as former smokers and 70.0% as occasional or current smokers. Two hundred and nineteen participants had attempted suicide amongst them 102 (46.6% once, 37 (16.9% twice, and 80 (36.5% attempted more than two times in their life time. In regression model, gender, age, and cigarette consumption were associated with previous suicide attempts and entered the model in this order as significant predictors. Conclusion There is an association of cigarette smoking and suicide attempt in psychiatric inpatients. Current smoking, a simple clinical assessment, should trigger greater attention by clinicians to potential suicidality and become part of a comprehensive assessment of suicide risk.
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%)…
Full Text Available A survey was carried out of almost 50% of Black inpatients in a state psychiatric hospital to evaluate the level of accessibility of the family network of the patients. Staff were interviewed on the problems they have with contacting families. The survey shows the extent of inadequate access and identifies reasons for the problem.
Introduction. An accused found unfit to stand trial and/or not criminally responsible for his/her actions because of mental illness, is declared a state patient by the court. Aim. The aim of the study was to analyse the biographical data and relevant particulars of forensic psychiatric inpatients who were admitted to the Free State ...
Fite, Paula J.; Stoppelbein, Laura; Greening, Leilani; Preddy, Teresa M.
The current study examined relations between relational aggression, depressive symptoms, and suicidal ideation in a child clinical population. Participants included 276 children (M age = 9.55 years; 69% Male) who were admitted to a child psychiatric inpatient facility. Findings suggested that relational aggression was associated with depressive…
Nijman, H.L.I.; Bowers, L.; Oud, N.E.; Jansen, G.J.
Using a survey instrument, the experiences of psychiatric nurses with inpatienaggression were investigated in East London, U.K. On this Perceptions of Prevalence Of Aggression Scale (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff members
Oulis, P; Lykouras, L; Dascalopoulou, E; Psarros, C
We studied, during 5 consecutive days, the prevalence, types and demographic, historical and clinical correlates of overt aggression in a population of 136 acute and chronic inpatients with mainly a diagnosis of psychotic disorder. Almost one fourth of them exhibited some sort of aggressive behavior. Verbal aggression was by far the most frequent type followed-in decreasing order-by physical aggression, aggression against property and self-aggression. Past threats of violence and attacks on others as well as concurrent motor excitement, agitation, low tolerance of frustration, difficulty in delaying gratification, depressive feelings, anger, hostility, affective lability and antisocial behavior differed significantly across the aggressive and the nonaggressive groups. The best short-term clinical predictors of aggression were different for each type, anger being their sole common predictor, and accounted for various proportions of the corresponding variances ranging from only 13.3% for self-aggression to 39.2% for verbal aggression.
Ellilä, Heikki; Välimäki, Maritta; Warne, Tony; Sourander, Andre
Research on nursing ideology and the ethics of child and adolescent psychiatric nursing care is limited. The aim of this study was to describe and explore the ideological approaches guiding psychiatric nursing in child and adolescent psychiatric inpatient wards in Finland, and discuss the ethical, theoretical and practical concerns related to nursing ideologies. Data were collected by means of a national questionnaire survey, which included one open-ended question seeking managers' opinions on the nursing ideology used in their area of practice. Questionnaires were sent to all child and adolescent psychiatric inpatient wards (n = 69) in Finland; 61 ward managers responded. Data were analysed by qualitative and quantitative content analysis. Six categories -- family centred care, individual care, milieu centred care, integrated care, educational care and psychodynamic care -- were formed to specify ideological approaches used in inpatient nursing. The majority of the wards were guided by two or more approaches. Nursing models, theories and codes of ethics were almost totally ignored in the ward managers' ideological descriptions.
Full Text Available Aim: The aim of this study was to evaluate the prevalence of alcohol and substance use disorders in psychiatric inpatient clinics and determine the frequencies of alcohol and substance use disorder among psychiatric disease groups and find out the differences in between these groups. Material and Methods: Thus all patients admitted to inpatients psychiatric clinics of in one year period were approached for inclusion into this study, and 155 patients with a hospitalization period longer than one day who provided informed consent were included in the study. All patients included in the study were interviewed with a semi structured interview scale to get information regarding the presence of alcohol, nicotine and other substance use disorder. Results: The results of this study confirmed high rates of alcohol, nicotine and substance use disorder comorbidity in psychiatric inpatients. The results of one year prospective follow up study revealed that 57.4% of patients had nicotine dependence, 21.9% alcohol dependence and misuse and 9% had sedative misuse or dependence. The rate of substance use disorder was high among all psychiatric disorder subgroups. Considering all substances including nicotine together, 55% of patients with psychotic disorder had at least one substance use disorder whereas these figures were 61% and 81% for affective disorders and anxiety disorders respectively. Conclusion: Professionals dealing with treatment of psychiatric disorders should always be aware of substance use disorder comorbidity, and start treatment immediately without causing any delay in treatment. Obviously we need future large prospective studies to get more insight into these dual-diagnose disorders. [Cukurova Med J 2012; 37(1.000: 37-48
Frauenfelder, Fritz; van Achterberg, Theo; Müller Staub, Maria
To detect the prevalence of NANDA-I diagnoses and possible relationships between those and patient characteristics such as gender, age, medical diagnoses and psychiatric specialty/setting. There is a lack on studies about psychiatric inpatient characteristics and possible relationships among these characteristics with nursing diagnoses. A quantitative-descriptive, cross-sectional, completed data sampling study was performed. The data were collected from the electronic patient record system. Frequencies for the social-demographic data, the prevalence of the NANDA-I diagnoses and the explanatory variables were calculated. In total, 410 nursing phenomena were found representing 85 different NANDA-I diagnoses in 312 patients. The NANDA-I diagnosis "Ineffective Coping" was the most frequently stated diagnosis followed by "Ineffective Health Maintenance," "Hopelessness" and "Risk for Other-Directed Violence". Men were more frequently affected by the diagnoses "Ineffective Coping," "Hopelessness," "Risk for Self-Directed Violence," "Defensive Coping" and "Risk for Suicide," whereas the diagnoses "Insomnia," "Chronic Confusion," "Chronic Low Self-Esteem" and "Anxiety" were more common in women. Patients under the age of 45 years were more frequently affected by "Chronic Low Self-Esteem" and "Anxiety" than older patients. "Ineffective Coping" was the most prevalent diagnosis by patients with mental disorders due to psychoactive substance use. Patients with schizophrenia were primarily affected by the diagnoses "Ineffective Coping," "Impaired Social Interaction" and "Chronic Low Self-Esteem." This study demonstrates the complexity and diversity of nursing care in inpatient psychiatric settings. Patients' gender, age and psychiatric diagnoses and settings are a key factor for specific nursing diagnosis. There are tendencies for relationships between certain nursing diagnosis and patient characteristics in psychiatric adult inpatients. This enhances the specific, extended
Hsu, Wei-Chi; Lai, Hui-Ling
The study was to assess the effectiveness of soft music for treatment of major depressive disorder inpatients in Kaohsiung City, Taiwan. A pretest-posttest with a two-group repeated measures design was used. Patients with major depressive disorder were recruited through referred by the psychiatric physicians. Subjects listened to their choice of music for 2 weeks. Depression was measured with the Zung's Depression Scale before the study and at two weekly posttests. Using repeated measures ANCOVA, music resulted in significantly better depressive scores, as well as significantly better subscores of depression compared with controls. Depression improved weekly, indicating a cumulative dose effect. The findings provide evidence for psychiatric nurses to use soft music as an empirically based intervention for depressed inpatients.
Gluyas, Cathy; Lum, Carmel; Chong, Sinn Yuin; Borg, Cynthia; Haines, Terry P
The objectives of this study were to characterize the psychiatric comorbidity of a group of older subacute inpatients and then determine whether their psychiatric comorbidity affected measures of rehabilitation outcomes. Eighty-eight older subacute inpatients were recruited for this prospective study. Psychiatric comorbidity was defined according to a participants' performance on four inventory scales: the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Brief Psychiatric Rating Scale and Health of the Nation Outcome Scale 65+. Rehabilitation outcome referred to the participants' length of stay and their performance at discharge on the EuroQol-5D health-related quality of life questionnaire and Barthel index. 68% of the participants scored in the clinical range on at least one of the four scales assessing psychiatric comorbidity at admission, with 51% in the clinical range for GDS and 32% for the GAI. The decrease in scores by the time of discharge was significant for all four scales. Linear regression analyses pointed to a trend for depressive symptoms at admission to be an influential but nonsignificant predictor of rehabilitation outcome. An interesting association was found between the length of the previous acute admission and the GDS score on admission to the subacute unit. A high prevalence of psychological symptoms was identified upon admission, with a significant decrease by the time of discharge. These factors did not significantly predict the selected measures of rehabilitation outcome. Opportunities for future longitudinal research on the prevalence and impact of psychiatric comorbidities on patient outcomes are considered.
Madsen, Trine; Agerbo, Esben; Mortensen, Preben B
OBJECTIVE: To study the incidence and risk factors of psychiatric inpatient suicide within a national cohort representing all psychiatric hospital admissions. METHOD: This national prospective register-based study followed all psychiatric hospital admissions in Denmark from the date of patient...... admission until patient discharge or inpatient suicide over a 10-year study period from 1997 through 2006. By using survival analysis techniques, this study was the first to take the inpatient time at risk into account in the estimation of the suicide rate and the predictors of suicide among hospital......-admitted psychiatric patients. RESULTS: Among 126,382 psychiatric inpatients aged 14 years or older, 279 suicides occurred. The risk of inpatient suicide was high: 860 suicides per 100,000 inpatient years. Of those individuals who completed suicide, 50% died within 18 days of admission. The inpatient suicide rate...
Madsen, Trine; Nordentoft, Merete
A reduction in the number of inpatient beds as well as shorter admissions have aroused concern that tendencies to deinstitutionalize may increase the suicide rate for psychiatric patients who have been hospitalized. One study indicates that a decreasing inpatient suicide rate may actually reflect...... a transfer to an increasing postdischarge suicide rate; however, uncertainties exist about this transfer, since it is not well studied. The objectives of this study were to estimate adjusted changes over time in suicide rates among psychiatric inpatients and recently discharged psychiatric patients...
Meza, Néstor W; Rossi, Nineth E; Galeazzi, Tatiana N; Sánchez, Nora M; Colmenares, Francisco I; Medina, Oscar D; Uzcategui, Néstor L; Alfonzo, Nacarid; Arango, Celso; Urdaneta, Haideé
Cysticercosis due to Taenia solium infection is endemic in developing countries of the Americas, Asia, and Africa. This study was designed to establish the prevalence of cysticercosis in 158 inpatients of a psychiatric institution in the state of Tachira (Venezuela) and in 127 healthy control subjects. Positive blood tests for cysticercosis by Western blotting were recorded in 18.35% of the patients and in 1.57% of the controls. Individuals with mental retardation were found to carry an increased risk of cysticercosis (RR: 2.92; 1.22 7.0; P health care system.
Taylor, Nathanael J; Mitchell, Sean M; Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Cukrowicz, Kelly C
Psychiatric inpatients are at heightened risk for suicide, and evidence suggests that psychiatric inpatients with bipolar mood disorders may be at greater risk for suicide ideation compared to those with non-bipolar mood disorders. There is a paucity of research directly comparing risk factors for suicide ideation in bipolar versus non-bipolar mood disorders in an inpatient sample. The current study sought to clarify the association between two constructs from the interpersonal theory of suicide (i.e., perceived burdensomeness and thwarted belongingness) in leading to suicide ideation among psychiatric inpatients with bipolar and non-bipolar mood disorders. Participants were (N=90) psychiatric inpatients with a bipolar (n = 20) or non-bipolar mood disorder (n=70; per their medical charts). Perceived burdensomeness, but not thwarted belongingness, was significantly associated with suicide ideation after adjusting for other covariates. This suggests perceived burdensomeness may play a key role in suicide ideation among psychiatric inpatients with any mood disorder and highlights the importance of assessment and intervention of perceived burdensomeness in this population. Contrary to our hypothesis, mood disorder group (i.e., bipolar versus non-bipolar) did not moderate the relations between perceived burdensomeness/thwarted belongingness and suicide ideation. Published by Elsevier Ireland Ltd.
Ho, Justin; Ralston, D Christopher; McCullough, Laurence B; Coverdale, John H
This Open Forum commentary reviews the ethical considerations relevant to the question of prosecuting assaultive psychiatric patients, with particular attention to the significance that should be attached to the arguments generated by those considerations. A comprehensive literature search was conducted incorporating the terms "assaultive patients," "ethics," "psychiatric inpatients," and "law." The literature of professional medical ethics was applied to identify relevant domains of ethical argument. Five domains were identified: fiduciary obligations of physicians to assaultive and other patients; obligations to staff members; professional virtues of compassion, self-sacrifice, and self-effacement; retributive justice; and the patient's right to confidentiality. The content of each domain is explained, and guidance is provided on how to assess the relative strengths of ethical argument within each domain. All five domains must be explicitly addressed in order to make ethically disciplined judgments about whether to seek prosecution. A distinctive feature of this ethical analysis is the central importance of the professional virtues.
U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...
U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...
U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...
Silverman, Michael J
The purpose of this study was to implement and measure the effectiveness of a single-session assertiveness music therapy role playing protocol for psychiatric inpatients. Participants (N=133) were randomly assigned by group to one of three conditions: (a) Assertiveness Music Therapy, (b) No Music Assertiveness, or (c) Music No Assertiveness. Participants in both assertiveness conditions role played a number of different commonly occurring scenarios at an inpatient psychiatric facility and in the community. There were no significant between-group differences in posttest quality of life, locus of control, or other subscales. However, participants in both assertiveness conditions tended to have slightly higher internal locus of control and overall quality of life scores than participants in the music no assertiveness condition. Additionally, the assertiveness music therapy condition had higher attendance rates than the other conditions. A higher percentage of participants from both the assertiveness music therapy and music no assertiveness conditions indicated they thought their session was the most helpful/therapeutic group therapy session in which they had participated; this was not the case for the assertiveness no music condition. Future research is warranted to measure the effects of protocols that can help psychiatric patients generalize skills learned in treatment.
Siu, B W M; Ng, B F L; Li, V C K; Yeung, Y M; Lee, M K L; Leung, A Y H
OBJECTIVES. To develop a questionnaire for measuring the perceived importance of the elements of mental health recovery in psychiatric inpatients in Hong Kong and to test the psychometric properties of the questionnaire. METHODS. Thematic content analysis of identified literature on mental health recovery was performed to identify the elements related to mental health recovery. A questionnaire was developed to assess the perceived importance of the identified elements. An expert panel was set up to evaluate the content validity and patient focus group's face validity of the questionnaire. Participants were recruited from medium-stay and rehabilitation wards of Castle Peak Hospital. RESULTS. A total of 101 psychiatric inpatients completed the questionnaire, the majority of whom suffered from schizophrenia (75%). Having meaning in life was rated by 91% of the participants as an important element of recovery, followed by hope (86%) and general health and wellness (85%). Cronbach's alpha for internal consistency was 0.91. Explorative factor analysis yielded 7 factors and intraclass correlation coefficients revealed a fair-to-good test-retest reliability. CONCLUSIONS. The results supported the psychometric properties of the questionnaire for measurement of mental health recovery and serve as a basis for the future development of recovery-oriented services in the psychiatric inpatient settings in this locality.
Molin, Jenny; Graneheim, Ulla Hällgren; Ringnér, Anders; Lindgren, Britt-Marie
WHAT IS KNOWN ON THE SUBJECT?: Psychiatric inpatient care has been described by both ward staff and patients as being demanding and disorganized, lacking opportunities for quality interactions in everyday life through joint activities. Qualitative research on interprofessional teams' perspectives on everyday life processes in psychiatric inpatient care is lacking. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Staff have ideals about care and collaboration, but the obstacles they face in everyday life, such as a poor environment, power asymmetry, lacking structure and the demands of managing chaos, mean that they appear to resign and shift focus from the patients' best interests to self-survival. Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge, these findings have not been reported in the international evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given these findings we suggest interventions such as Protected Engagement Time as well as reflective dialogues within interprofessional teams. This would help staff to resume their caring role in everyday life in psychiatric inpatient care and put their ideals into practice. Introduction Patients and ward staff describe psychiatric inpatient care as demanding, characterized by unpredictable events, yet research on interprofessional teams perspectives of everyday life processes in psychiatric inpatient care lacks. Aim This study aims to explore everyday life processes in psychiatric inpatient care, as reported by staff in interprofessional teams. Method A grounded theory design was used and 36 participants were interviewed. Results The analysis resulted in a process-oriented core category From ideals to resignation. Related to this core category were three further categories: Knowing where to go, Walking a path of obstacles and Shifting focus from the patient's best
Aligeti, Sabitha; Baig, Muhammad R; Barrera, Fernando F
Delirium is a neuropsychiatric condition characterized by acute change in cognition and disturbance of consciousness. A similar state during the final days of life is termed "terminal delirium." We present three cases with end-stage chronic medical problems without any significant psychiatric history who were admitted to an inpatient psychiatric unit or a locked dementia unit for management of "depression," "dementia," or "psychosis." Early diagnosis of terminal delirium helps prevent patients, family members, and staff from undergoing severe emotional distress and facilitates appropriate end-of-life care.
Modestin, J; Nussbaumer, C; Angst, K; Scheidegger, P; Hell, D
A series of 417 consecutively admitted psychiatric inpatients were studied with regard to their use of potentially abusive psychotropic substances in the last 3 months preceding admission. In all patients face-to-face interviews were performed; in 354 of them urine specimens could also be tested. Alcohol and benzodiazepines belonged to the most frequently used substances followed by cannabis, opiates and cocaine. Barbiturates, hallucinogens and amphetamine derivatives were only exceptionally reported. The most important finding of the study is that every fifth patient regularly used "hard" drugs (opiates and/or cocaine), every fourth patient illegal drugs and every third patient alcohol. Substances were found in 54% of all urine specimens; methadone, opiates and cocaine were hardly found alone. For the latter substances excellent agreement was found between interview reports and urine exams. Excluding patients diagnosed as substance-use disorders, there were no statistically significant differences between schizophrenic, affective, neurotic/stress/somatoform and other disorders with regard to the use of "hard" drugs and illegal drugs. Regular substance use correlated with much worse psychosocial adjustment. Substance use has to be explored and considered in every individual psychiatric inpatient.
Zander, Eduard; Wyder, Lea; Holtforth, Martin Grosse; Schnyder, Ulrich; Hepp, Urs; Stulz, Niklaus
To examine the validity of diagnoses obtained by clinicians during routine clinical examination on acute psychiatric inpatient wards. N=100 inpatients with a broad spectrum of major mental disorders were randomly selected in a mental hospital's department of general psychiatry. Patients were diagnosed by independent assessors within Md = 5 (Range: 1-18) days of admission using the SCID I in order to examine the validity of the diagnoses given by the clinical staff based on routine assessments. The commonly used clinical examination technique had good overall agreement with the SCID I assessments regarding primary diagnoses at the level of ICD-10 main categories (F2, F30-31, F32-F33, F4; κ = 0.65). However, agreement between routine clinical diagnoses and the SCID I diagnoses tended to be low for some specific mental disorders (e.g., depressive disorders) and for secondary diagnoses. The validity of routine clinical diagnoses established in acute inpatient settings is limited and should be improved. Copyright © 2017 Elsevier B.V. All rights reserved.
Deux, Natalie; Schlarb, Angelika A; Martin, Franziska; Holtmann, Martin; Hebebrand, Johannes; Legenbauer, Tanja
Adolescent psychiatric patients are vulnerable to weight problems and show an overrepresentation of overweight compared to the healthy population. One potential factor that can contribute to the etiology of overweight is higher impulsivity. As of yet, it is unclear whether it is a general impulse control deficit or weight-related aspects such as lower impulse control in response to food that have an impact on body weight. As this may have therapeutic implications, the current study investigated differences between overweight and non-overweight adolescent psychiatric inpatients (N = 98; aged 12-20) in relation to trait impulsivity and behavioral inhibition performance. The Barratt Impulsiveness Scale and two go/no-go paradigms with neutral and food-related stimulus materials were applied. Results indicated no significant differences concerning trait impulsivity, but revealed that overweight inpatients had significantly more difficulties in inhibition performance (i.e. they reacted more impulsively) in response to both food and neutral stimuli compared to non-overweight inpatients. Furthermore, no specific inhibition deficit for high-caloric vs. low-caloric food cues emerged in overweight inpatients, whereas non-overweight participants showed significantly lower inhibition skills in response to high-caloric than low-caloric food stimuli. The results highlight a rather general, non-food-specific reduced inhibition performance in an overweight adolescent psychiatric population. Further research is necessary to enhance the understanding of the role of impulsivity in terms of body weight status in this high-risk group of adolescent inpatients. Copyright © 2017 Elsevier Ltd. All rights reserved.
Webb, Roger; Pickles, Andrew R.; Appleby, Louis
CONTEXT: Offspring of psychiatric inpatients are at higher risk of death from all causes, but their cause-specific risks have not been quantified. OBJECTIVE: To investigate cause-specific deaths at 1 to 25 years in offspring of parents previously admitted as psychiatric inpatients. DESIGN: Popula...
Bord, Benjamin; Courtet, Philippe; Hansel, Sylvie; Barbotte, Eric; Marhuenda, Yolande; Peyrière, Hélène
To evaluate occurrence of the inappropriate prescriptions in a psychiatric department. In this prospective survey over a two-month period, the medical orders were analysed. Inappropriate prescription was defined as any discrepancy with summary of product characteristics (SPC) or our hospital treatment guidelines. One hundred inpatients (72 women, mean age 37.5+/-15 years) were included. We reviewed 495 medication orders, which represent 1875 prescribed drugs. We found 2636 discrepancies with SPC or our hospital treatment guidelines. The proportion of discrepancies related to legal informations was 21.28% and them related to pharmacotherapy was 55.04%. The proportion of discrepancy per patient was estimated to 4.93%. Our study shows a high proportion of inappropriate prescriptions, none of them having induced adverse-drug effects.
Björkdahl, Anna; Perseius, Kent-Inge; Samuelsson, Mats; Lindberg, Mathilde Hedlund
There is an increased interest in exploring the use of sensory rooms in psychiatric inpatient care. Sensory rooms can provide stimulation via sight, smell, hearing, touch and taste in a demand-free environment that is controlled by the patient. The rooms may reduce patients' distress and agitation, as well as rates of seclusion and restraint. Successful implementation of sensory rooms is influenced by the attitudes and approach of staff. This paper presents a study of the experiences of 126 staff members who worked with sensory rooms in a Swedish inpatient psychiatry setting. A cross-sectional descriptive survey design was used. Data were collected by a web based self-report 12-item questionnaire that included both open- and closed-ended questions. Our findings strengthen the results of previous research in this area in many ways. Content analyses revealed three main categories: hopes and concerns, focusing on patients' self-care, and the room as a sanctuary. Although staff initially described both negative and positive expectations of sensory rooms, after working with the rooms, there was a strong emphasis on more positive experiences, such as letting go of control and observing an increase in patients' self-confidence, emotional self-care and well-being. Our findings support the important principals of person-centred nursing and recovery-oriented mental health and the ability of staff to implement these principles by working with sensory rooms. © 2016 Australian College of Mental Health Nurses Inc.
Siu, B W M; Tsang, M M Y; Lee, V C K; Liu, A C Y; Tse, S; Luk, H S M; Lo, N K Y; Lo, P H; Leung, Y L
Exploration of the information and participation needs of psychiatric inpatients is an important step for the implementation of recovery-oriented mental health service. The objective of this study was to explore the information and participation needs of Chinese psychiatric inpatients in the largest psychiatric hospital in Hong Kong. The study was divided into two parts. In the first part, eight focus groups with patients, patients' relatives and healthcare professionals were held to identify 22 items of information needs and 16 items of participation needs of Chinese psychiatric inpatients. Basing on the items identified in the first part of the study, a questionnaire was developed to survey on the importance of the different information and participation needs in the second part of the study. Participants were asked to rate in rank order their perceived importance of the items in the questionnaire survey. A hundred and eighty three Chinese psychiatric inpatients completed the questionnaire and the majority of them suffered from schizophrenia (68.3 %). For information needs, the top three needs rated by patients as the most important in descending order were: "Information on the classifications of mental illnesses, signs and symptoms and factors contributing to relapse", "Information on the criteria and arrangements for discharge", and "Information on the importance of psychiatric drug taking and its side effects". For participation needs, the top three needs rated by patients as the most important in descending order were: "Enquiring about personal needs and arrangements", "Keeping in touch with the outside world", and "Learning and practising self-management". This study reveals that Chinese psychiatric inpatients are concerned about information on their mental illness and its treatments as well as the criteria for discharge. On the other hand, patients are concerned about their personal needs, their self-management, as well as their keeping in touch with the
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
Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan
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 patient group that
Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan
Background and Objectives 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. Review Methods 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. Results 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. Conclusions 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
Cho, Un Jung; Lee, JooYoung; Kim, Hyo-Won; Lee, Jung Sun; Joo, Yeon-Ho; Kim, Seong-Yoon; Kim, Chang Yoon; Shin, Yong-Wook
Study of inpatient aggression in psychiatric inpatient units (PIUs), where vulnerable patients interact intensely in small groups, is hampered by a lack of systematic monitoring of aggressive events in the context of group dynamics. Our current study examines the relationship between aggression and group structure in the PIU of a general tertiary-care hospital over a 9-month period. The severity of aggression was monitored daily using the Overt Aggression Scale (OAS). Clinical data including the daily number and mean age of subpopulations with different diagnoses were acquired. Cross-correlation function and autoregressive integrated moving average modeling were used to assess the effects of various group structure parameters on the incidence of aggressive events in the PIU. The daily total OAS score correlated positively with the daily mean age of patients with schizophrenia and bipolar disorder. By contrast, the OAS total score demonstrated a negative correlation with the daily mean age of patients with major depression. The age of the patients at diagnosis is an important group structure that affects the incidence of aggression in a PIU.
Zimmermann, Peter; Alliger-Horn, Christina; Kowalski, Jens T; Plate, Stefan; Wallner, Franziska; Wolff, Elisabeth; Ströhle, Andreas
Military duty places high demands on the soldiers' social adaptability and competences. Avoidant personality traits can lead to interpersonal conflicts and at least to mental disorders. 192 German Armed Forces soldiers were treated in a multimodal inpatient psychiatric treatment setting at a Bundeswehr hospital between 2007 and 2010. 129 of these patients received a social skills group training (group training of social competence [GSC]) as part of this setting. A comparison group (n=63) did not participate but got unspecific treatment elements instead. The Symptom Checklist 90-Revised (SCL-90-R) and the Inventory on Competence and Control Beliefs (Fragebogen zu Kompetenz- und Kontrollüberzeugungen [FKK]) were applied. Symptom severity in the SCL-Global Severity Index, sum scale of the SCL-90-R and the four primary scales of the FKK showed significant improvements both immediately after treatment and at follow-up. No significant influence of the form of treatment (with/without GSC), age, gender, diagnosis, and deployments on the treatment result was established in the analysis of covariance. The data suggest that an inpatient psychiatric treatment setting focused on avoidant personality traits has a favorable effect on psychiatric symptom severity in military personnel. Social skills group training as a treatment component does not seem to be significantly superior to the standard setting.
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.
Fink, Kathryn; Ross, Colin A
Sixty-three inpatients in a psychiatric hospital who had previously undergone bariatric surgery were interviewed by the hospital dietitian. The purpose of the study was to determine the frequency of adverse childhood experiences in this population. Participants completed the Adverse Childhood Experiences (ACE) Scale. The average score on the ACE was 5.4 (3.3); 76% of participants reported childhood emotional neglect, 70% childhood verbal abuse, and 64% childhood sexual abuse; only two participants reported no adverse childhood experiences. The participants in the study reported high levels of adverse childhood experiences compared to the general population, which is consistent with prior literature on rates of childhood trauma in post-bariatric surgery patients. The role of adverse childhood experiences in post-bariatric surgery adaptation should be investigated in future research, including in prospective studies.
Hammer, Joseph H.; Springer, Justin; Beck, Niels C.; Menditto, Anthony; Coleman, James
Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations…
Kivisto, Aaron J
This study presents data on the relative contribution to gun violence by people with a history of inpatient psychiatric treatment and on federal efforts to deter presumptively dangerous persons from obtaining firearms, information useful for analyzing the potential public health benefits of gun policies targeting people with serious mental illness. The study also estimates the reduction in gun violence victims that would be expected if individuals with a previous psychiatric hospitalization were prohibited from purchasing firearms. Data from 838 violent gun offenders from a nationally representative sample of state prison inmates were analyzed. Those with and without a history of psychiatric hospitalization were compared on a range of offense characteristics, including relationship to the victim, number of victims, location of the offense, and source of firearms. Inmates with a history of hospitalization constituted 12% of all violent gun offenders and accounted for 13% of the sample's victims. They were less likely than those without a previous hospitalization to victimize strangers (odds ratio=.52) and were no more likely to commit gun violence in public or to have multiple victims. Among those with previous hospitalizations, 78% obtained guns from sources not subject to federal background checks. Of the total 1,041 victims of gun violence, only 3% were victimized by participants with a history of hospitalization who obtained guns from currently regulated sources. Prohibiting all individuals with a history of psychiatric hospitalization from purchasing firearms, absent expanded background checks, was estimated to reduce the number of gun violence victims by only 3%.
Fletcher, Teresa M; Markley, Laura A; Nelson, Dana; Crane, Stephen S; Fitzgibbon, James J
To assess patient outcomes and describe demographic data of pregnant adolescents admitted to an inpatient child and adolescent psychiatric unit, as well as to determine if it is safe to continue to admit pregnant adolescents to such a unit. A descriptive retrospective chart review conducted at a free-standing pediatric hospital in northeast Ohio of all pregnant adolescents aged 13 to 17 years admitted to the inpatient child and adolescent psychiatric unit from July 2005 to April 2013. Data collection included details on demographic, pregnancy status, and psychiatric diagnoses. Eighteen pregnant adolescents were admitted to the psychiatric unit during the time frame. Sixteen of those were in the first trimester of pregnancy. Pregnancy was found to be a contributing factor to the adolescent's suicidal ideation and admission in 11 of the cases. Admission to an inpatient psychiatric facility did not lead to adverse effects in pregnancy. Pregnant adolescents did not have negative pregnancy outcomes related to admission to an inpatient psychiatric unit. Results of this study suggest that it is safe to continue to admit uncomplicated pregnant adolescents in their first trimester to an inpatient child and adolescent psychiatric unit for an acute stay. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Aggression in the form of violence has been reportedly associated with a variety of psychiatric diagnoses, and in some cases, serious consequences have resulted form such assault. The study was aimed at determining the ranges and target of aggressive behaviour among Psychiatric in-patients at Jos University Teaching ...
Bohus, M; Schmahl, C; Herpertz, S C; Lieb, K; Berger, M; Roepke, S; Heinz, A; Gallinat, J; Lyssenko, L
Borderline personality disorders (BPD) are severe mental diseases which place high pressure on the psychiatric healthcare system. Nowadays, well-tested, disorder-specific treatment concepts are available also for inpatient treatment in Germany. These show very good and long-term improvements in the psychopathology as well as posttreatment social participation; however, prerequisites for the implementation of these evidence-based inpatient psychotherapy programs are well-trained treatment teams and appropriate financing of resource expenditure. The aim was to formulate a definition of normative needs for treatment duration and intensity for a guideline-conform, empirically proven and effective inpatient treatment of borderline personality disorder as well as the derived personnel requirements in comparison to the currently available resources within the framework of the Psychiatry Personnel Act (Psych-PV). The resource requirements were established based on evaluated hospital ward models, the recommendations of the S2 guidelines and the criteria of specialist societies and compared with the personnel stipulations according to the Psych-PV. The results for a normatively established treatment program showed a pronounced deficit in the financing of the evaluated resource requirements, even when the stipulations laid down in the Psych-PV were implemented to 100 %. Disorder-specific inpatient treatment programs for borderline personality disorder have been scientifically proven to be highly effective; however, resource analyses show that the personnel requirements necessary for effective implementation of these programs are much higher than those allocated by the funding according to the Pysch-PV. The current underfunding leads to inadequate treatment outcomes with high readmission rates and as a result high direct and indirect costs of illness.
Serper, Mark R; Goldberg, Brett R; Herman, Kristine G; Richarme, Danielle; Chou, James; Dill, Charles A; Cancro, Robert
Patients with severe mental illness are at increased risk to commit acts of aggression in the inpatient hospital setting. Aggressive behaviors have severe negative consequences for the patient, victims, clinical staff, and the therapeutic community as a whole. While risk factors of community and inpatient aggression overlap, many predictive factors diverge between the two settings. For example, while medication noncompliance has been a robust predictor of community aggression, this factor has little predictive value for inpatient settings where patients' pharmacotherapy is closely monitored. Relatively fewer investigators have examined a wide range of predictive factors associated with aggressive acts committed on the psychiatry inpatient service, often with conflicting results. The present study examined demographic, clinical, and neurocognitive performance predictors of self, other, object, and verbal aggressiveness in 118 acute inpatients. Results revealed that the arrival status at the hospital (voluntary vs involuntary), female gender, and substance abuse diagnosis were predictors of verbal aggression and aggression against others. Impaired memory functioning also predicted object aggression. Fewer symptoms, combined with higher cognition functioning, however, were significant predictors of self-aggressive acts committed on the inpatient service. The need for relating predictors of specific types of aggressiveness in schizophrenia is discussed.
Grant, Lyle G; Oliffe, John L; Johnson, Joy L; Bottorff, Joan L
Smoke-free grounds policies (SFGPs) were introduced to inpatient psychiatric hospital settings to improve health among patients, staff, and visitors. We conducted an ethnographic study in Northern British Columbia, Canada, to describe how the implementation of SFGPs is affected by institutional cultures. Data reported here included participant observation, document review, informal discussions (n = 11), and interviews with health care professionals (HCPs; n = 19) and staff (n = 2) at two hospitals. We used iterative and inductive processes to derive thematic findings. Findings related to HCPs illustrate how local contexts and cultural factors affect SFGP implementation. These factors included individual beliefs and attitudes, the influence of group norms, leadership and consensus building, and locale-specific norms. Strong, consultative leadership, in which leaders solicited input from and long-term support of people most directly responsible for policy implementation, was key to success. © The Author(s) 2014.
Lukaschek, Karoline; Baumert, Jens; Krawitz, Marion; Erazo, Natalia; Förstl, Hans; Ladwig, Karl-Heinz
Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge. To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment. The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis. Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, Punemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide. Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease. Royal College of Psychiatrists.
Such audit of psychiatric services is not a popular research venture in Nigeria. Objectives: The study aims to describe the pattern of old psychiatric admissions in a tertiary health facility and the socio-cultural and environmental factors that may influence the pattern. Methods: Data on monthly admissions over a 5-year period ...
Delaney, Kathleen R; Johnson, Mary E
Inpatient psychiatric nurses are a large workforce, but their work is poorly articulated and thus poorly understood outside of the professional inpatient community. To learn how inpatient psychiatric nurses depict their work, define important aspects of their role, and view the impact of the unit environment on their clinical practice. Metasynthesis of research that has focused on the ideas and perceptions of inpatient psychiatric nurses around their role and practice on inpatient psychiatric units. Three themes emerged from the analysis; the first was an umbrella for three important aspects of nursing work: the nurses' efforts to forge engagement with patients; their activities which maintained the safety of the unit and interventions nurses viewed as educating/empowering patients. The second theme captures the conditions that enabled nurses to do this work such as a cohesive nursing team and their sense of self-direction in their role. The final theme centers on difficulties nurses encountered in enacting their role which included multiple responsibilities for patient care and management of the milieu; intense work often with low visibility and scant support within the organization. Nurses need to articulate their practice so they can assert for the staffing and resources needed to keep units safe and promote patients' well-being, strive toward quality, and promote the development of the specialty.
Leonard T. Buller
Full Text Available Background. The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods. The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results. A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P<0.001. Depression was associated with higher odds of inpatient blood transfusion (P<0.001. Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P<0.001. Patients with a diagnosis of schizophrenia had a mean of 12 (P<0.001 more days of care than patients with no psychiatric comorbidity. Discussion. Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.
Tulloch, Alex D
Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.
The purpose of this study was to investigate the effects of relaxation exercises on anxiety levels in an inpatient general psychiatric unit. The conceptual framework used was holism. A convenience sample of 39 subjects was studied. Anxiety levels were measured prior to and post interventions with the state portion of the State-Trait Anxiety Inventory. Progressive muscle relaxation, meditative breathing, guided imagery, and soft music were employed to promote relaxation. A significant reduction in anxiety level was obtained on the post-test. The findings of this study can be incorporated by holistic nurses to help reduce anxiety levels of general psychiatric inpatients by using relaxation interventions.
Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.
The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit.
Staal, Jason A; Sacks, Amanda; Matheis, Robert; Collier, Lesley; Calia, Tina; Hanif, Henry; Kofman, Eugene S
A randomized, controlled, single-blinded, between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit. All participants received pharmacological therapy, occupational therapy, structured hospital environment, and were randomized to receive multi sensory behavior therapy (MSBT) or a structured activity session. Greater independence in activities of daily living (ADLs) was observed for the group treated with MSBT and standard psychiatric inpatient care on the Katz Index of Activities of Daily Living (KI-ADL; P = 0.05) than standard psychiatric inpatient care alone. The combination treatment of MSBT and standard psychiatric care also reduced agitation and apathy greater than standard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease (P = 0.05). Multiple regression analysis predicted that within the multi-sensory group, activities of daily living (KI-ADL) increased as apathy and agitation reduced (R2 = 0.42; p = 0.03). These data suggest that utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone.
Park, Jae Soon; Lee, Kyunghee
Meager research has been carried out to determine the effectiveness of the token economy among patients behaving violently in mental hospitals. The purpose of this study was to examine the effectiveness of the Short-Term Token Economy (STTE) on violent behavior among chronic psychiatric in-patients. A nonequivalent control group design method was utilized. Participants in an experimental group (n=22) and control group (n=22) took part in this study from January to April, 2008. Observation on aggressive behavior among male in-patients in one hospital as a baseline was made during the week before the behavior modification program and measurement of aggressive behavior was done using the Overt Aggression Scale (OAS), which includes verbal attacks, property damage and physical attacks. The aggressive behavior scores of the experimental group decreased, those of the control group, scores showed an increase after the eight-week behavior modification program utilizing STTE. The results of the study indicate that STTE is effective in reducing the incidence of aggressive behavior among male in-patients in psychiatric hospitals. The outcome of this study should be helpful in reducing the use of coercive measures or psychoactive medication in controlling the violent behavior among in-patients in hospitals.
Niethammer, Oliver; Frank, Reiner
To examine the prevalence of use, abuse, and dependence on legal and illegal psychotropic substances in an adolescent in-patient psychiatric population in relation to age and gender. Participants were all consecutive admissions (patients aged from 14 to 17) to the adolescent psychiatric in-patient unit. Of the 86 patients who met all the criteria for taking part in the study 70 were interviewed, giving a response rate of 81%. Prevalence of use and of substance use disorders were assessed through structured diagnostic interviews (M-CIDI), conducted from March 2000 through July 2000. We found high prevalence of use and of the diagnosis of legal and illegal psychotropic substances. Around 76% reported a regular use of tobacco, 44% regular alcohol use, and 40% regular use of illegal substances. Diagnosis (abuse or dependence) was found in 50% of cases for nicotine, 29% for alcohol, and 26% for illegal substances. The adolescent in-patient psychiatric population is at high risk of use, abuse, and dependence on legal and illegal psychotropic substances. It is important to diagnose these disorders (anamnesis, screening tools) and to install preventive and therapeutic programs in clinical therapeutic settings.
Jones, Heather A; Bilge-Johnson, Sumru; Rabinovitch, Annie E; Fishel, Hazel
The current study investigated relationships among self-reported peer victimization, suicidality, and depression in adolescent psychiatric inpatients. Sixty-seven adolescent psychiatric inpatients at a Midwestern children's hospital completed measures of bullying and peer victimization, suicidal ideation, and depression during their inpatient stay. Analyses indicated significant moderate correlations among victimization, suicidal ideation, and depression in adolescents. Results from mediational analyses found that negative self-esteem mediated the relationship between peer victimization and suicidal ideation. To date, this study is the first to directly examine the mechanisms underlying the relationship between peer victimization and suicidal ideation in adolescent psychiatric inpatients. © The Author(s) 2013.
Simoens Steven R
Full Text Available Abstract Background Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatric hospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway and the differences in the treatment of depressive episodes. Methods A convenience sample of 11 Flemish psychiatric hospitals participated in this qualitative study. Semi-structured interviews were conducted with different types of health care professionals (n = 43. The websites of the hospitals were searched for information on their approach to treating depressive episodes. Results A flow chart was made including the identified stages of the pathway: pre-admission, admission (observation and treatment, discharge and follow-up care. The characteristics of each stage are described. Although the stages are identified in all hospitals, differences between hospitals on various levels of the pathway exist. Hospitals emphasized the individual approach of each patient. The results point to a biopsychosocial approach to treating depressive episodes. Conclusion This study outlined current practice as a pathway for Flemish inpatients with depressive episodes. Within the context of surveillance of quality and quantity of care, this study may encourage hospitals to consider developing clinical pathways.
Hjorth, Peter; Davidsen, A.S.; Killian, R.
BACKGROUND: Patients with psychiatric illness have increased somatic morbidity and increased mortality. Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required. The aims of this study were to investigate whether an intervention...... programme to improve physical health is effective. METHODS: An extension of the European Network for Promoting the Health of Residents in Psychiatric and Social Care Institutions (HELPS) project further developed as a 12-month controlled cluster-randomized intervention study in the Danish centre. Waist...... circumference was a proxy of unhealthy body fat in view of the increased risk of cardiovascular diseases and type 2 diabetes. RESULTS: Waist circumference was 108 cm for men and 108 cm for women. Controlled for cluster randomization, sex, age, and body fat, the intervention group showed a small...
James, Anthony; Clacey, Joe; Seagroatt, Valerie; Goldacre, Michael
Background: Adolescence is a time of very rapid change not only in physical but also psychological development. During the teenage years there is a reported rise in the prevalence of psychiatric disorders. The aim of this study was to investigate age- and sex-specific National Health Service (NHS) hospital inpatient admission rates for psychiatric…
Weber, Bernhard; Schneider, Barbara; Fritze, Jurgen; Gille, Boris; Hornung, Stefan; Kuhner, Thorsten; Maurer, Konrad
Investigated the acceptance of computerized assessment, particularly compared to conventional paper-and-pencil techniques, in seriously impaired psychiatric inpatients. Describes the development of a self-rating questionnaire (OPQ, Operation and Preference Questionnaire) and reports results that showed computerized assessment was convincingly…
A.J. Zwets (Almar); R.H.J. Hornsveld (Ruud); P.E.H.M. Muris (Peter); T. Kanters (Thijs); E. Langstraat (Egbert); H.J.C. van Marle (Hjalmar)
textabstractThe first results of psychomotor therapy (PMT) as an additional component to Aggression Replacement Training (ART) were explored in a group of forensic psychiatric inpatients (N = 37). Patients were divided into two groups: ART+PMT (experimental group) and ART+Sports (control group).
Medel-Herrero, Alvaro; Gomez-Beneyto, Manuel
Little is published about the impact of the 2008 economic crisis on mental health services in Spain. An interrupted time series analysis was conducted to investigate a potential short-term association between the 2008 economic crisis and the number of psychiatric hospital admissions. The timing of the intervention (April 2008) was based on observed changes in Gross Domestic Product (GDP). Data on 1,152,880 psychiatric inpatients from the national Hospital Morbidity Survey, 69 months before and after the onset of the economic crisis (April 2008), were analyzed. Age-adjusted psychiatric (ICD9 290-319) hospital discharge rates significantly increased from April 2008, matching the onset of the crisis, especially for inpatients aged 15-24 years old and to a less extend for inpatients aged 25-34 years old. Other age groups were not affected. There was a significant increase in diagnoses for disturbance of conduct and emotions, depression, neurotic and personality disorders and alcohol and drug disorders; however, diagnoses for mental retardation and organic psychosis for 15-34 years old inpatients were unaffected. Psychiatric hospital admissions abruptly increased in April 2008, coinciding with the onset of the economic crisis. We identified age groups and diagnoses affected. Increased hospitalizations were found only at the age-ranges most affected by the rise in unemployment. The diagnoses affected were those most sensitive to environmental changes. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.
Zhand, Naista; Matheson, Katherine; Courtney, Darren
This study presents a comprehensive report of children and adolescents who engaged in self-harm during their admission to a psychiatric inpatient unit. A chart review was conducted on all admissions to an acute care psychiatric inpatient unit in a Canadian children's hospital over a one-year period. Details on patients with self-harm behaviour during the admission were recorded, including: demographics, presentation to hospital, self-harm behaviour and outcome. Baseline variables for patients with and without self-harm behaviour during admission were compared. Self-harm incidents were reported in 60 of 501 (12%) admissions during the one-year period of the study. Fourteen percent of patients (50 of 351) accounted for total number of 136 self-harm incidents. Half of these incidents (49%) occurred outside of the hospital setting, when patients were on passes. Using the Beck Lethality Scale (0-10), mean severity of the self-injury attempts was 0.33, and there were no serious negative outcomes. Self-harm behaviour during inpatient psychiatric admission is a common issue among youth, despite safety strategies in place. While self-harm behaviour is one of the most common reasons for admission to psychiatric inpatient unit, our understanding of nature of these acts during the admission and contributing factors are limited. Further research is required to better understand these factors, and to develop strategies to better support these patients.
Pettipher, Alexander; Ovens, Richard
There is increased morbidity and mortality among patients suffering from mental illness. This is believed to be multi-factorial. Poor access to healthcare, the stigma of mental illness, reduced clinic attendance, lifestyle factors, and side effects of medications are cited as possible contributing factors. It is therefore vital to perform a physical examination to identify previously undiagnosed conditions during the admission of a psychiatric inpatient. The Royal College of Psychiatrists recommends that all patients admitted to a psychiatric hospital should receive a full physical examination on admission, or within twenty-four hours of admission. A snapshot audit was carried out at Prospect Park Hospital in Reading, which highlighted that The Royal College of Psychiatrist's recommendation, along with Trust guidelines regarding physical examination were not being met, with only 78 out of 111 patients (70.3%) undergoing an examination during their admission. In addition to this, examinations were often poorly documented and not covering all examination domains. A psychiatric inpatient physical health assessment sheet (PIPHAS) was designed and introduced, providing a quick and standardised approach to the documentation of a physical examination. After the intervention was put into practice, its impact was assessed by performing a retrospective review of the admission clerking notes of the next 100 admissions to Prospect Park Hospital. Following the introduction of the PIPHAS form there was an increase in the number of patients undergoing physical examination on admission to hospital (75 out of 100 patients, 75%). There was also an increase in the thorough documentation of all examination domains (e.g. respiratory examination) for patients that had a completed PIPHAS form scanned within their medical records. This quality improvement project demonstrates that the PIPHAS form is a useful tool to improve the speed, efficiency, and documentation of a thorough physical
Vruwink, F.J.; Noorthoorn, E.O.; Nijman, H.L.I.; Nagel, J.E.L. van der; Hox, J.J.C.M.; Mulder, C.L.
ome aggressive incidents in psychiatric wards result in seclusion, whereas others do not. We used the Staff Observation Aggression Scale-Revised and the mental health trust's database to identify determinants that predicted seclusion after aggression. These consisted of demographic, diagnostic,
Conclusion: Professionals dealing with treatment of psychiatric disorders should always be aware of substance use disorder comorbidity, and start treatment immediately without causing any delay in treatment. Obviously we need future large prospective studies to get more insight into these dual-diagnose disorders. [Cukurova Med J 2012; 37(1: 37-48
pattern of psychiatric admission that may be found in. Nigeria. Such findings may improve the preparedness of mental health facilities by guiding service organisation and planning in most sub-Sahara African countries like Nigeria where mental health services are poorly developed and professionals are scarce5.
Elisei, Sandro; Pauselli, Luca; Balducci, Pierfrancesco Maria; Moretti, Patrizia; Quartesan, Roberto
Mood disorders (MD) show higher prevalence among psychiatric disorders. As a matter of fact 10% of inpatients in non psychiatric health care structures are affected by MD. A consultation-liaison service bridges the gap between psychiatric and other medical disciplines and increases the cooperation in the context of care, improving the diagnostic process for all inpatients in medical wards. Our sample is composed of 1702 patients assessed from 1 January 2012 to 31 December 2012 referred from the wards for psychiatric specialist evaluation in Santa Maria della Misericordia, Perugia, Italy. Each patient was assessed by a consultant psychiatrist performing a psychiatric interview leading to a diagnosis according to DSM-IV-TR criteria. Clinical and sociodemographic data were collected and registrered in the clinical records. SPSS software (ver. 18) was used for data analysis. Chi-square test and T-student tests were performed as appropriate. A p-valueconsultation referral urgent status we found that 84% of requests needed to be seen within 24 h, most of them come from Emergency room. Statistically significant correlations can be found between the source of referrals, the reasons for the referrals, psychiatric care prior to the evaluation and the psychiatric disorder which was diagnosed during the assessment. Consultation-liaison service for MD in an italian general hospital is generally based on emergency/urgency referrals from the Emergency room for patients already assessed to mental care facilities by private or national health service psychiatrists.
Häfner, Sibylle; Wolff-Menzler, Claus; Schulz, Michael; Noelle, Rüdiger; Wiegand, Hauke Felix; Seemüller, Florian; Nienaber, Andre; Löhr, Michael; Godemann, Frank
Individuals suffering from mental illness have one to two decades reduced life expectancy. The increased morbidity and mortality is mainly due to cardiometabolic disorders. Despite these numbers, international studies give evidence that diagnoses and treatment of metabolic risk factors in psychiatric patients is insufficient. We assume that in Germany metabolic risk factors are also underdiagnosed and insufficiently treated. We tested for the frequency of diagnoses of the metabolic risk factors obesity, nicotine dependence and abuse, disorders of lipid metabolism, hypertension and diabetes in 139 307 cases of residential treatment and semi-residential care in 47 psychiatric hospitals in Germany in the year 2012. Data were derived from the VIPP(indicators of treatment quality in psychiatry and psychosomatic medicine)-project, a project that comprises the routine data of psychiatric hospitals, that are sent to the InEK (institute for the lump sum payment system for hospitals). Frequencies were compared with prevalence of metabolic risk factors in the German population and prevalences of metabolic risk factors found in psychiatric patients in international studies. In particular obesity (2.8 %), disorders of lipid metabolism (2.8 %) and nicotin dependence (4.2 %) were underdiagnosed. We assume that also diabetes (6.8 %) and hypertension (17.7 %) were underdiagnosed. The results give evidence that metabolic risk factors are underdiagnosed and possibly insufficiently treated in German psychiatric hospitals. We cannot exclude that the results might also be due to poor documentation. It remains to be seen if the introduction of the PEPP (the new lump sum payment system in German psychiatry) will heighten the level of attention for metabolic risk factors and their treatment. © Georg Thieme Verlag KG Stuttgart · New York.
Menkes David B
Full Text Available Abstract Background Vitamin D deficiency is widespread in New Zealand, confers multiple health risks, and may be particularly common among people with psychiatric illness. We studied vitamin D status in an unselected sample of adult psychiatric inpatients in Hamilton (latitude 37.5 S during late winter. Methods We recruited 102 consenting subjects and measured 25-hydroxy vitamin D3 levels in venous blood using a competitive electrochemiluminescence immunoassay. In addition to descriptive statistics, we used one-sample t-tests to determine the extent to which ethnic and diagnostic subgroups fell below the vitamin D deficiency threshold of 50 nM. Results 75 subjects (74% had vitamin D levels Conclusions Vitamin D deficiency is prevalent in the psychiatric inpatient setting in New Zealand and may be relevant to poor physical health outcomes, notably among Maori and those with schizophrenia. These findings support proposals to provide vitamin D supplementation, particularly during the winter months.
psychiatric facilities in Denmark: an outpatient psychiatric long-term treatment clinic and a closed psychiatric ward. The applied methods are participant observation, interviews with patients and professionals and analysis of documents. Employing discursive and narrative approaches, the aim of the project...
Wöckel, Lars; Goth, Kirstin; Matic, Nina; Zepf, Florian Daniel; Holtmann, Martin; Poustka, Fritz
The majority of adult patients with borderline personality disorder (BPD) are treated with psychotropic drugs. However, there are no data on psychotropic therapy in adolescents. This study examines the prevalence of BPD in an adolescent population undergoing either inpatient or outpatient psychiatric treatment and assesses psychotropic prescription patterns in adolescent in- and outpatients with BPD. Out of a population of adolescents undergoing psychiatric treatment over a seven-year observation period, 58 adolescent patients with BPD (16.7 +/- 2.5 years) were investigated retrospectively with regard to their first episode of treatment, type of medication, and different risk variables. Out of the investigated population, 37 inpatients and 21 outpatients received treatment. Inpatients were shown to have higher rates of risk variables (approx. 68% with co-morbid disorders and approx. 49% with self-harmful behaviour, significantly (p NaSSA) were most commonly prescribed, followed by neuroleptics. More than 50% of the medicated patients were treated with multiple psychotropic drugs administered simultaneously. Pharmacotherapy in BPD has a high and increasing therapeutic value, with the prescription of psychotropic drugs being primarily symptom-orientated. Pharmacotherapy of co-morbid disorders should be accorded equal treatment priority. In line with this, psychotropic treatment of BPD in adolescents is increasingly important. Inpatient adolescents are more burdened in terms of psychiatric risk variables, and also receive medication more often.
Hilts, Darolyn; Moore, James M
The present study examined the base rates of normal range Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) profiles in an inpatient sample and examined the differences between adolescents with apparently valid normal range profiles (all clinical scale T-scores MMPI-A validity scale scores and other indexes of underreporting. Normal range profiles cannot be adequately explained by a less pathological history prior to hospitalization or by defensiveness. Thirty percent of male and 25% of female adolescents produced valid MMPI-A profiles in which none of the clinical scales were elevated. Both male and female adolescents with normal range profiles were generally less likely to report internalizing symptoms than those with elevated profiles, but both groups report externalizing symptoms. Neither the standard MMPI-A validity scales nor additional validity scales discriminated between profile groups. Clinicians should not assume that normal range profiles indicate an absence of problems.
Beecham, Jennifer; Chisholm, Daniel; O'Herlihy, Anne; Astin, Jack
Child and adolescent in-patient care is a highly specialised service, ideally requiring planning at a national level, but there are no routine data collections specifically for these services. To estimate unit costs for child and adolescent psychiatric in-patient units and to analyse the variations in costs between units. Data collection alongside a national survey with cost estimations guided by principles drawn from economic theory. Bivariate and multivariate analyses are employed to identify cost influences. Fifty-eight units could provide sufficient data to allow calculation of the cost per in-patient day; mean= pound 197 (s.d.=71.6; 1999-2000 prices). The management sector, type of provision, number of rooms, capacity and location explained nearly half of the cost variation. Child and adolescent psychiatric in-patient units are an expensive resource, with personnel absorbing two-thirds of the total costs. Costs per in-patient day vary fourfold and the exploration of cost variations can inform commissioning strategies.
Our objectives were to examine patients' perceptions with psychiatric care to prioritize action for quality improvement (QI), and to explore differences in care experiences across domains of care by sample subgroups in psychiatric inpatient hospitals. Analysis of frequency, central tendency, and variation examined the distribution of 11,778 Inpatient Consumer Surveys (ICS), from 67 psychiatric inpatient hospitals, by domain of care and Likert scale. The percentage of patients responding positively to each domain of care was evaluated. A performance-importance matrix was constructed to identify key drivers and prioritize action for QI. Chi-squared, t test, and analysis of variance (ANOVA) analyses evaluated the experiences of care by sample subgroups. Overall, patients tended to be satisfied with the care received. However, patients perceived their care differently across hospitals. Hospitals scored lower in the rights domain, mainly attributed to problems with communication between patients and hospital staff. Patients' care experiences varied among sample subgroups; however, four sample characteristics were common to all domains of care. Patients who were Latinos, aged 65 years and older, who completed the survey at discharge, before leaving the hospital, had a higher perception of care across all domains of care. Either an examination of the individual items on the ICS or the aggregation of them by domain of care, the ICS could be a significant tool for hospitals that continuously strive to improve the quality of care provided to psychiatric patients in a time driven by the needs and expectations of consumers.
Haker, Helene; Lauber, Christoph; Malti, Tina; Rössler, Wulf
Disasters of the magnitude of September 11, 2001 have a serious public health impact. By dominating media broadcasts, this effect is not limited to the site of the disaster. We tested the hypothesis whether such extraordinary burden results in an increase of psychiatric inpatient treatment. As such we analysed all psychiatric inpatient admissions in the Canton of Zurich/Switzerland. To test the influence of proximity to a disaster, we additionally analysed the impact of a local amok run on September 27, 2001. Psychiatric inpatient admissions in the Canton of Zurich from September 2000 to September 2002 were analysed based on the data of the psychiatric case register. ARIMA modelling was employed to describe time-series of admissions per week over the 2-year period and to identify the impact of the incidents of 9/11 and 9/27, 2001. Mean numbers of weekly admissions were comparable in a time span of one month before and one month after the two incidents, thus, no significant changes were detected by the ARIMA modelling. Against widespread beliefs, for patients with severe mental disorders requiring hospitalisation illness factors seem to play a more relevant role for decompensation than external psychosocial factors such as the described incidents.
Zanarini, Mary C; Temes, Christina M; Magni, Laura R; Fitzmaurice, Garrett M; Aguirre, Blaise A; Goodman, Marianne
The validity of borderline personality disorder (BPD) in children and adolescents has not been studied in a rigorous manner reflecting the criteria of Robins and Guze first detailed in 1970. This paper and the others in this series address some aspects of this multifaceted validation paradigm, which requires that a disorder has a known clinical presentation, can be delimited from other disorders, 'runs' in families, and something of its aetiology, treatment response and course is known. Three groups of subjects were studied: 104 adolescent inpatients meeting the Revised Diagnostic Interview for Borderlines and DSM-IV criteria for BPD, 60 psychiatrically healthy adolescents and 290 adult inpatients meeting the Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for BPD. Adolescents with BPD had significantly higher prevalence rates of 22 of the 24 symptoms studied than psychiatrically healthy adolescents. Only rates of serious treatment regressions and countertransference problems failed to reach the Bonferroni-corrected level of 0.002. Adolescents and adults with BPD had only four symptomatic differences that reached this level of significance, with adolescents with BPD reporting significantly lower levels of quasi-psychotic thought, dependency/masochism, devaluation/manipulation/sadism and countertransference problems than adults with BPD. Taken together, the results of this study suggest that adolescents report BPD as severe as that reported by adults. They also suggest that BPD in adolescents is not a tumultuous phase of normal adolescence. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Bioulac, S; Bourgeois, M; Ekouevi, D K; Bonnin, J M; Gonzales, B; Castello, M F
Suicide is the most dramatic complication of psychiatric disorders. Certain risk factors are generally accepted by practitioners. Mental disorders increase (tenfold) suicidal risk. However, this "statistically rare event" renders very difficult the definition of predictive factors. A personal prospective longitudinal study of 200 psychiatric inpatients followed up during an 8-year period found 5% of deaths by suicide. Amongst the various risk factors reputed predictive for suicide, only 2 were found statistically more frequent in the suicidal group: familial antecedents (1st degree relatives) of suicide and hospitalization in psychiatry. Impulsivity was also more frequent but could be imputed to the younger age of the suicide victims. Therefore, it was impossible to find determinants of suicide. This makes difficult preventive measures, excepted that psychiatric patients are at a much greater risk and should be diagnosed and correctly treated. There are also increasing legal aspects of responsibility for psychiatrists and psychiatric institutions in charge of these patients.
Conning, A M; Brownlow, J M
Fifty-three long-stay patients on the back wards of a large psychiatric hospital in London were assessed to determine their suitability for other placements after the hospital was closed. The general and deviant behavior subscales of the REHAB Scale were used in the assessment. A wide range of scores indicated that these patients varied greatly in basic living skills. Associations were investigated between patients' scores and somatic problems, fluctuations in mental state, and adverse reactions to change, which affect patients' ability to live in the community. Of 14 patients whose scores indicated a potential for discharge, two had significant deviant behaviors, seven had fluctuating mental states, and two were known to react adversely to change. Although the REHAB Scale is useful, results show that placement decisions should not be based on scores alone. Flexible services that take into account fluctuations in patients' functioning are required.
Full Text Available Background: Oral health has an impact on general health, self-esteem and quality of life, but it often has a low priority in the context of mental health and in some phases of illness, the priority may be nonexistent Patients with psychiatric illness have poor oral hygiene than general population. Very few studies have been reported regarding the oral health among Indian psychiatric inpatients. Aim: To assess the oral health status of long-term psychiatric inpatients in a psychiatric institute and to evaluate the treatment requirements of psychiatric inpatients for maintaining the oral hygiene. Materials and methods: Psychiatric inpatients were examined and data was collected using the WHO standardized dental evaluation form in the psychiatric institute. Results: One hundred and forty-one patents (53% female: mean age: 36.56 ± 13.28 years: 47% male: mean age: 37.36 ± 12.49 years: length of illness: More than 5 years, 35.5%: less than 5 years, 84.5% were included in the study. 73% being schizophrenics. Dental canes was found in 55.3% patients. Calculus was present in 94.3% patients. Missing teeth was found in 22.7% patients. Mucosal lesions and oral ulcers were seen in 5.7 and 1 4% of total examined patients respectively. Percentages of patient requiring extractions were 34.8%. oral prophylaxis 98.6%. conservative treatment 31.9% and prosthesis 20.6%. Age was significantly correlated with number of decayed (r = 0.294, p < 0.01 and missing teeth (r = 0.436, p < 0.01. Length of illness was significantly correlated with number of decayed (r = 0.258. p < 0.01 and missing teeth (r = 0.229. p < 0.0 1 Conclusion: Oral health is an important and integral part of health care. Members of multidisciplinary team should be encouraged to assist psychiatric patients in maintaining their oral health with good oral hygiene and access to dental treatment taking into account their special needs.
Full Text Available Fahad D Alosaimi,1 Abdulhadi Alhabbad,2 Mohammed F Abalhassan,3 Ebtihaj O Fallata,4 Nasser M Alzain,5 Mohammad Zayed Alassiry,6 Bander Abdullah Haddad71Department of Psychiatry, King Saud University, Riyadh, 2Department of Psychiatry, Prince Mohammed Medical City, Aljouf, 3Department of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, 4Department of Psychiatry, Mental Health Hospital, Jeddah, 5Department of Psychiatry, Al-Amal Complex for Mental Health, Dammam, 6Medical Services Department, Abha Psychiatric Hospital, Abha, 7Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard, Riyadh, Saudi ArabiaObjective: To study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia.Method: This cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651 and female (n=594 patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient’s type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients.Results: Several studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004, unmarried (P<0.001, have less number of children (1–3; P=0.002, unemployed (P=0.001, have a lower family income (<3,000 SR; P<0.001, live in rural communities (P<0.001, have a lower body mass index (P=0.001, and are smokers (P<0.001; however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%, antidepressants (41.4%, mood stabilizers
Jones, Nicole Tuomi; McGill, Amanda C; Vogler, Jason E; Oxley, Stephen
The primary goals of compulsory, inpatient, psychiatric treatment are to decrease dangerous behaviors and help improve functioning so that a safe discharge to a less restrictive environment can be obtained. This study examined the aggression rates, levels of functioning, and treatment adherence for persons treated for schizophrenia (N = 506) compared with persons treated for borderline personality disorder (BPD) (N = 98) in an inpatient psychiatric facility. Over half of persons engaged in at least one incident of aggressive behavior during hospitalization. Differences in the types of aggression and functional deficits between these two clinical sub-groups were found. In addition, overall impairment increased the likelihood of aggressive behavior for persons diagnosed with schizophrenia, whereas irritability and social dependence increased the risk of aggression for persons diagnosed with BPD. Treatment interventions that target the improvement of these deficits may help reduce the intensity and severity of aggressive behaviors and help improve functioning and discharge readiness.
Lunsky, Yona; Bradley, Elspeth A; Gracey, Carolyn D; Durbin, Janet; Koegl, Chris
There are few published studies on the relationship between gender and psychiatric disorders in individuals with intellectual disabilities. Adults (N = 1,971) with and without intellectual disabilities who received inpatient services for psychiatric diagnosis and clinical issues were examined. Among individuals with intellectual disabilities, women were more likely to have a diagnosis of mood disorder and sexual abuse history; men were more likely to have a substance abuse diagnosis, legal issues, and past destructive behavior. Gender difference patterns found for individuals with intellectual disabilities were similar to those of persons without intellectual disabilities, with the exception of eating disorder and psychotic disorder diagnoses. Gender issues should receive greater attention in intellectual disabilities inpatient care.
Peters, Shannon M; Knauf, Kendra Quincy; Derbidge, Christina M; Kimmel, Ryan; Vannoy, Steven
We sought to characterize diagnostic and treatment factors associated with receiving a prescription for benzodiazepines at discharge from a psychiatric inpatient unit. We hypothesized that engaging in individual behavioral interventions while on the unit would decrease the likelihood of receiving a benzodiazepine prescription at discharge. This is an observational study utilizing medical chart review (n=1007) over 37 months (2008-2011). Descriptive statistics characterized patient demographics and diagnostic/prescription frequency. Multivariate regression was used to assess factors associated with receiving a benzodiazepine prescription at discharge. The sample was 61% female with mean age=40.5 (S.D.=13.6). Most frequent diagnoses were depression (54.7%) and bipolar disorder (18.6%). Thirty-eight percent of participants engaged in an individual behavioral intervention. Benzodiazepines were prescribed in 36% of discharges. Contrary to our hypothesis, individual behavioral interventions did not influence discharge benzodiazepine prescriptions. However, several other factors did, including having a substance use disorder [odds ratio (OR)=0.40]. Male sex (OR=0.56), Black race (OR=0.40) and age (OR=1.03) were nonclinical factors with strong prescribing influence. Benzodiazepines are frequently prescribed at discharge. Our results indicate strong racial and sex biases when prescribing benzodiazepines, even after controlling for diagnosis. Copyright © 2015 Elsevier Inc. All rights reserved.
markdownabstractThe first goal of the current research project was to get more insight in the determinants of reactive aggression, namely psychopathy, as measured with the Psychopathy Checklist-Revised (PCL-R), and implicit attitudes toward violence. The second goal was was to investigate the possible treatment effects of a multi-modal treatment program for violent forensic psychiatric inpatients, consisting of the extended Aggression Replacement Training (ART) and psychomotor therapy (PMT). ...
Zwets, Almar; Hornsveld, Ruud; Muris, Peter; Kanters, Thijs; Langstraat, Egbert; Marle, Hjalmar
textabstractThe first results of psychomotor therapy (PMT) as an additional component to Aggression Replacement Training (ART) were explored in a group of forensic psychiatric inpatients (N = 37). Patients were divided into two groups: ART+PMT (experimental group) and ART+Sports (control group). Primary outcome measures of aggression, anger, and social behavior, and secondary outcome measures of coping behavior and bodily awareness during anger were administered on three occasions: pretreatme...
Zwets, Almar J.; Hornsveld, Ruud H J; Muris, Peter; Huijding, Jorg; Kanters, Thijs; Snowden, Robert J.; van Marle, Hjalmar
In order to investigate the relation between implicit attitudes toward violence and different aspects of violent and social behavior in Dutch forensic psychiatric inpatients, an implicit association test was related to measures of psychopathy, aggression, and socially adaptive behaviors. Results
Bousardt, Annelea M C; Hoogendoorn, Adriaan W; Noorthoorn, Eric O; Hummelen, Jacobus W; Nijman, Henk L I
Empirical knowledge of 'predictors' of physical inpatient aggression may provide staff with tools to prevent aggression or minimise its consequences. To test the value of a self-reported measure of impulsivity for predicting inpatient aggression. Self-report measures of different domains of impulsivity were obtained using the Urgency, Premeditation, Perseverance, Sensation seeking, Positive urgency (UPPS-P) impulsive behaviour scale with all 74 forensic psychiatric inpatients in one low-security forensic hospital. Aggressive incidents were measured using the Social Dysfunction and Aggression Scale (SDAS). The relationship between UPPS-P subscales and the number of weeks in which violent behaviour was observed was investigated by Poisson regression. The impulsivity domain labelled 'negative urgency' (NU), in combination with having a personality disorder, predicted the number of weeks in which physical aggression was observed by psychiatric nurses. NU also predicted physical aggression within the first 12 weeks of admission. The results indicate that NU, which represents a patient's inability to cope with rejection, disappointments or other undesired feelings, is associated with a higher likelihood of becoming violent while an inpatient. This specific coping deficit should perhaps be targeted more intensively in therapy. Self-reported NU may also serve as a useful adjunct to other risk assessment tools and as an indicator of change in violence risk. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Hooman, Sharifi; Zahra, Hessami; Safa, Mitra; Hassan, Farhadi Mohammad; Reza, Masjedi Mohammad
...) who were admitted in Razi mental health Hospital in Tehran, Iran. We recruited 984 participants, who were receiving services from Razi mental health Hospital and hospitalized for at least two days between 21 July to 21 September, 2010...
Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete
People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools. PMID:28257103
Full Text Available People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.
Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete
People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.
Biancosino, Bruno; Delmonte, Sara; Grassi, Luigi; Santone, Giovanni; Preti, Antonio; Miglio, Rossella; de Girolamo, Giovanni
Violence committed by acute psychiatric inpatients represents an important and challenging problem in clinical practice. Sociodemographic, clinical, and treatment information were collected for 1324 patients (677 men and 647 women) admitted to Italian public and private acute psychiatric inpatient facilities during an index period in 2004, and the sample divided into 3 groups: nonhostile patients (no episodes of violent behavior during hospitalization), hostile patients (verbal aggression or violent acts against objects), and violent patients (authors of physical assault). Ten percent (N = 129) of patients showed hostile behavior during hospitalization and 3% (N = 37) physically assaulted other patients or staff members. Variables associated with violent behavior were: male gender, attitude at admission, and a diagnosis of schizophrenia, bipolar disorder, personality disorder, mental retardation, organic brain disorder or substance/alcohol abuse. Violent behavior during hospitalization was a predictive factor for higher Brief Psychiatric Rating Scale scores and for lower Personal and Social Performance scale scores at discharge. Despite the low percentage of violent and hostile behavior observed in Italian acute inpatient units, this study shed light on a need for the careful assessment of clinical and treatment variables, and greater effort aimed at improving specific prevention and treatment programs of violent behavior.
Beaglehole, Ben; Bell, Caroline; Beveridge, John; Frampton, Chris
Following the devastating earthquake in Christchurch, New Zealand, there was the widespread perception that the demand for inpatient mental health services would increase. However, our clinical observation was to the contrary, with substantial reductions in inpatient utilisation being noted. We therefore examined psychiatric bed occupancy and admission data to improve understanding of the impact of the disaster on mental health services. We audited acute psychiatric bed occupancy and admission rates prior to and following a major earthquake. After the earthquake, total bed occupancy reduced from an average of 93% to 79%. Daily admissions also reduced by 20.2% for the 30 days following the earthquake. All diagnostic groups, with the exception of the 'Schizophrenia, schizotypal and delusional disorders' category, contributed to the reduction. No rebound to increased occupancy or admissions was seen over the study period. The study confirmed our clinical observation that demand for acute inpatient psychiatric services were markedly reduced after the February 2011 earthquake. © The Royal Australian and New Zealand College of Psychiatrists 2014.
Brugman, S.; Lobbestael, J.; von Borries, A.K.L.; Bulten, B.E.H.; Cima, M.; Schuhmann, T.; Dambacher, F.; Sack, A.T.; Arntz, A.
This study tested the predictive value of attentional bias, emotion recognition, automatic associations, and response inhibition, in the assessment of in-clinic violent incidents. Sixty-nine male forensic patients participated and completed an Emotional Stroop to measure attentional bias for threat
Berling, Ingrid; Gupta, Rahul; Bjorksten, Cecilia; Prior, Felicity; Whyte, Ian M; Berry, Sherman
There is an increased rate of sudden cardiac death (SCD) in mental health patients. Some antipsychotic medications are known to prolong the QT interval, thus increasing a patient's risk of SCD via the arrhythmia, torsades de pointes (TdP). Our aim was to evaluate assessment for QT prolongation within a public inpatient mental health facility by auditing electrocardiograph (ECG) use. We reviewed records of all mental health inpatient admissions to a public emergency mental health inpatient unit between 1 January 2016 and 11 February 2016. ECG availability was noted and QT interval was manually measured and assessed for risk of TdP using the QT nomogram when present. Demographic information and medication use was collected. Of 263 mental health inpatient admissions, 50 (19%) presentations had an ECG. A total of four (8%) had a prolonged QT interval. Of the 50 patients with an ECG, 12 (24%) were taking medication known to prolong the QT interval. There was very limited risk assessment for QT prolongation in a public hospital psychiatric inpatient unit, with less than 20% of patients having an ECG performed. Our study supports an association between QT-prolonging drugs and a clinically significant prolonged QT interval; however, a larger study with routine ECG screening is required.
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.
Maria P Henning
Full Text Available Background. Syphilis research has neglected the prevalence of the disease among psychiatric patients, and traditional syphilis screening has been reported as inadequate. Objectives. (i To assess the syphilis prevalence among psychiatric patients; (ii to compare psychiatric diagnoses of syphilis-infected and -uninfected patients; (iii to assess self-reported high-risk sexual behaviour; (iv to establish syphilis/HIV co-morbidity; and (v to investigate the performance of the rapid plasma reagin (RPR test in syphilis screening, compared with the Treponema pallidum haemagglutination (TPHA test. Methods. Psychiatric inpatients at Weskoppies Hospital, Pretoria, who consented to participate in the study (N=195 were categorised according to gender and length of admission (long-term or recent. Non-treponemal RPR, confirmatory TPHA, HIV-rapid and HIV enzyme-linked immunosorbent assay (ELISA tests were performed. A reactive TPHA test was used to diagnose syphilis. Results. The estimated prevalence of syphilis was 11.7%. There was no significant association between TPHA sero-positivity and primary psychiatric diagnosis or self-reported high-risk sexual behaviour. Significant co-morbidity existed between syphilis and HIV (p=0.012. Compared with the TPHA test, the RPR test performed poorly, identifying only 2/23 patients who had a sero-positive TPHA test (8.7% sensitivity and 100% specificity. Conclusions. The prevalence of syphilis was higher than anticipated, supporting the need for routine testing. The significant co-morbidity and alarming prevalence of HIV and syphilis warrant testing for both conditions in all psychiatric admissions. Current syphilis screening with a single RPR test is inadequate; both RPR and TPHA tests should be performed.
Selenius, Heidi; Leppänen Östman, Sari; Strand, Susanne
Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing. The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients' self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression. Female forensic psychiatric patients (n = 130) from a high security hospital were included. The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff. These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor 'Symptom of major mental illness' within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.
Albayrak, Özgür; Föcker, Manuel; Kliewer, Josephine; Esber, Simon; Peters, Triinu; de Zwaan, Martina; Hebebrand, Johannes
Our aims were to investigate the relationship between food addiction and mental disorders including eating disorders (ED), eating-related psychopathology and body mass index-standard deviation score in a sample of adolescent psychiatric inpatients. Food addiction was assessed with the Yale Food Addiction Scale (YFAS). Eating-related psychopathology was measured with the Three-Factor Eating Questionnaire (TFEQ). Psychiatric diagnoses were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The sample consisted of n = 242 adolescent psychiatric inpatients, of which n = 37 (15.3%) met criteria for an ED. Multiple regression analysis was used to examine the association between YFAS symptom count, TFEQ scales and ED controlling for age and gender. Food addiction frequency was 16.5%, and the mean YFAS symptom count was 2.39 (SD: 1.60). In patients with food addiction, TFEQ scale scores were significantly higher than patients without food addiction. Frequency of ED was 42.9% in patients with and 9.9% in patients without food addiction. The TFEQ subscales disinhibition and hunger as well as diagnosis of ED were associated with YFAS symptom count. Food addiction in adolescent psychiatric inpatients occurs with rates higher than those seen in community samples of children, adolescents and adults. Food addiction might be associated with eating styles related to susceptibility to hunger and feelings of loss of control. The implications of high-YFAS scores in restricting-type anorexia nervosa warrant further investigations to explore which and how the respective items are interpreted in this ED subgroup. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Full Text Available Abstract Background Medical spending on psychiatric hospitalization has been reported to impose a tremendous socio-economic burden on many developed countries with public health insurance programmes. However, there has been no in-depth study of the factors affecting psychiatric inpatient medical expenditures and differentiated these factors across different types of public health insurance programmes. In view of this, this study attempted to explore factors affecting medical expenditures for psychiatric inpatients between two public health insurance programmes covering the entire South Korean population: National Health Insurance (NHI and National Medical Care Aid (AID. Methods This retrospective, cross-sectional study used a nationwide, population-based reimbursement claims dataset consisting of 1,131,346 claims of all 160,465 citizens institutionalized due to psychiatric diagnosis between January 2005 and June 2006 in South Korea. To adjust for possible correlation of patients characteristics within the same medical institution and a non-linearity structure, a Box-Cox transformed, multilevel regression analysis was performed. Results Compared with inpatients 19 years old or younger, the medical expenditures of inpatients between 50 and 64 years old were 10% higher among NHI beneficiaries but 40% higher among AID beneficiaries. Males showed higher medical expenditures than did females. Expenditures on inpatients with schizophrenia as compared to expenditures on those with neurotic disorders were 120% higher among NHI beneficiaries but 83% higher among AID beneficiaries. Expenditures on inpatients of psychiatric hospitals were greater on average than expenditures on inpatients of general hospitals. Among AID beneficiaries, institutions owned by private groups treated inpatients with 32% higher costs than did government institutions. Among NHI beneficiaries, inpatients medical expenditures were positively associated with the proportion of
Brugman, Suzanne; Lobbestael, Jill; von Borries, A Katinka L; Bulten, Berend Erik H; Cima, Maaike; Schuhmann, Teresa; Dambacher, Franziska; Sack, Alexander T; Arntz, Arnoud
This study tested the predictive value of attentional bias, emotion recognition, automatic associations, and response inhibition, in the assessment of in-clinic violent incidents. Sixty-nine male forensic patients participated and completed an Emotional Stroop to measure attentional bias for threat and aggression, a Single Target - Implicit Association Task to assess automatic associations, a Graded Emotional Recognition Task to measure emotion recognition, and an Affective Go/NoGo to measure response inhibition. Violent incidents were derived from patient files and scored on severity level. The predictive value of level of psychopathy was tested with the Psychopathy Checklist - Revised (PCL-R). Generalized linear mixed model analyses showed that increased attention towards threat and aggression, difficulty recognizing sad faces and factor 2 of the PCL-R predicted the sum of violent incidents. Specifically, verbal aggression was predicted by increased attention towards threat and aggression, difficulty to recognize sad and happy faces, and PCL-R factor 2; physical aggression by decreased response inhibition, higher PCL-R factor 2 and lower PCL-R factor 1 scores; and aggression against property by difficulty recognizing angry faces. Findings indicate that cognitive tasks could be valuable in predicting aggression, thereby extending current knowledge on dynamic factors predicting aggressive behavior in forensic patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Slemon, Allie; Jenkins, Emily; Bungay, Vicky
The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.
Zarea, K; Nikbakht-Nasrabadi, A; Abbaszadeh, A; Mohammadpour, A
Patients with mental illness require unique and specific care. The purpose of this study was to explore the experiences of nurses, who provide such care for mentally ill people, within the context of Iranian culture. This hermeneutic phenomenological study was carried out in a university-affiliated hospital in an urban area of Iran. We interviewed 10 mental health nurses to capture in detail their experiences in psychiatric units, and the approach developed by Diekelmann et al. was employed to analyse the data. Four themes and five sub-themes were identified: 'being engaged with patients' (sub-themes: 'struggle for monitor/control', 'safety/security concerns', 'supporting physiological and emotional needs'), 'being competent', 'altruistic care' and 'facing difficulties and challenges' (sub-themes: 'socio-cultural' and 'organizational challenges'). The results provide valuable insights and greater understanding of the professional experiences of psychiatric nurses in Iran, and indicate the need for a stable and responsible organizational structure for those nurses who are expected to manage patient care in psychiatric wards. © 2012 Blackwell Publishing.
Schwarzkopf, Kathleen; Conrad, Nathalie; Straus, Doris; Porschke, Hildburg; von Känel, Roland
We studied the clinical course and long-term effects of inpatient treatment in 723 patients with job burnout referred with an ICD-10 F diagnosis and Z73.0 code («overwhelming exhaustion») to a Swiss hospital specialized in the treatment of job stress-related disorders. Patients were characterized in terms of age, gender, socioeconomic status. Self-rated psychological measures related to general and burnout-specific symptoms (i. e., emotional exhaustion, depersonalization, and diminished personal accomplishments) were applied before and after a six-week treatment program, as well as at 15 months after hospital discharge in 232 patients. The results show that the multimodal inpatient psychiatric-psychotherapeutic treatment was successful with a sustainable effect on psychological well-being (>90 %), including improvements regarding emotional exhaustion, depersonalization and personal accomplishments as well as professional reintegration in 71 % of cases.
Full Text Available Introduction: The study objective was to epidemiologically analyse patients presenting at an adult and mixed-gender psychiatric inpatient unit in Essex, Kingswood Centre, UK, to report the predominant diagnoses, gender, and admission duration. Method and material: Meta-analysis and descriptive statistics analysed the year 2016 discharge data on Excel® for 162 patients. ICD-10 codes classified their mental illnesses. Results: Meta-analysis evidenced statistically significant heterogeneity in numbers admissions (I2=95%; p≤0.001, length (I2=78%; p≤0.001, and gender (I2=76%; p≤0.001. The prevailing diagnosis was borderline personality disorder (BPD (rate, 95% CI=0.46 [0.38-0.54]. The longest admission was for schizoaffective disorder (mean duration, 95% CI=53 [22.65-83.34], p=0.001. Gender presented a prevalence of male over female admissions for schizophrenia (OR, 95% CI=0.14 [0.05-0.35], p≤0.001 and BPD with prevalence of female over male admissions (OR, 95% CI=2.79 [1.35-5.76], p=0.05. Conclusion: Female patients with BPD were the most represented category in non-forensic psychiatric inpatient wards in the population studied. Male patients with schizophrenia represented the other gender highly represented. The longest admission was recorded for schizoaffective disorder due to the complexity to treat both mood and psychotic symptoms. It is likely that women with BPD will be the future recipients of psychiatric inpatient and outpatient healthcare services.
Pogge, David L; Stokes, John M; McGrath, Robert E; Bilginer, Lale; DeLuca, Victoria A
This study examined the prevalence and correlates of Archer and Krishnamurthy's MMPI-A Structural Summary (SS) dimensions in a sample of 632 adolescent psychiatric inpatients through a series of correlational analyses. These analyses examined the relationship between factor dimensions and categorically defined dimension elevations and external criterion measures that included chart review data, therapist ratings, chart diagnoses, and cognitive test performance. The SS dimensions provided additional interpretive yield for some within-normal-limits profiles. An examination of the pattern of correlations revealed small to moderate relationships between all SS variables and external criterion measures.
Al-Sagarat, Ahmad Y; Hamdan-Mansour, Ayman M; Al-Sarayreh, Faris; Nawafleh, Hani; Moxham, Lorna
In this study, we investigated the correlates of aggression among consumers with mental illness within two psychiatric hospitals in Jordan. This was a descriptive, cross sectional study carried out by auditing consumers' medical records in regards to incidents of aggression before and during admission. Approval was gained from 203 next of kins to review the consumers' medical records. Results from this case analysis, found the prevalence of aggressive behaviours among psychiatric inpatient's in Jordan to be 23.6%, the most common form of aggression was consumer to consumer and that the aggressive act was more likely to be perpetrated by younger consumers. Such findings contribute to the discourse about aggression and understanding who and what causes aggression can go toward identify strategies for early intervention and management. After all, mental health units should be places of safety, that is, an asylum, and everyone who enters that environment deserves to be safe. © 2015 Wiley Publishing Asia Pty Ltd.
Hamilton, Matthew J; Watson, Hunna J; Egan, Sarah J; Hoiles, Kimberley J; Harper, Emily; McCormack, Julie; Shu, Chloe; Forbes, David A
To examine the prevalence and importance of psychological, behavioural, and situational correlates of impending psychiatric inpatient admissions in children and adolescents with eating disorders. The sample consisted of 285 patients (8-17 years, M = 14.4, SD = 1.49) with DSM-5 eating disorders assessed between 2006 and 2013 from the Helping to Outline Pediatric Eating Disorders (HOPE) Project. The sample was split into two groups, those with (n = 38) and without (n = 247) impending psychiatric admission; Discriminant function analysis was used to examine correlates. The prevalence of impending psychiatric admission was 13.3%. Suicidal ideation provided the greatest discriminating power, followed by eating pathology, depressive symptoms, anxiety, multiple methods of weight control, binge eating, and family functioning. Earlier recognition of comorbid symptoms in eating disorders in the community may reduce the number of young people with eating disorders who present needing critical psychiatric care. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.
Full Text Available Background: A culture-bound syndrome common in Baluchistan is Djinnati that is classified as trance and possession state, a sub-class of dissociative disorders NOS, in DSM IV-TR. The present study aims to determine the frequency of Djinnati syndrome among in-patients at Baharan psychiatric hospital in Zahedan, Iran. Materials and Methods: In this descriptive study, the statistical community includes all patients (N=773 who were admitted in Baharan psychiatric hospital during a 6 months period. After considering the inclusion and exclusion criteria, 150 subjects (61 males and 89 females were selected. Semi-structural interview and Dissociative Experience Scale (DES questionnaire were performed for them. Spearman’s rank correlation coefficient, χ2, and t-tests were employed for analysis of data in SPSS-18. Results: Frequency of Djinnati syndrome among patients admitted in this referral psychiatric hospital was 4.1% and this syndrome showed a significant dominance in female sex (M/F=1/3. There was also a positive and significant correlation between child abuse and dissociative experiences including Djinnati. Conclusion: The study has shown that dissociative disorders NOS, in the form of trance and possession states (such as Djinnati, are not rare especially in the eastern parts of Iran and among poor and young women. It is important to define Djinnati syndrome in this region and prepare medical students and psychiatric residents for diagnosing and managing this condition. Its relationship with child abuse should be considered in preventive medicine.
Pederson, Casey A; Rathert, Jamie L; Fite, Paula J; Stoppelbein, Laura; Greening, Leilani
Psychiatric inpatient hospitalization is a costly intervention for youth. With rates of hospitalization rising, efforts to refine prevention and intervention are necessary. Aggression often precedes severe internalizing behaviors, and proactive and reactive functions of aggression are differentially associated with internalizing symptomatology. Thus, further understanding of the links between functions of aggression and internalizing symptomatology could aid in the improvement of interventions for hospitalized youth. The current study examined parenting styles, gender, and age as potential moderators of the relations between proactive and reactive aggression and internalizing symptoms. Participants included 392 children, 6-12 years of age admitted consecutively to a psychiatric inpatient unit. Reactive aggression was uniquely associated with anxiety symptoms. However, proactive aggression was associated with internalizing problems only when specific parenting styles and demographic factors were present. Although both proactive and reactive subtypes of aggression were associated with internalizing symptoms, differential associations were evident. Implications of findings are discussed.
Wiltgen, Anika; Arbona, Consuelo; Frankel, Leslie; Frueh, B Christopher
Current research suggests that interpersonal trauma has an impact on insecure attachment and anxiety. Some research further suggests that attachment may play a mediating role between traumatic events and psychopathology. The purpose of this study was to examine the relationship between the experience of interpersonal trauma, attachment anxiety, attachment avoidance and clinical anxiety severity among adult psychiatric inpatients who reported having experienced interpersonal trauma after the age of 16. It was hypothesized that attachment anxiety and attachment avoidance would mediate the relationship between interpersonal trauma and clinical anxiety level. This study used archival data on 414 adult psychiatric inpatients in a large city in the Southwest U.S. Results suggest that interpersonal trauma was correlated to attachment avoidance but not to attachment anxiety and that attachment avoidance partially mediated the relation of interpersonal trauma to anxiety. The attachment framework appositely explains how a negative model of other contributes to the relation between experiences of interpersonal trauma and anxiety in adulthood. Copyright © 2015 Elsevier Ltd. All rights reserved.
Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat
In this study, we investigated whether liberty-restricting and other factors can predict internalized stigma among psychiatric inpatients and outpatients. The study sample comprised of 129 inpatients, admitted at least once to psychiatry ward, and 100 outpatients who have never been hospitalized, receiving psychiatric treatment. In addition to demographic and clinical features, patients were evaluated for perceived deprivation of liberty and internalized stigma levels. Patients stated that their liberty was restrained mostly due to involuntary treatment, communication problems, side effects of medical treatment and inability to choose their treatment team. Regression analysis showed that internalized stigma was predicted by perceived deprivation of liberty, marital status and number of admissions to ward. Stigma was related to marital status and admissions to the psychiatry ward. Perceived deprivation of liberty predicts stigma regardless of the disease severity CONCLUSION: Perception of stigma leads to self-isolation, behavioral avoidance and refusal of aid-seeking. Our study indicated that perceived deprivation of liberty is one of the most important factors that lead to increased stigma. Based on our findings, we can say that as patients experience less perceived deprivation of liberty, they would have less stigma and thus, their compliance would increase.
Mountain Debbie A
Full Text Available Abstract Background At any time, about 1% of people with severe and enduring mental illness such as schizophrenia require in-patient psychiatric rehabilitation. In-patient rehabilitation enables individuals with the most challenging difficulties to be discharged to successful and stable community living. However, the length of rehabilitation admission that is required is highly variable and the reasons for this are poorly understood. There are very few case-control studies of predictors of outcome following hospitalisation. None have been carried out for in-patient rehabilitation. We aimed to identify the factors that are associated with achieving discharge from in-patient rehabilitation by carrying out a case-control study. Methods We compared two groups: 34 people who were admitted to the Rehabilitation Service at the Royal Edinburgh Hospital and discharged within a six year study period, and 31 people who were admitted in the same period, but not discharged. We compared the groups on demographic, illness, treatment and risk variables that were present at the point of their admission to rehabilitation. We used independent t tests and Pearson Chi-Square tests to compare the two groups. Results We found that serious self harm and suicide attempts, treatment with high dose antipsychotics, antipsychotic polypharmacy and previous care in forensic psychiatric services were all significantly associated with non-discharge. The non-discharged group were admitted significantly later in the six year study period and had already spent significantly longer in hospital. People who were admitted to rehabilitation within the first ten years of developing psychosis were more likely to have achieved discharge. Conclusions People admitted later in the study period required longer rehabilitation admissions and had higher rates of serious self harm and treatment resistant illness. They were also more likely to have had previous contact with forensic services. This
Lay, Barbara; Salize, Hans Joachim; Dressing, Harald; Rüsch, Nicolas; Schönenberger, Thekla; Bühlmann, Monika; Bleiker, Marco; Lengler, Silke; Korinth, Lena; Rössler, Wulf
The high number of involuntary placements of people with mental disorders in Switzerland and other European countries constitutes a major public health issue. In view of the ethical and personal relevance of compulsory admission for the patients concerned and given the far-reaching effects in terms of health care costs, innovative interventions to improve the current situation are much needed. A number of promising approaches to prevent involuntary placements have been proposed that target continuity of care by increasing self-management skills of patients. However, the effectiveness of such interventions in terms of more robust criteria (e.g., admission rates) has not been sufficiently analysed in larger study samples. The current study aims to evaluate an intervention programme for patients at high risk of compulsory admission to psychiatric hospitals. Effectiveness will be assessed in terms of a reduced number of psychiatric hospitalisations and days of inpatient care in connection with involuntary psychiatric admissions as well as in terms of cost-containment in inpatient mental health care. The intervention furthermore intends to reduce the degree of patients' perceived coercion and to increase patient satisfaction, their quality of life and empowerment. This paper describes the design of a randomised controlled intervention study conducted currently at four psychiatric hospitals in the Canton of Zurich. The intervention programme consists of individualised psycho-education focusing on behaviours prior to and during illness-related crisis, the distribution of a crisis card and, after inpatient admission, a 24-month preventive monitoring of individual risk factors for compulsory re-admission to hospital. All measures are provided by a mental health care worker who maintains permanent contact to the patient over the course of the study. In order to prove its effectiveness the intervention programme will be compared with standard care procedures (control group
Wale, Joyce B; Belkin, Gary S; Moon, Robert
The reduction of seclusion and restraint (S/R) use has been given national priority by the US government, The Joint Commission, and patient advocacy groups. It is associated with high rates of patient and staff injuries and is a coercive and potentially traumatizing intervention. The New York City Health and Hospitals Corporation (HHC) is the largest municipal health care system in the country, with 11 HHC facilities operating psychiatric emergency services and inpatient psychiatric services. HHC operates 1117 adult inpatient psychiatric beds with an average length of stay of 22.2 days that generated over 19,000 discharges in 2009. In 2009, there were over 36,000 psychiatric emergency services visits. HHC's Office of Behavioral Health provides strategic leadership, planning, and support for the operations and quality objectives of these services. In January 2007, the corporate office initiated the Seclusion and Restraint Reduction Initiative, with a sequenced, intensive series of interventions and strategies to help focus the behavioral health leadership and staff on the need for continued culture change toward a more patient-centered and safe system of psychiatric emergency and adult inpatient care. From 2007 to 2009, there was a substantial decline in HHC's overall rate of S/R incidents in inpatient units. The more substantial impact was in the reduced overall time spent in S/R; the reduced frequency of use of S/R; and the reduced likelihood of patient injury from S/R use. PMID:21841927
Wale, Joyce B; Belkin, Gary S; Moon, Robert
The reduction of seclusion and restraint (S/R) use has been given national priority by the US government, The Joint Commission, and patient advocacy groups. It is associated with high rates of patient and staff injuries and is a coercive and potentially traumatizing intervention. The New York City Health and Hospitals Corporation (HHC) is the largest municipal health care system in the country, with 11 HHC facilities operating psychiatric emergency services and inpatient psychiatric services. HHC operates 1117 adult inpatient psychiatric beds with an average length of stay of 22.2 days that generated over 19,000 discharges in 2009. In 2009, there were over 36,000 psychiatric emergency services visits. HHC's Office of Behavioral Health provides strategic leadership, planning, and support for the operations and quality objectives of these services. In January 2007, the corporate office initiated the Seclusion and Restraint Reduction Initiative, with a sequenced, intensive series of interventions and strategies to help focus the behavioral health leadership and staff on the need for continued culture change toward a more patient-centered and safe system of psychiatric emergency and adult inpatient care. From 2007 to 2009, there was a substantial decline in HHC's overall rate of S/R incidents in inpatient units. The more substantial impact was in the reduced overall time spent in S/R; the reduced frequency of use of S/R; and the reduced likelihood of patient injury from S/R use.
Waters, Amanda; Sands, Natisha; Keppich-Arnold, Sandra; Henderson, Kathryn
Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm. © 2014 Australian College of Mental Health Nurses Inc.
regression analyses were conducted to test study hypotheses. Results: Previously psychiatrically hospitalized service members demonstrated...predicting positive Two-Item Conjoint Screen (TICS) from history of inpatient psychiatric hospitalization (N = 492...positive Two-Item Conjoint Screen (TICS) in inpatient cases (Group 1; N = 246) . 63 Table 6. Summary of logistic regression model predicting positive Two
Mustanoja, Susanna; Luukkonen, Anu-Helmi; Hakko, Helinä; Räsänen, Pirkko; Säävälä, Hannu; Riala, Kaisa
We examined the relationship of exposure to domestic violence and violence occurring outside home to bullying behaviour in a sample (508; 40.9% males, 59.1% females) of underage psychiatric inpatient adolescents. Participants were interviewed using K-SADS-PL to assess DSM-IV psychiatric diagnoses and to gather information about domestic and other violence and bullying behaviour. Witnessing interparental violence increased the risk of being a victim of bullying up to 2.5-fold among boys. For girls, being a victim of a violent crime was an over 10-fold risk factor for being a bully-victim. Gender differences were seen in witnessing of a violent crime; girls were more likely to be bullies than boys. Further, as regards being a victim of a violent crime outside home and physical abuse by parents at home, girls were significantly more often bully-victims than boys. When interfering and preventing bullying behaviour, it is important to screen adolescents' earlier experiences of violence.
Jansen, Trine-Lise; Hanssen, Ingrid
The aim of this study was to explore psychiatric nurses' experiences and perspectives regarding patient participation. Patient participation is an ambiguous, complex and poorly defined concept with practical/clinical, organisational, legal and ethical aspects, some of which in psychiatric units may cause ethical predicaments and moral stress in nurses, for instance when moral caring acts are thwarted by constraints. An explorative quantitative pilot study was conducted at a psychiatric subacute unit through three focus group interviews with a total of nine participants. A thematic analytic approach was chosen. Preliminary empirical findings were discussed with participants before the final data analysis. Ethical research guidelines were followed. Patient participation is a difficult ideal to realise because of vagueness of aim and content. What was regarded as patient participation differed. Some interviewees held that patients may have a say within the framework of restraints while others saw patient participation as superficial. The interviewees describe themselves as patient's spokespersons and contributing to patients participating in their treatment as a great responsibility. They felt squeezed between their ethical values and the 'system'. They found themselves in a negotiator role trying to collaborate with both the doctors and the patients. Privatisation of a political ideal makes nurses vulnerable to burn out and moral distress. Nurses have a particular ethical responsibility towards vulnerable patients, and may themselves be vulnerable when caught in situations where their professional and moral values are threatened. Unclear concepts make for unclear division of responsibility. Patient participation is often a neglected value in current psychiatric treatment philosophy. When healthcare workers' ethical sensibilities are compromised, this may result in moral stress. © 2016 Nordic College of Caring Science.
Stellwagen, Kurt K; Kerig, Patricia K
This study examined the association of ringleader bullying with psychopathic traits and theory of mind among 100 youth aged 10-15 (62 boys and 38 girls) receiving inpatient psychiatric services at a state facility. Results of hierarchical multiple regression analyses indicated a positive association between ringleader bullying and psychopathic narcissism, and a significant interaction effect between narcissism and theory of mind. More specifically, narcissism moderated the relationship between theory of mind and ringleader bullying such that theory of mind was positively associated with ringleader bullying when levels of narcissism were high, and theory of mind was negatively associated ringleader bullying when levels of narcissism were low. The discussion of these results focuses on the importance of developing effective treatment techniques for youth whose bullying behavior is associated with narcissistic features and social acuity.
Hornsveld, R.H.J.; Nijman, H.L.I.; Hollin, C.R.; Kraaimaat, F.W.
The Observation Scale for Aggressive Behavior (OSAB) has been developed to evaluate inpatient treatment programs designed to reduce aggressive behavior in Dutch forensic psychiatric patients with an antisocial personality disorder, who are "placed at the disposal of the government". The scale should
Full Text Available Abstract Background The nurses working in psychiatric hospitals and wards are prone to encounter completed suicides. The research was conducted to examine post-suicide stress in nurses and the availability of suicide-related mental health care services and education. Methods Experiences with inpatient suicide were investigated using an anonymous, self-reported questionnaire, which was, along with the Impact of Event Scale-Revised, administered to 531 psychiatric nurses. Results The rate of nurses who had encountered patient suicide was 55.0%. The mean Impact of Event Scale-Revised (IES-R score was 11.4. The proportion of respondents at a high risk (≥ 25 on the 88-point IES-R score for post-traumatic stress disorder (PTSD was 13.7%. However, only 15.8% of respondents indicated that they had access to post-suicide mental health care programmes. The survey also revealed a low rate of nurses who reported attending in-hospital seminars on suicide prevention or mental health care for nurses (26.4% and 12.8%, respectively. Conclusions These results indicated that nurses exposed to inpatient suicide suffer significant mental distress. However, the low availability of systematic post-suicide mental health care programmes for such nurses and the lack of suicide-related education initiatives and mental health care for nurses are problematic. The situation is likely related to the fact that there are no formal systems in place for identifying and evaluating the psychological effects of patient suicide in nurses and to the pressures stemming from the public perception of nurses as suppliers rather than recipients of health care.
Takahashi, Chizuko; Chida, Fuminori; Nakamura, Hikaru; Akasaka, Hiroshi; Yagi, Junko; Koeda, Atsuhiko; Takusari, Eri; Otsuka, Kotaro; Sakai, Akio
The nurses working in psychiatric hospitals and wards are prone to encounter completed suicides. The research was conducted to examine post-suicide stress in nurses and the availability of suicide-related mental health care services and education. Experiences with inpatient suicide were investigated using an anonymous, self-reported questionnaire, which was, along with the Impact of Event Scale-Revised, administered to 531 psychiatric nurses. The rate of nurses who had encountered patient suicide was 55.0%. The mean Impact of Event Scale-Revised (IES-R) score was 11.4. The proportion of respondents at a high risk (≥ 25 on the 88-point IES-R score) for post-traumatic stress disorder (PTSD) was 13.7%. However, only 15.8% of respondents indicated that they had access to post-suicide mental health care programmes. The survey also revealed a low rate of nurses who reported attending in-hospital seminars on suicide prevention or mental health care for nurses (26.4% and 12.8%, respectively). These results indicated that nurses exposed to inpatient suicide suffer significant mental distress. However, the low availability of systematic post-suicide mental health care programmes for such nurses and the lack of suicide-related education initiatives and mental health care for nurses are problematic. The situation is likely related to the fact that there are no formal systems in place for identifying and evaluating the psychological effects of patient suicide in nurses and to the pressures stemming from the public perception of nurses as suppliers rather than recipients of health care.
Lavelle, Mary; Stewart, Duncan; James, Karen; Richardson, Michelle; Renwick, Laoise; Brennan, Geoffrey; Bowers, Len
To explore the factors that influence the use of de-escalation and its success in halting conflict in acute psychiatric inpatient setting. De-escalation is the use of verbal and nonverbal communication to reduce or eliminate aggression and violence during the escalation phase of a patient's behaviour. Although de-escalation is a first-line intervention in aggression management in acute psychiatric settings, little is known about the use or effectiveness of this technique. A retrospective case note analysis. For each patient (n = 522), their involvement in conflict (e.g. aggression) or containment (e.g. coerced medication) during the first two weeks of their admission was recorded. The frequency and order of the conflict and containment events were identified during each shift. The sequences of events occurring in shifts involving de-escalation were analysed. Sequences where de-escalation ended the pattern of conflict or containment were categorised as 'successful', and all others were categorised as 'unsuccessful'. Over half of patients (53%) experienced de-escalation during the first two weeks of admission, with the majority of these (37%) experiencing multiple episodes. De-escalation was successful in approximately 60% of cases. Successful de-escalations were preceded by fewer, and less aggressive, conflict events, compared with unsuccessful de-escalations, which were most frequently followed by administration of pro re nata medication. Patients with a history of violence were more likely to experience de-escalation, and it was more likely to be unsuccessful. De-escalation is frequently effective in halting a sequence of conflict in acute inpatient settings, but patients with a history of violence may be specifically challenging. These findings provide support for de-escalation in practice but suggest that nurses may lack confidence in using the technique when the risk of violence is greater. Providing evidence-based staff training may improve staff confidence
Gopalakrishnapillai, Ajithkrishnan Champettil; Iyer, Ramya Radhakrishnan; Kalantharakath, Thanveer
This paper assessed the periodontal status of inpatients at Government Mental Hospital, Vadodara, India, and studied the possible relationship between periodontal status and age, length of hospitalization, type of mental illness, and medication and tobacco use. Information about psychiatric diagnosis, length of hospitalization, and prescribed medication was obtained from hospital records. We interviewed 165 inpatients and recorded their chief dental complaints (if any) and relevant histories. Periodontal status was assessed using the Community Periodontal Index (CPI). Descriptive statistics, nonparametric tests, and multiple logistic regression analyses were used. The most prevalent periodontal condition was shallow pockets (47.27%). Some subjects (10.3%) had loss of attachment (LOA) of 9-11 mm. Age and length of hospitalization were significantly associated with periodontal status. Multiple logistic regression revealed that only age was significantly associated with periodontal pockets. Male gender, age, and tobacco-related habits were significantly associated with LOA of more than 0-3 mm. © 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.
Kristiansen, S T; Videbech, P; Kragh, M; Thisted, C N; Bjerrum, M B
To synthesize the evidence on how patients with serious mental disorders perceived patient education on psychiatric wards and to learn more about the patient perceived benefits and limitations related to patient education and how well patient education meets the perceived needs of inpatients. Quantitative and qualitative data were categorized and synthesized. A systematic literature search was conducted. Articles were validated using validated critical appraisal tools. Data were analyzed using inductive content analysis. Five articles met the inclusion criteria. The results concerned the specific population with bipolar disorder or schizophrenia. Two explanatory syntheses were aggregated: (I) Benefits and perceived barriers to receiving education and (II) Educational needs of mental health patients. Patients reported mechanical information dissemination and lack of individual and corporative discussions. Patients preferred patient education from different educational sources with respect to individual needs. Patient education were most useful when it could be tailored to an individuaĺs specific needs and match patient preference for how to receive it. The findings did not provide evidence to support any educational methods of preference. The findings may contribute to the development of educational interventions that are perceived more helpful for in-patients suffering from serious mental disorders. Copyright © 2017 Elsevier B.V. All rights reserved.
Sanislow, C A; Grilo, C M; McGlashan, T H
The goal of this study was to examine the factor structure of the DSM-III-R criteria for borderline personality disorder in young adult psychiatric inpatients. The authors assessed 141 acutely ill inpatients with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. They used correlational analyses to examine the associations among the different criteria for borderline personality disorder and performed an exploratory factor analysis. Cronbach's coefficient alpha for the borderline personality disorder criteria was 0.69. A principal components factor analysis with a varimax rotation accounted for 57.2% of the variance and revealed three homogeneous factors. These factors were disturbed relatedness (unstable relationships, identity disturbance, and chronic emptiness); behavioral dysregulation (impulsivity and suicidal/self-mutilative behavior); and affective dysregulation (affective instability, inappropriate anger, and efforts to avoid abandonment). Exploratory factor analysis revealed three homogeneous components of borderline personality disorder that may represent personality, behavioral, and affective features central to the disorder. Recognition of these components may inform treatment plans.
Vyssoki, B; Willeit, M; Blüml, V; Höfer, P; Erfurth, A; Psota, G; Lesch, O M; Kapusta, N D
During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates. Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants. While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers. Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert. Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates. Copyright © 2011 Elsevier B.V. All rights reserved.
Matusevich, Daniel; Ruiz, Martín; Vairo, María; Girard, Paula; Rozadilla, Gustavo; Castagnola, Guido; Job, Alfredo; Pinto, Inés; Finkelsztein, Carlos
the aim of this paper is to communicate a project of short term psychiatric hospitalization, based on a therapeutic community model, considering qualitative and quantitative aspects in the present socio - cultural context. this psychiatric hospitalization model that embraces psychodynamic and pharmacological interventions is focused in the intensity of interactions between members of the therapeutic community and integrated to the administrative structure of a general hospital; this will be the key to consider patient's return to the community and to move forward over the prejudices that inpatients suffer. quantitative, prospective, observational and transversal study on a Dynamic Psychiatric Inpatient Unit. 605 patients were included. mean length of stay was 16.34 days; principal causes of admission were depression (19.4%), suicide ideas (17.7%), suicide attempt (17.6%), substance abuse or dependence (14.3%), psychosis (13.8%), behavioral and psychological symptoms of dementia (6%). There were 75 readmissions. 14.88% patients were physically restrained. Principal Axis I diagnosis were depression (32.1%), substance dependence (13.2%), bipolar disorder (10.2%), dementia (7.6%), schizophrenia (7.5%), and psychotic disorder (5.8). Axis II diagnosis were borderline personality disorder (27.3%), narcissistic personality disorder (8.9%), histrionic personality disorder (5.3%). this kind of approach shows a structural model that allows possible and persistent favorable changes for psychiatric inpatients.
Woo, Benjamin K P; Ma, Albert Y
The University of California, Los Angeles (UCLA), along with Kern Medical Center (KMC) and Kern County Mental Health (KCMH), established a new psychiatry residency program in 2004. In this study, we compared psychiatric care at a county psychiatric facility serving a population of 760,000 inhabitants before and after the initiation of this psychiatry residency program. Medical charts for all patients admitted to the psychiatric inpatient service during the year before the inception of the psychiatry residency program (2003-2004) and during the first year in which there was full implementation of residents after inception of the psychiatry residency program (2005-2006) were reviewed. Baseline characteristics, demographics, and various outcomes of the two groups were compared. After the residency program was established, the mean length of stay increased from 8.8 to 9.8 days (p psychiatric inpatient setting. More research is needed to identify strategies, such as guidelines to eliminate over-utilization of resources and methods to improve residents' competency, that may successfully enhance the quality of care provided by residents to psychiatric inpatients.
Korkmaz, Gülçin; Küçük, Leyla
This descriptive study aims to identify the relationship between internalized stigma and perceived family support in patients hospitalized in an acute psychiatric unit. The sample is composed of 224 patients treated in an acute inpatient psychiatric ward in İstanbul, Turkey. The data were collected using information obtained from the Internalized Stigma of Mental Illness Scale and Social Support from Family Scale. The mean age of the patients was 37±11.56years, and the mean duration of treatment was 6.27±5.81years. Most patients had been hospitalized three or more times. Of the total number of patients, 66.1% had been taken to the hospital by family members. We noted a statistically significant negative correlation between the total scores obtained from the perceived Social Support from Family Scale and the Internalized Stigma of Mental Illness Scale. The patients were observed to stigmatize themselves more when the perceived social support from their family had decreased. Copyright © 2015 Elsevier Inc. All rights reserved.
Wölfling, Klaus; Beutel, Manfred E; Koch, Andreas; Dickenhorst, Ulrike; Müller, Kai W
Addictive Internet use has recently been proposed to be included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Still, little is known about its nosological features, including comorbidity with other mental disorders and disorder-specific psychopathological symptoms. To investigate whether Internet addiction (IA) is an issue in patients in addiction treatment, 1826 clients were surveyed in 15 inpatient rehabilitation centers. Male patients meeting criteria for comorbid IA (n = 71) were compared with a matched control group of male patients treated for alcohol addiction without addictive Internet use (n = 58). The SCL-90-R, the Patient Health Questionnaire, and the seven-item Generalized Anxiety Disorder were used to assess associated psychiatric symptoms and further comorbid disorders. Comorbid IA was associated with higher levels of psychosocial symptoms, especially depression, obsessive-compulsive symptoms, and interpersonal sensitivity. Moreover, the patients with IA more frequently met criteria for additional mental disorders. They display higher rates of psychiatric symptoms, especially depression, and might be in need of additional therapeutic treatment. In rehabilitation centers, a regular screening for IA is recommended to identify patients with this (non-substance-related) addiction and supply them with additional disorder-specific treatment.
Kanzaki, Tetsuto; Uju, Yoriyasu; Sekine, Keisuke; Ishii, Yukihiro; Yoshimi, Taro; Yasui, Reiko; Yasukawa, Asuka; Sato, Mamoru; Okamoto, Seiko; Hisaoka, Tetsuya; Miura, Masafumi; Kusanishi, Shun; Murakami, Kanako; Nakano, Chieko; Mizuta, Yasuhiko; Mimori, Seisuke; Mishima, Shunichi; Igarashi, Kazuei; Takizawa, Tsuyoshi; Hayakawa, Tatsuro; Tsukada, Kazumi
Patients with schizophrenia have increased risk of atherosclerotic diseases. It is already known that lifestyle-related disorders and the use of antipsychotics are closely related with the progression of atherosclerosis in psychiatric patients. Stroke as well as coronary heart disease play an important role in the cause of death in Asia and Japan. Thus, we studied the prevalence of cerebrovascular disease in psychiatric inpatients in Japan using brain magnetic resonance imaging (MRI). This cross-sectional study was performed from January 2012 to December 2013. Study participants were 152 hospitalized patients (61 men and 91 women) in the Department of Psychiatry at Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City, Japan. Mean ages were 50.0 and 57.1 years old for men and women, respectively. The diagnoses (DSM-IV-TR criteria) of participants were schizophrenia (69.1%), mood disorder (18.4%), and other mental disorders (12.5%). We checked physical status, metabolic status of glucose and lipid levels, and brain MRI within 1 week of admission. The study group showed a significantly high prevalence of diabetes and low high-density lipoprotein (HDL) cholesterolemia in both sexes (n = 61 in men, n = 91 in women, P < .05). In the study group, serum fasting plasma glucose and hemoglobin A1c levels were significantly high (n = 152, P < .05), but serum HDL cholesterol and total cholesterol were significantly low in both sexes (n = 61 in men, n = 90 in women, P < .05), and triglycerides were low in men (n = 61, P < .05). Silent brain infarction was recognized at a higher rate (n = 98, P < .05) compared with healthy controls. Participants in this study had an increased ratio of silent brain infarction compared with Japanese healthy controls, accompanied with higher ratios of diabetes and low HDL cholesterol.
Stockings, Emily A L; Bowman, Jenny A; Baker, Amanda L; Terry, Margarett; Clancy, Richard; Wye, Paula M; Knight, Jenny; Moore, Lyndell H; Adams, Maree F; Colyvas, Kim; Wiggers, John H
Persons with a mental disorder smoke at higher rates and suffer disproportionate tobacco-related burden compared with the general population. The aim of this study was to determine if a smoking cessation intervention initiated during a psychiatric hospitalization and continued postdischarge was effective in reducing smoking behaviors among persons with a mental disorder. A randomized controlled trial was conducted at an Australian inpatient psychiatric facility. Participants were 205 patient smokers allocated to a treatment as usual control (n = 101) or a smoking cessation intervention (n = 104) incorporating psychosocial and pharmacological support for 4 months postdischarge. Follow-up assessments were conducted at 1 week, 2, 4, and 6 months postdischarge and included abstinence from cigarettes, quit attempts, daily cigarette consumption, and nicotine dependence. Rates of continuous and 7-day point prevalence abstinence did not differ between treatment conditions at the 6-month follow-up; however, point prevalence abstinence was significantly higher for intervention (11.5%) compared with control (2%) participants at 4 months (OR = 6.46, p = .01). Participants in the intervention condition reported significantly more quit attempts (F[1, 202.5] = 15.23, p = .0001), lower daily cigarette consumption (F[4, 586] = 6.5, p < .001), and lower levels of nicotine dependence (F[3, 406] = 8.5, p < .0001) compared with controls at all follow-up assessments. Postdischarge cessation support was effective in encouraging quit attempts and reducing cigarette consumption up to 6 months postdischarge. Additional support strategies are required to facilitate longer-term cessation benefits for smokers with a mental disorder. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: email@example.com.
Gabrielsson, Sebastian; Looi, Git-Marie E; Zingmark, Karin; Sävenstedt, Stefan
Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession-specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision-making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first-hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person-centred care. © 2014 Nordic College of Caring Science.
de Oliveira, Alice Guimarães Bottaro; Conciani, Marta Ester
The psychiatric reform in Brazil articulates several dimensions - conceptual, technical, administrative, legislative and cultural. It is aimed at overcoming the psychiatric paradigm based on isolation and exclusion of the mentally ill. The Reform makes part of the Brazilian Health System and presupposes a hierarchical system, municipality, participation and social control. Besides the advances made in the administrative dimension, in the state of Mato Grosso the reform takes place in centralized management contexts, revealing an apparent contradiction. Analyzing the participative processes in the construction of the psychiatric reform in Cuiabá and in the state of Mato Grosso by means of analyses of documents of the Health Councils and Conferences held over the period 2000 to 2005. The fragility of the political processes of the Health Councils hampers their constitution as environments for articulating new practices. The process of changes toward the psychiatric reform is in accordance with a new management, determined by new financing models - reduction of hospitalizations and not hospital-centered care. This is possible because it is not a result of criticisms to the asylum logic represented in the analyzed dimensions of the Brazilian Health System.
Wel, T.F. van; Felling, A.J.A.; Persoon, J.M.G.
During the last decades of the 20th century, many psychiatric hospitals changed the living environments of their clients with long-term psychiatric disabilities. We investigated the effect of this environmental psychiatric rehabilitation and normalization process on the activity and participation
Wel, Tom van; Felling, Albert; Persoon, Jean
During the last decades of the 20th century, many psychiatric hospitals changed the living environments of their clients with long-term psychiatric disabilities. We investigated the effect of this environmental psychiatric rehabilitation and normalization process on the activity and participation
Dutcher, Christina D; Vujanovic, Anka A; Paulus, Daniel J; Bartlett, Brooke A
Emotion regulation difficulties are a potentially key mechanism underlying the association between childhood maltreatment and alcohol use in adulthood. The current study examined the mediating role of emotion regulation difficulties in the association between childhood maltreatment severity (i.e., Childhood Trauma Questionnaire total score) and past-month alcohol use severity, including alcohol consumption frequency and alcohol-related problems (i.e., number of days of alcohol problems, ratings of "bother" caused by alcohol problems, ratings of treatment importance for alcohol problems). Participants included 111 acute-care psychiatric inpatients (45.0% female; Mage=33.5, SD=10.6), who reported at least one DSM-5 posttraumatic stress disorder Criterion A traumatic event, indexed via the Life Events Checklist for DSM-5. Participants completed questionnaires regarding childhood maltreatment, emotion regulation difficulties, and alcohol use. A significant indirect effect of childhood maltreatment severity via emotion regulation difficulties in relation to alcohol use severity (β=0.07, SE=0.04, 99% CI [0.01, 0.21]) was documented. Specifically, significant indirect effects were found for childhood maltreatment severity via emotion regulation difficulties in relation to alcohol problems (β's between 0.05 and 0.12; all 99% bootstrapped CIs with 10,000 resamples did not include 0) but not alcohol consumption. Emotion regulation difficulties may play a significant role in the association between childhood maltreatment severity and alcohol outcomes. Clinical implications are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.
Köster, M; Grohmann, R; Engel, R R; Nitsche, M A; Rüther, E; Degner, D
There is little clinical data available about seizure rates in psychiatric inpatients, and there are no studies with reference data to the frequencies of antidepressant (AD) use for this important clinical population. This study investigates seizure rates during AD treatment in psychiatric inpatient settings, drawn from the transnational pharmacovigilance programme Arzneimittelsicherheit in der Psychiatrie (AMSP) in relation to the known frequencies of ADs used in the participating clinics. Comparisons are made to former publications and their limitations. Seventy-seven cases were identified with grand mal seizures (GMS) during AD treatment between 1993 and 2008, with a total number of 142,090 inpatients under surveillance treated with ADs in the participating hospitals. The calculated overall rate of reported seizures of patients during AD treatment in this collective is 0.05 % for ADs imputed alone or in combination with other psychotropic drug groups and 0.02 % when only ADs were given and held responsible for GMS. The patients receiving tri- or tetracyclic ADs (TCAs) had a 2-fold risk to develop a seizure as compared to the overall average rate in this sample. In 11 cases, there was only one AD imputed--the majority of these cases (9/11) were TCA. Monotherapy with selective serotonin reuptake inhibitors (SSRI) or dual serotonin and noradrenaline reuptake inhibitors (SNRI) were never imputed alone in this sample. The results of the study favour the assumption that SSRIs, noradrenergic and specific serotonergic antidepressants (NaSSA) and dual SNRI might be more appropriate than TCAs for the treatment of psychiatric patients with an enhanced seizure risk.
Mundt, Adrian P; Fakhriddinov, Sardor; Fayzirahmanova, Maria; Aichberger, Marion C; Ivens, Sebastian; Schouler-Ocak, Meryam; Grohmann, Renate; Magzumova, Shakhnoza; Heinz, Andreas; Sartorius, Norman; Ströhle, Andreas
The present study shows a comparison of diagnoses used for the treatment of urban psychiatric inpatients in Tashkent/Uzbekistan and Berlin/Germany. Differential diagnostic practices related to different traditions in psychopathology between the two settings are analysed to explain part of the difference in relative frequencies of the diagnoses. We conducted a cross-sectional survey of diagnoses used for the treatment of 845 inpatients including 17 out of 18 wards of the Tashkent psychiatric hospital and of all 2,260 psychiatric and psychotherapeutic inpatients in Berlin in October 2008. Relative frequencies of diagnostic categories were calculated for each setting and compared between the two settings using the Chi-square test. A descriptive analysis of differential diagnostic practice is used to explain differences in relative frequencies. Patients diagnosed with schizophrenia (59.3 vs. 21.0%), with organic mental disorders (20.5 vs. 8.3%), with mental retardation (6.9 vs. 0.2%) and with neurasthenia (1.4 vs. 0.0%) had larger relative frequencies of the psychiatric inpatient population in Tashkent than in Berlin. Patients diagnosed with unipolar depression (24.1 vs. 0.9%), substance use disorder (17.4 vs. 6.4%), adjustment disorder (6.0 vs. 0.4%), schizoaffective disorder (4.9 vs. 0.0%), mania and bipolar disorder (5.3 vs. 0.4%), personality disorder (3.2 vs. 2.0%) and anxiety disorder (3.1 vs. 0.1%) had larger relative frequencies in Berlin than in Tashkent. The diagnostic concept of schizophrenia in Tashkent includes patients with affective psychoses, schizoaffective psychoses and delusional disorders. In Tashkent, mental disorders are more readily associated with organic brain disease such as head trauma or vascular disease than in Berlin. In Tashkent, most of the psychiatric inpatient capacities are used for the treatment of schizophrenia and organic mental disorders, whereas in Berlin patients with affective disorders, schizophrenia and substance use
Nurenberg, Jeffry R; Schleifer, Steven J; Shaffer, Thomas M; Yellin, Mary; Desai, Prital J; Amin, Ruchi; Bouchard, Axel; Montalvo, Cristina
Animal-assisted therapy (AAT), most frequently used with dogs, is being used increasingly as an adjunctive alternative treatment for psychiatric patients. AAT with larger animals, such as horses, may have unique benefits. In this randomized controlled study, equine and canine forms of AAT were compared with standard treatments for hospitalized psychiatric patients to determine AAT effects on violent behavior and related measures. The study included 90 patients with recent in-hospital violent behavior or highly regressed behavior. Hospitalization at the 500-bed state psychiatric hospital was two months or longer (mean 5.4 years). Participants were randomly selected to receive ten weekly group therapy sessions of standardized equine-assisted psychotherapy (EAP), canine-assisted psychotherapy (CAP), enhanced social skills psychotherapy, or regular hospital care. Participants' mean age was 44, 37% were female, 76% had diagnoses of schizophrenia or schizoaffective disorder, and 56% had been committed involuntarily for civil or forensic reasons. Violence-related incident reports filed by staff in the three months after study intake were compared with reports two months preintake. Interventions were well tolerated. Analyses revealed an intervention group effect (F=3.00, df=3 and 86, p=.035); post hoc tests showed specific benefits of EAP (p<.05). Similar AAT effects were found for the incidence of 1:1 clinical observation (F=2.70, df=3 and 86, p=.051); post hoc tests suggested benefits of CAP (p=.058) as well as EAP (p=.082). Covariance analyses indicated that staff can predict which patients are likely to benefit from EAP (p=.01). AAT, and perhaps EAP uniquely, may be an effective therapeutic modality for long-term psychiatric patients at risk of violence.
Cohen, Lisa J; Tanis, Thachell; Ardalan, Firouz; Yaseen, Zimri; Galynker, Igor
Diagnostic criteria for borderline personality disorder (BPD) and mood and psychotic disorders characterized by major mood episodes (i.e., major depressive, bipolar and schizoaffective disorder) share marked overlap in symptom presentation, complicating differential diagnosis. The current study tests the hypothesis that maladaptive interpersonal schemas (MIS) are characteristic of BPD, but not of the major mood disorders. One hundred psychiatric inpatients were assessed by SCID I, SCID II and the Young Schema Questionnaire (YSQ-S2). Logistic regression analyses tested the association between MIS (measured by the YSQ-S2) and BPD, bipolar, major depressive and schizoaffective disorder. Receiver operator characteristic (ROC) curve analyses assessed the sensitivity and specificity of MIS as a marker of BPD. After covariation for comorbidity with each of the 3 mood disorders, BPD was robustly associated with 4 out of 5 schema domains. In contrast, only one of fifteen regression analyses demonstrated a significant association between any mood disorder and schema domain after covariation for comorbid BPD. ROC analyses of the 5 schema domains suggested Disconnection/Rejection had the greatest power for identification of BPD cases. These data support the specific role of maladaptive interpersonal schemas in BPD and potentially contribute to greater conceptual clarity about the distinction between BPD and the major mood disorders. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Arredondo, Beth C; Marcopulos, Bernice A; Brand, Jesse G; Campbell, Kristen T; Kent, Julie-Ann
A paucity of peer-reviewed research exists regarding the relation between cognitive functioning and adjudicative competence, despite increasing awareness of cognitive deficits associated with serious mental illness. This retrospective study sought to add to and expand upon existing research by considering performance validity and court determinations of competence, when available. We compared demographic and cognitive variables of a group of defendants with presumed valid testing admitted to an inpatient psychiatric facility for evaluation of adjudicative competence and referred for neuropsychological evaluation (n = 45) and compared individuals determined by the evaluator and/or the court to be competent (n = 30) and incompetent (n = 15). Defendants who were incompetent were more likely to be diagnosed with a cognitive disorder, with a medium effect size. There was a difference in tests of immediate and delayed memory as measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with medium to large effects, and high delayed memory scores were helpful in ruling out incompetence (Negative predictive power = 85.71%). These results provide support for the relationship between cognitive functioning and trial competence, particularly at high and low levels of performance.
Kavanaugh, Brian C; Gaudet, Charles E; Dupont-Frechette, Jennifer A; Tellock, Perrin P; Maher, Isolde D; Haisley, Lauren D; Holler, Karen A
Despite a wealth of studies in adults and adolescents, only a handful of studies have examined executive function in childhood depression. This study utilized retrospective chart review of a children's psychiatric inpatient program to evaluate executive function via Wisconsin Card Sorting Test (WCST) in 33 children (6-12 years old) with a depressive disorder and 61 age/sex-matched children without a depressive disorder referred for neuropsychological evaluation. WCST categories, perseverative errors, and failure to maintain set errors were examined as potential predictors of depressive disorder diagnosis and self-reported depressive symptoms. After controlling for age, length of hospital stay, and ADHD, failure to maintain set significantly predicted depressive disorder diagnosis. Failure to maintain set was also significantly associated with self-reported depressive symptoms. Current findings provide preliminary evidence to suggest that failure to maintain set may reflect a core deficit of childhood depression. While findings are preliminary, this may have important implications for the diagnosis and treatment of childhood depression. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Owen, Gareth S; Szmukler, George; Richardson, Genevra; David, Anthony S; Hayward, Peter; Rucker, James; Harding, Duncan; Hotopf, Matthew
In England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians. To describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained but have mental capacity. Cross-sectional study of 200 patients admitted to psychiatric wards. We assessed mental capacity using a semi-structured interview, the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Of the in-patient sample, 24% were informal but lacked capacity: these patients felt more coerced and had greater levels of treatment refusal than informal participants with capacity. People detained under the Mental Health Act with capacity comprised a small group (6%) that was hard to characterise. Our data suggest that psychiatrists in England and Wales need to take account of the Mental Capacity Act, and in particular best interests judgments and deprivation of liberty safeguards, more explicitly than is perhaps currently the case.
Yvette M Nel
Full Text Available Background. Evidence suggests that the presence of mental illness may be associated with poorer adherence to antiretroviral therapy (ART. There is also a general understanding that patients initiated on ART as inpatients have poorer outcomes than those initiated as outpatients. Negative perceptions regarding future adherence may affect the clinical decision to initiate ART in hospitalised psychiatric patients. Attendance at clinic appointments is an indicator of medication adherence, and is easily measurable in a limited-resource setting. Objectives. The primary objective of this study was to examine the rate of attendance at the first clinic appointment post discharge from a period of psychiatric hospitalisation in HIV-positive psychiatric patients initiated on ART as inpatients. A secondary objective was to determine which factors, if any, were associated with clinic attendance. Methods. This study was a retrospective record review, conducted at the Luthando Neuropsychiatric HIV Clinic in Soweto, which is an integrated mental healthcare and ART clinic. Patients who were initiated on ART as psychiatric inpatients from 1 July 2009 to 31 December 2010, and subsequently discharged for outpatient follow-up at Luthando Clinic were included in the sample. Results. There were 98 patients included in the analysis. The sample was predominantly female. The rate of attendance was 80%. The attendant and non-attendant groups were similar in terms of demographic and clinical data. Significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (p=0.01. Conclusion. Non-disclosure of HIV status needs to be further addressed in integrated psychiatric HIV treatment facilities in order to improve attendance. Female predominance in this setting should also be further investigated.
Yoshida, Madoka; Kanzaki, Tetsuto; Mizoi, Mutsumi; Nakamura, Mizuho; Uemura, Takeshi; Mimori, Seisuke; Uju, Yoriyasu; Sekine, Keisuke; Ishii, Yukihiro; Yoshimi, Taro; Yasui, Reiko; Yasukawa, Asuka; Sato, Mamoru; Okamoto, Seiko; Hisaoka, Tetsuya; Miura, Masafumi; Kusanishi, Shun; Murakami, Kanako; Nakano, Chieko; Mizuta, Yasuhiko; Mishima, Shunichi; Hayakawa, Tatsuro; Tsukada, Kazumi; Kashiwagi, Keiko; Igarashi, Kazuei
We clarified the correlation between brain damage, associated biomarkers and medication in psychiatric patients, because patients with schizophrenia have an increased risk of stroke. The cross-sectional study was performed from January 2013 to December 2015. Study participants were 96 hospitalized patients (41 men and 55 women) in the Department of Psychiatry at Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan. Patients were classified into schizophrenia (n=70) and mood disorders (n=26) by psychiatric diagnoses with DSM-IV-TR criteria. The incidence of brain damage [symptomatic and silent brain infarctions (SBIs) and white matter hyperintensity (WMH)] was correlated more with mood disorders than with schizophrenia. It has been previously shown that the concentrations of protein-conjugated acrolein (PC-Acro) and interleukin-6 (IL-6) increased in plasma of brain infarction patients together with C-reactive protein (CRP). The concentration of PC-Acro was significantly higher in patients with mood disorders than in those with schizophrenia. The concentration of IL-6 in both groups was nearly equal to that in the control group, but that of CRP in both groups, especially in mood disorders, was higher than that in the control group. Accordingly, the relative risk value for brain infarction was higher in patients with mood disorders than with schizophrenia. Medication with atypical antipsychotics reduced PC-Acro significantly in all psychiatric patients and reduced IL-6 in mood disorder patients. Measurement of 3 biomarkers (CRP, PC-Acro and IL-6) are probably useful for judgement of severity of brain damage and effectiveness of medication in psychiatric patients. Copyright © 2016 Elsevier B.V. All rights reserved.
Dack, C; Ross, J; Papadopoulos, C; Stewart, D; Bowers, L
To combine the results of earlier comparison studies of in-patient aggression to quantitatively assess the strength of the association between patient factors and i) aggressive behaviour,ii) repetitive aggressive behaviour. A systematic review and meta-analysis of empirical articles and reports of comparison studies of aggression and non-aggression within adult psychiatric in-patient settings. Factors that were significantly associated with in-patient aggression included being younger, male, involuntary admissions, not being married, a diagnosis of schizophrenia, a greater number of previous admissions, a history of violence, a history of self-destructive behaviour and a history of substance abuse. The only factors associated with repeated in-patient aggression were not being male, a history of violence and a history of substance abuse. By comparing aggressive with non-aggressive patients, important differences between the two populations may be highlighted. These differences may help staff improve predictions of which patients might become aggressive and enable steps to be taken to reduce an aggressive incident occurring using actuarial judgements. However, the associations found between these actuarial factors and aggression were small. It is therefore important for staff to consider dynamic factors such as a patient's current state and the context to reduce in-patient aggression. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.
... resource use and costs among psychiatric hospitals and psychiatric units. Section 405(g)(2) of the Medicare... differences in patient resource use and costs among psychiatric hospitals and psychiatric units. Section 405(g...(s)(3)(B)) for RYs 2013 and 2014 that reduces the update to the IPF PPS base rate for the FY...
Adamis, D; Ball, C
This study examines the prevalence of physical morbidity in elderly psychiatric inpatients and the possible relationships between major psychiatric disorders (organic mental disorders, schizophrenic and mood disorders) and physical illnesses. The clinical implications of such relationships are discussed. Data were obtained from two old age psychiatry wards over a six month period. Seventy-nine subjects were studied and information was obtained from their medical files. Demographic characteristics, psychiatric diagnosis, number of physical illnesses and number of body systems affected were collected. Analysis of variance (ANOVA) was used to compare the psychiatric groups on continuous outcome data and chi(2) test to compare psychiatric groups on categorical data. Seventy-five per cent of subjects had at least one physical illness. The number of medical illnesses was independent from the psychiatric disorder. Subjects with mood disorders, and especially depression, were more likely to suffer from hypertension, diabetes and cardiovascular illnesses than subjects with schizophrenic or organic disorders. Subjects with organic disorders had the lowest prevalence of endocrine disease and diabetes. It was concluded the link between mood disorders (depression), cardiovascular diseases and hypertension could be of a 'cause/effect' type or are the results of a survivor effect. The high prevalence of physical morbidity has implications for training and continuing professional development of those in Old Age Psychiatry Services. It should also be taken into consideration when the location of services is being decided.
Procyshyn, Ric M; Su, Johnny; Elbe, Dean; Liu, Angela Y; Panenka, William J; Davidson, Jana; Honer, William G; Barr, Alasdair M
The objective of this study was to examine the prevalence and patterns of antipsychotic use in children and adolescents at the time of admission and discharge from a tertiary care inpatient psychiatric facility. This retrospective analysis included all patients 18 years and younger, who were admitted and discharged from a child and adolescent tertiary care inpatient psychiatric facility between May 1, 2008 and December 31, 2009. Data for medications at admission were obtained using a province-wide network that links all pharmacies in British Columbia, Canada to a central set of data systems, whereas data for medications at discharge were obtained using the Department of Pharmacy's (British Columbia Children's Hospital, Vancouver, British Columbia, Canada) inpatient computer database. Apart from antipsychotics, overall drug use included antidepressants, mood stabilizers, benzodiazepines, anticholinergics, stimulants, and sleep medications. Referral and discharge diagnoses were also examined. During the study period, 335 patients were admitted and discharged from the tertiary care inpatient psychiatric facility. Significantly, more patients were prescribed with an antipsychotic at the time of discharge from hospital compared with that of the time when they were admitted to hospital (51.6% vs 30.7%; P discharge (32.0% vs 42.2%, respectively) followed by attention-deficit/hyperactivity disorder medications (22.3% vs 24.9% at admission and discharge, respectively) and anticonvulsants (19.4% vs 19.1% at admission and discharge, respectively). Whether the significant increase in antipsychotic use seen from the time of admission to discharge is solely attributed to clinical worsening or other variables requires further investigation.
Alderton, H R
The role of punishment in the psychiatric in-patient treatment of nonpsychotic latency-age children with behaviourdisorders is discussed. Punishment is defined as the removal of previously existing positive reinforcers or the administration of aversive stimuli. Ways in which appropriate social behaviour may be acquired are briefly considered. These include reinforcement of desirable responses, non-reinforcement of undesirable responses, reinforcement of incompatible responses and imitative learning. The reported effects of punishment on behaviour are reviewed and the psychological functions necessary before punishment can have the intended effects considered. For seriously disturbed children punishment is ineffective as a treatment technique. It reinforces pathological perceptions of self and adults even if it successfully suppresses behaviour. The frame of reference of the seriously disturbed child contraindicates the removal of positive reinforcers and verbal as well as physical aversive stimuli. Controls and punishments must be clearly distinguished. Controls continue only as long as the behaviour towards which they are directed. They do not include the deliberate establishment of an unpleasant state by the adult as a result of particular behaviour. Control techniques such as removal from a group may be necessary but when possible should be avoided in favour of techniques less likely to be misinterpreted. Avoidance of punishment in treatment makes even more important explicit expectations and provision of realistic controls. Natural laws may result in unpleasant experiences as an unavoidable result of certain behaviour. By definition such results can never be imposed by the adult. Treatment considerations may necessitate that the child be protected from the results of his actions. Avoidance of punishment requires a higher staff/child ratio, more mature and better trained staff. Sometimes children have previously been deterred from serious community acting out
Full Text Available Abstract Background The debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS, which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables. Methods We considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables. We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS. Results All but two syndrome scores (mania, hostility were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%. Conclusions Psychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent
HUGO KARLING MORESCHI
Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.
Full Text Available Objective: To evaluate effects of a preventive monitoring program targeted to reduce compulsory re-hospitalization and perceived coercion in patients with severe mental disorder. We analyze patient outcomes in terms of perceived coercion, empowerment and self-reported mental health functioning at 12 months. Methods: The program consists of individualized psycho-education, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 psychiatric inpatients who had had compulsory admission(s during the past 24 months were included in the trial. T1-assessment 12 months after baseline was achieved for 182 patients. Results: Study participants reported lower levels of perceived coercion, negative pressures and process exclusion, a higher level of optimism, and a lesser degree of distress due to symptoms, interpersonal relations and social role functioning (significant time effects. However, improvements were not confined to the intervention group, but seen also in the TAU group (no significant group or interaction effects. Altered perceptions were linked to older age, shorter illness duration, female sex, non-psychotic disorder, and compulsory hospitalization not due to risk of harm to others. Conclusion: Our findings suggest that changes in the subjective perspective were fuelled primarily by participation in this study, rather than by having received the specific intervention. The study contributes to a better understanding of the interaction between 'objective' measures (compulsory readmissions and patients’ perceptions and highlights the need for treatment approaches promoting empowerment in individuals with a history of involuntary psychiatric hospitalizations.
Lay, Barbara; Drack, Thekla; Bleiker, Marco; Lengler, Silke; Blank, Christina; Rössler, Wulf
To evaluate the effects of a preventive monitoring program targeted to reduce compulsory rehospitalization and perceived coercion in patients with severe mental disorder. We analyze patient outcomes in terms of perceived coercion, empowerment, and self-reported mental health functioning at 12 months. The program consists of individualized psychoeducation, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 psychiatric inpatients who had had compulsory admission(s) during the past 24 months were included in the trial. T1-assessment 12 months after baseline was achieved for 182 patients. Study participants reported lower levels of perceived coercion, negative pressures, and process exclusion, a higher level of optimism, and a lesser degree of distress due to symptoms, interpersonal relations, and social role functioning (significant time effects). However, improvements were not confined to the intervention group, but seen also in the treatment-as-usual group (no significant group or interaction effects). Altered perceptions were linked to older age, shorter illness duration, female sex, non-psychotic disorder, and compulsory hospitalization not due to risk of harm to others. Our findings suggest that changes in the subjective perspective were fueled primarily by participation in this study rather than by having received the specific intervention. The study contributes to a better understanding of the interaction between "objective" measures (compulsory readmissions) and patients' perceptions and highlights the need for treatment approaches promoting empowerment in individuals with a history of involuntary psychiatric hospitalizations.
Jansen, Gerard J.; Middel, Berry; Dassen, Theodoor; Reijneveld, Menno S A
Little is currently known about the attitudes of psychiatric nurses toward patient aggression, particularly from an international perspective. Attitudes toward patient aggression of psychiatric nurses from five European countries were investigated using a recently developed and tested attitude
Troisi, Alfonso; Kustermann, Stefano; Di Genio, Massimo; Siracusano, Alberto
A critical step for improving the prediction of on-ward violence is the identification of variables that are not only consistently associated with an increased risk of aggression but also easily evaluated during the admission interview. The goal of this prospective study was to assess the predictive utility of hostility during admission interview. The sample consisted of 80 newly admitted male patients with heterogeneous DSM-IV psychiatric diagnoses recruited from the psychiatric ward of an urban public hospital. Psychiatric symptoms at admission were assessed with the Brief Psychiatric Rating Scale (BPRS). Aggressive behavior during the first week of hospitalization was measured with the Modified Overt Aggression Scale. Data were collected between January and June 1998. In a multiple regression model, BPRS items hostility and tension-excitement emerged as significant predictors of verbal aggression, whereas thinking disturbance (high) and suspiciousness-uncooperativeness (low) emerged as significant predictors of aggression against objects. In contrast, when aggression was treated as a binary dependent variable in a logistic model, hostility during the admission interview had no utility in predicting on-ward aggressive behavior. This study confirms the importance of distinguishing between different types of aggression to improve the accuracy of predictions of violence. The findings suggest that the question whether hostility is a useful short-term predictor of aggression in psychiatric inpatients cannot be answered conclusively. The predictive utility of hostility was relatively high for predicting verbal aggression but was negligible for predicting other types of aggressive behavior.
Park, Subin; Kim, Jae-Won; Kim, Bung-Nyun; Bae, Jeong-Hoon; Shin, Min-Sup; Yoo, Hee-Jeong
Objective We aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea. Methods The subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office. Results Among 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge. Conclusion These results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide. PMID:25670943
Nenadić, Igor; Lamberth, Sina; Reiss, Neele
Group schema therapy (GST) has been proposed as a novel long-term treatment programme for borderline and cluster C personality disorders. We implemented a short-term GST programme (12-15 sessions, based on the manual by Farrell and Shaw (2012), including both cognitive / behavioural and experiential interventions for in-patients (n=9) with either borderline or cluster C personality disorders (and axis I co-morbidities) treated in a (sub)acute psychiatric in-patient setting. We evaluated pre- and post-treatment self-report of maladaptive and adaptive schema modes (using the SMI) and early maladaptive schemas (YSQ-3), as well as overall symptom severity (brief symptom check list, BSCL-53-S), patient satisfaction (ZUF-8) and group climate and coherence (GCQ-S). We found significant reduction of symptoms, and trend-level improvement for schema mode activation, but not maladaptive schemas. Effect sizes of Cohen's d=0.857 for symptoms and d=0.693 for maladaptive schema mode reduction were, however, lower than previous GST trials in in-patient settings with a longer treatment phase and outpatient GST trials using the Farrell and Shaw-model, indicating importance of duration in ST treatment. Our findings in this uncontrolled study provide first evidence that GST (based on the Farrell and Shaw model) can be implemented and adapted for use in short-term in-patient (sub)acute settings. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Watson, Charles G.
Geriatric ward patients (N=84) were randomly assigned to groups targeted for outplacement planning or inpatient care. During the following year, the mean Morale Inventory score of the outplacement sample improved while that of the inpatient group remained statis. Results argue for an increased emphasis on outplacement programs among geriatric…
Ghahramanlou-Holloway, Marjan; Cox, Daniel W.; Greene, Farrah N.
To date, no empirically based inpatient intervention for individuals who have attempted suicide exists. We present an overview of a novel psychotherapeutic approach, Post-Admission Cognitive Therapy (PACT), currently under development and empirical testing for inpatients who have been admitted for a recent suicide attempt. PACT is adapted from an…
Kullberg, Anna; Sharp, Lena; Johansson, Hemming; Bergenmar, Mia
This prospective pilot study aimed to investigate patients' perception of information exchange and its associations with patient satisfaction, participation and safety at inpatient oncology wards. Consecutive patients with cancer who spent ≥3 days at an oncological inpatient ward at the Department of Oncology, Karolinska University Hospital during the study period (March-August 2013) were invited to respond to EORTC-INPATSAT32 measuring patient satisfaction and a study specific questionnaire. Data on changes in medication and fall risk assessments was collected from the patients' electronic health records. A total of 104 patients (58%) participated in the study. Patients rated doctors' and nurses' information provision lower than their technical and interpersonal skills, and 13% considered the information exchange "excellent". Changes in medication were registered for 83% of participating patients, which 56% of the patients were aware of. Fall risk assessment was registered for 73% of responding patients, and 39% reported having discussed risk of falling during the hospital stay. The Downton Fall Risk Index scores were not associated with actual falls or fall prevention actions. Deficits were found on information exchange and information provision between health care professionals and patients. This might have a negative impact on known patient safety risks such as medication errors and falls. More effective strategies to perform fall risk assessments in an oncological inpatient setting are needed. Further studies evaluating interventions to improve participation and information exchange are necessary to increase patient satisfaction, participation and safety in oncological inpatient care. Copyright © 2014 Elsevier Ltd. All rights reserved.
Pelto-Piri, Veikko; Engström, Karin; Engström, Ingemar
Psychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients' opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity. All staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives. The majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.•Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.•Autonomy; 1) respecting the patient's right to self-determination and information, 2) respecting the patient's integrity and 3) protecting human rights.•Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients. Paternalism clearly appeared to be the dominant
Colón Vilar, Giancarlo; Concepción, Erika; Galynker, Igor; Tanis, Thachell; Ardalan, Firouz; Yaseen, Zimri; Cohen, Lisa J
Sexuality is an important aspect of quality of life and sexual fantasies comprise a normal part of human sexuality. However, the nature of sexuality and sexual fantasies of patients with mental illness remains an understudied area. To investigate the nature and frequency of sexual fantasies in psychiatric patients, the present study compared the frequency of four types of sexual fantasies across four different mood and psychotic diagnoses and three personality disorder clusters. Study participants included 133 psychiatric inpatients recruited from an urban hospital. Sexual fantasies were compared across patients with schizophrenia, bipolar disorder, schizoaffective disorder, major depressive disorder and three nonclinical samples from the literature and then correlated with personality cluster scores. Subjects were administered the Structured Clinical Interview for DSM-IV for Axis I and for Axis II Disorders. Sexual fantasies were assessed by the Wilson Sexual Fantasies Questionnaire, which measures four types of sexual fantasies (exploratory, intimate, impersonal, and sadomasochistic). Within the entire sample, there were significant differences across sexual fantasy types, with subjects scoring highest on intimate sexual fantasies and then exploratory, impersonal, and sadomasochistic. There were no significant differences across mood and psychotic diagnostic groups for any of the sexual fantasy scales and the scores were within the normative range of nonclinical samples. Patients with high cluster B scores scored significantly higher on all four fantasy scales than those without. Patients with high cluster A scores scored lower on intimate fantasies, but there was no association between cluster C scores and sexual fantasies. The association between cluster B and sexual fantasies remained consistent across Structured Clinical Interview for DSM-IV for Axis I diagnoses (no interaction effect). Patients with severe mental illness report sexual fantasies that are
Silverman, Michael J
Social support is associated with enhanced illness management and recovery in persons with mental illness, making it an important topic addressed through acute inpatient psychoeducational programs. In addition, trust in the therapist may mediate clinical outcomes in this patient population. To date, few studies have examined the effect of music-based psychoeducational programs on these variables. The purpose of this study was to isolate and examine the component parts of a live educational music therapy intervention, and its effect on acute psychiatric inpatients' perceived social support from significant others, family, and friends and trust in the therapist. This study also explored whether trust in therapist varied across conditions, but did not examine it as a mediator for social support. Participants (N = 96) were cluster-randomized in a single-session posttest-only design to one of four conditions: live educational music therapy, recorded educational music therapy, education without music, or recreational music therapy without education. Conditions were designed to isolate the following intervention components: live vs. recorded music, educational vs. non-educational content, and music vs. nonmusic modality. Dependent measures were assessed post intervention via established self-report instruments evaluating perceived social support and trust in the therapist. There were no significant between-group differences for social support or trust in therapist total scores. However, subscale score analyses revealed two significant between-group differences: (a) participants in the Live Educational Music Therapy condition reported significantly higher perceived therapist competence compared with the Recorded Educational Music Therapy condition; (b) participants in the Live Educational Music Therapy condition reported significantly higher perceived support from friends compared with the Recreational Music Therapy condition. Live educational music therapy may be a way to
Lucchetti, Giancarlo; Lucchetti, Alessandra Lamas Granero; de Bernardin Gonçalves, Juliane Piasseschi; Vallada, Homero P
Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp 12) is one of the most used and most validated instruments for assessing spiritual well-being in the world. Some Brazilian studies have used this instrument without, however, assessing its psychometric properties. The present study aims to validate the Portuguese version of the FACIT-Sp 12 among Brazilian psychiatric inpatients. A self-administered questionnaire, covering spiritual well-being (FACIT-Sp 12), depression, anxiety, religiosity, quality of life, and optimism, was administered. Of those who met the inclusion criteria, 579 patients were invited to participate and 493 (85.1 %) were able to fill out the FACIT-Sp 12 twice (test and retest). Subsequently, the validation analysis was carried out. Estimation of test-retest reliability, discriminant, and convergent validity was determined by the Spearman's correlation test, and the internal consistency was examined by the Cronbach's alpha. The sample was predominantly male (63.9 %) with a mean age of 35.9 years, and the most common psychiatric condition was bipolar disorder (25.7 %) followed by schizophrenia (20.4 %), drug use (20.0 %), and depression (17.6 %) according to ICD-10. The total FACIT-Sp 12 scale as well as the subscales demonstrated high internal consistency (coefficient alphas ranging from 0.893 for the total scale to 0.655 for the Meaning subscale), good convergent and divergent validity, and satisfactory test-retest reliability (rho = 0.699). The Portuguese version of FACIT-Sp 12 is a valid and reliable measure to use in Brazilian psychiatric inpatients. The availability of a brief and broad measure of spiritual well-being can help the study of spirituality and its influence on health by researchers from countries that speak the Portuguese language.
Hoshii, Junko; Yotsumoto, Kayano; Tatsumi, Eri; Tanaka, Chito; Mori, Takashi; Hashimoto, Takeshi
To compare the therapeutic effects of subject-chosen and therapist-chosen activities in occupational therapy for inpatients with chronic schizophrenia. Prospective comparative study. A psychiatric hospital in Japan. Fifty-nine patients with chronic schizophrenia who had been hospitalized for many years. The subjects received six-months occupational therapy, participating in either activities of their choice (subject-chosen activity group, n = 30) or activities chosen by occupational therapists based on treatment recommendations and patient consent (therapist-chosen activity group, n = 29). The Positive and Negative Syndrome Scale and the Global Assessment of Functioning (GAF) Scale were used to evaluate psychiatric symptoms and psychosocial function, respectively. After six-months occupational therapy, suspiciousness and hostility scores of the positive scale and preoccupation scores of the general psychopathology scale significantly improved in the subject-chosen activity group compared with the therapist-chosen activity group, with 2(2) (median (interquartile range)) and 3(1.25), 2(1) and 2.5(1), and 2(1) and 3(1), respectively. There were no significant differences in psychosocial functions between the two groups. In within-group comparisons before and after occupational therapy, suspiciousness scores of the positive scale, preoccupation scores of the general psychopathology scale, and psychosocial function significantly improved only in the subject-chosen activity group, with 3(1) to 2(2), 3(1) to 2(1), and 40(9) to 40(16) respectively, but not in the therapist-chosen activity group. The results suggested that the subject-chosen activities in occupational therapy could improve the psychiatric symptoms, suspiciousness, and preoccupation of the inpatients with chronic schizophrenia.
...: Organizational Environment § 418.110 Condition of participation: Hospices that provide inpatient care directly. A... hospice must have a written disaster preparedness plan in effect for managing the consequences of power... changes in the edition of the Code are incorporated by reference, CMS will publish a notice in the Federal...
In France, World War II lasted from 1939 to 1945. Under-nourishment was a national problem, and was more severe in mental hospitals. The mortality of psychiatric inpatients in France during World War II has long been a controversial issue in the country. Some authors wrote of the "soft extermination" of 40 000 mental patients, although this has been proven false. The historical study published in 2007 by Isabelle von Bueltzingsloewen provides in-depth description and analysis of starvation due to food restrictions in French mental hospitals. Although the French official statistic services published detailed data, no demographic study has been published so far. Such studies have been conducted in Norway and in Finland. "The influence of a period of under-nourishment upon mortality in mental hospitals can rarely be seen with a clarity equal to that in this work. The strict rationing was the same for everybody, but, extra muros, there was private initiative and ingenuity to help in alleviating the distress. Naturally, patients in institution had no ability to act on their own. The immense increase during the period of war from 1941 to 1945 appeared both as an increase in the exact death-risk and as an increase in the disproportion with normal mortality. The men reacted more strongly than women; which is readily comprehensible on physiological grounds, as the rations were virtually the same for all." Excess mortality continued after the war. Even though under-nourishment had ceased, death rates from tuberculosis remained high the following year. Both papers state that the poor hygiene and bad living conditions existing in mental hospitals before the war worsened the effects of food restrictions. DEMOGRAPHIC DATA: French data were published by the General Statistics of France (SGF) that became the National Institute of Statistics and Economic Studies (Insee) in 1946. A series of datasets were published each year according to sex, diagnosis and type of psychiatric
Risgaard, Bjarke; Waagstein, Kristine; Winkel, Bo Gregers
hospital contact and was identified using The Danish Psychiatric Central Research Register. All diagnoses in Danish registries are coded according to ICD-8 or ICD-10. All hospital records were retrieved manually. Results: Among 5,178 deaths, 395 were due to SCD and autopsies were performed on 262 (66......Introduction: Psychiatric patients have premature mortality compared to the general population. The incidence of sudden cardiac death (SCD) in psychiatric patients is unknown in a nationwide setting. The aim of this study was to compare nationwide SCD incidence rates in young individuals...... with and without previous psychiatric disease. Method: Nationwide, retrospective cohort study including all deaths in people aged 18–35 years in 2000–2006 in Denmark. The unique Danish death certificates and autopsy reports were used to identify SCD cases. Psychiatric disease was defined as a previous psychiatric...
Hopwood, C J; Ansell, E B; Fehon, D C; Grilo, C M
Childhood maltreatment is a risk factor for eating disorder and negative/depressive affect appears to mediate this relation. However, the specific elements of eating- and body-related psychopathology that are influenced by various forms of childhood maltreatment remain unclear, and investigations among adolescents and men/boys have been limited. This study investigated the mediating role of negative affect/depression across multiple types of childhood maltreatment and eating disorder features in hospitalized adolescent boys and girls. Participants were 148 adolescent psychiatric inpatients who completed an assessment battery including measures of specific forms of childhood maltreatment (sexual, emotional, and physical abuse), negative/depressive affect, and eating disorder features (dietary restriction, binge eating, and body dissatisfaction). Findings suggest that for girls, negative/depressive affect significantly mediates the relationships between childhood maltreatment and eating disorder psychopathology, although effects varied somewhat across types of maltreatment and eating disorder features. Generalization of mediation effects to boys was limited.
Hopwood, Christopher J.; Ansell, Emily B.; Fehon, Dwain C.; Grilo, Carlos M.
Objective Childhood maltreatment is a risk factor for eating disorder and negative/depressive affect appears to mediate this relation. However, the specific elements of eating- and body-related psychopathology that are influenced by various forms of childhood maltreatment remain unclear and investigations among adolescents and men/boys have been limited. This study investigated the mediating role of negative affect/depression across multiple types of childhood maltreatment and eating disorder features in hospitalized adolescent boys and girls. Method Participants were 148 adolescent psychiatric inpatients who completed an assessment battery including measures of specific forms of childhood maltreatment (sexual, emotional, and physical abuse), negative/depressive affect, and eating disorder features (dietary restriction, binge eating, and body dissatisfaction). Results Findings suggest that for girls, negative/depressive affect significantly mediates the relationships between childhood maltreatment and eating disorder psychopathology, although effects varied somewhat across types of maltreatment and eating disorder features. Generalization of mediation effects to boys was limited. PMID:21727786
Full Text Available The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics—Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience—are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff’s perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.
Veale, David; Akyüz, Elvan U; Hodsoll, John
The aim of this study was to estimate the prevalence of body dysmorphic disorder (BDD) on an inpatient ward in the UK with a larger sample than previously studied and to investigate the value of a simple screening question during an assessment interview. Four hundred and thirty two consecutive admissions were screened for BDD on an adult psychiatric ward over a period of 13 months. Those who screened positive had a structured diagnostic interview for BDD. The prevalence of BDD was estimated to be 5.8% (C.I. 3.6-8.1%). Our screening question had a slightly low specificity (76.6%) for detecting BDD. The strength of this study was a larger sample size and narrower confidence interval than previous studies. The study adds to previous observations that BDD is poorly identified in psychiatric inpatients. BDD was identified predominantly in those presenting with depression, substance misuse or an anxiety disorder. The screening question could be improved by excluding those with weight or shape concerns. Missing the diagnosis is likely to lead to inappropriate treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Grilo, C M
Cluster-analytic studies of eating disorders in adult patients have yielded two subtypes (pure dietary and mixed dietary-negative affect). This study aimed to replicate the subtyping in female adolescent psychiatric inpatients with features of eating disorders. Cluster analyses of 137 patients with eating-disordered features revealed a dietary-negative affect subtype (43%) and a pure dietary subtype (57%). The dietary-negative affect subtype was characterized by greater likelihood of binge eating, greater eating-related psychopathology, and greater body image dissatisfaction. The two subtypes did not differ significantly in scores reflective of clinical syndromes (other than the significantly higher depressive affect in the negative affect subtype), but the dietary-negative affect subtype was characterized by greater personality disturbance and higher reported concerns in clinical areas, including suicidality and childhood abuse. The cluster analysis produced different results from an alternative approach to subtyping by vomiting. These findings provide further support for the reliability and validity of this subtyping scheme for eating pathology. Clinically, the findings suggest that the combination of dieting and negative affect signals a more disturbed variant of eating-disorder related psychopathology in female adolescent psychiatric inpatients.
Li, Shuang; Galynker, Igor I; Briggs, Jessica; Duffy, Molly; Frechette-Hagan, Anna; Kim, Hae-Joon; Cohen, Lisa J; Yaseen, Zimri S
Insecure attachment is associated with suicidal behavior. This relationship and its possible mediators have not been examined in high-risk psychiatric inpatients with respect to the critical high-risk period following hospital discharge. Attachment styles and perception of entrapment were assessed in 200 high-risk adult psychiatric inpatients hospitalized following suicidal ideation or suicide attempt. Suicidal behaviors were evaluated with the Columbia Suicide Severity Rating Scale at 1-2 months post-discharge. Associations between different attachment styles and suicidal behaviors were assessed and mediation of attachment effects by entrapment was modeled. Fearful attachment was associated with post-discharge suicidal behavior and there was a trend-level negative association for secure attachment. In addition, entrapment mediated the relationship between fearful attachment and suicidal behavior. The current study highlights the mediating role of perceptions of entrapment in the contribution of fearful attachment to suicidal behavior in high-risk patients, suggesting entrapment as potential therapeutic target to prevent suicidal behavior in these individuals. Further research is warranted to establish the mechanisms by which entrapment experiences emerge in patients with insecure attachment styles. Copyright © 2017 Elsevier B.V. All rights reserved.
Luukkonen, Anu-Helmi; Räsänen, Pirkko; Hakko, Helinä; Riala, Kaisa
To investigate the association of bullying behavior with suicide attempts and self-mutilation among adolescents. The study sample consisted of 508 Finnish adolescents (age 12-17 years) admitted to psychiatric inpatient care between April 2001 and March 2006. DSM-IV psychiatric diagnoses and variables measuring suicidal behavior (i.e. suicide attempts and self-mutilation) and bullying behavior (i.e. a victim, a bully or a bully-victim) were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL). Logistic regression analyses were conducted to examine the impact of being a victim, a bully or both a bully and a victim on suicide attempts and self-mutilation. After adjusting for age, school factors, family factors and psychiatric disorders, there was a higher risk of suicide attempts in girls who were victims of bullying (OR=2.07, CI=1.04-4.11, p=0.037) or who bullied others (OR=3.27, CI=1.08-9.95, p=0.037). Corresponding associations were not found for boys; nor was any association of bullying behavior with self-mutilation found among either sex. Among girls, being bullied or bullying others are both potential risk factors for suicidal behavior. Psychiatric assessment and treatment should thus be considered not only for victims of bullying, but also for bullies. Suicide-prevention programs should also routinely include interventions to reduce bullying. However, the generalization of our findings to all adolescents is limited because our study sample consisted of psychiatric adolescent patients. In addition, some of the possible findings might have remained statistically insignificant due to the small sample size among adolescents who had performed suicide attempts or self-mutilation. Copyright 2009 S. Karger AG, Basel.
Full Text Available Abstract Background The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants. Methods 93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses. Results The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate. Conclusions The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.
Full Text Available Miguel Angel Gonzalez-Torres,1,2 Miguel Angel Salazar,3 Manuel Imaz,4 Lucía Inchausti,1,2 Berta Ibañez,5 Aranzazu Fernandez-Rivas,1,2 Javier Pastor,3 Bosco Anguiano,3 Pedro Muñoz,3 Eduardo Ruiz,1,2 Rodrigo Oraa,3 Sonia Bustamante,1,2 Sofia Alvarez de Eulate,2 Ramón Cisterna4,61Department of Neuroscience, University of the Basque Country, 2Psychiatry Service, Basurto University Hospital, Bilbao, 3Mental Health Network of Biscay, Basque Health Service, Biscay, 4Microbiology Service, Basurto University Hospital, Bilbao, 5Navarra Biomed-Miguel Servet Foundation, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC, Pamplona, 6Department of Microbiology, University of the Basque Country, Bilbao, SpainBackground: The aims of this study were to evaluate the prevalence of HIV and its associated demographic and clinical factors among psychiatric inpatients of a general hospital.Methods: This was a single-center, observational, cross-sectional study that included patients consecutively admitted to our unit aged 16 years or older and with no relevant cognitive problems. The patients were evaluated using a semistructured interview and an appropriate test for HIV infection.Results: Of the 637 patients who were screened, 546 (86% who consented to participate were included in the analyses. Twenty-five (4.6%, 95% confidence interval [CI] 3.0–6.8 patients were HIV-positive. The prevalence was higher among patients with substance misuse (17.4%, 95% CI 9.7–28.8. All except one of the 25 patients knew of their seropositive condition prior to participation in the study. Only 14 (56% of the 25 seropositive patients had previously received pharmacological treatment for their infection. According to the multiple logistic regression analysis, the likelihood of HIV infection was lower in patients with higher levels of education and higher among patients who were single, had history of intravenous drug use, and had an HIV
Laukkanen, Matti; Hakko, Helinä; Riala, Kaisa; Räsänen, Pirkko
This study investigated whether adolescent's family type was associated with regular smoking or the use of illicit substances (cannabis or hard drugs) among underage adolescent psychiatric in-patients. The sample consisted of 471 adolescents aged 12-17 years admitted to psychiatric hospital between April 2001 and March 2006 at Oulu University Hospital, Finland. The information on family factors and substance use was based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime interview and the European modification of the Addiction Severity Index questionnaire. Compared to adolescent boys from two-parent families, those from child welfare placement were more likely to regularly use both cannabis (odds ratio [OR]=4.4; 95%confidence interval [CI]=1.4-13.7; P=.012) and hard drugs (OR=8.4; 95% CI=1.7-42.1; P=.01).Among girls, no association was found between family type and the use of illicit substances. Two-parent or foster family units may protect adolescents from involvement with illicit substances. In clinical adolescent psychiatric practice more attention should be paid to family interventions and parental support.
Luukkonen, Anu-Helmi; Riala, Kaisa; Hakko, Helinä; Räsänen, Pirkko
The recent school shootings in Europe and the USA have raised the question of whether victims of bullying run an increased risk of committing violent crimes later in life, but scientific research in this area is scarce. The aim of this work was to investigate whether bullying behaviour is associated with later criminal offences committed in adolescence and young adulthood. We studied a sample of 508 Finnish adolescents (age 12-17 years) admitted to psychiatric inpatient care between April 2001 and March 2006. Data on crimes committed and the age of onset of criminal activity were extracted from the official criminal records of the national Legal Register Centre in October 2008. The Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime (K-SADS-PL) was used to define bullying status, and to obtain DSM-IV-based psychiatric diagnoses for the adolescents. Violent crimes were statistically significantly associated with bullying behaviour, but not non-violent crimes. Furthermore, being a bully was predictive of an early onset of severe violent offences. When controlled for the psychiatric diagnoses of the adolescents, we observed decreased likelihood of criminality among victims. Thus bullying others may increase the risk of violent offences, while being a victim is not a risk factor for criminality. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Elz, Carolin Dorothee
Little is known about the effect of the detention of general-psychiatric patients on the subjective outcome of treatment. Patient satisfaction and therapeutic alliance are especially relevant as subjective outcome parameters: The satisfaction of patients has gained growing importance as part of statutory quality managment and the alliance is discussed as one of the most crucial factors of psychotherapeutic success, it correlates positively with objective outcome. In general-psychiatric settin...
Clarke, David; Vemuri, Murali; Gunatilake, Deepthi; Tewari, Sidhartha
Background: A high prevalence of "Helicobacter pylori" infection has been reported among people with intellectual disability, especially those residing in hospital and similar settings. Surveys of inpatients have found unusually high rates of gastrointestinal malignancy, to which "H. pylori" infection predisposes. Methods: "Helicobacter pylori"…
Bartlem, Kate; Bailey, Jacqueline; Metse, Alexandra; Asara, Ashley; Wye, Paula; Clancy, Richard; Wiggers, John; Bowman, Jenny
Policies and clinical guidelines acknowledge the role mental health services have in addressing the physical health of individuals with a mental illness; however, little research has explored interest in reducing health risk behaviours or the acceptability of receiving support to reduce such risks among psychiatric inpatients. This study estimated the prevalence of four long-term disease risk behaviours (tobacco smoking, hazardous alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity); patient interest in reducing these risks; and acceptability of being provided care to do so during a psychiatric inpatient stay. A cross-sectional survey was undertaken with 2075 inpatients from four inpatient psychiatric facilities in one health district in Australia (October 2012-April 2014). Prevalence of risk behaviours ranged from 50.2% (inadequate physical activity) to 94.8% (inadequate fruit and/or vegetable consumption). The majority of respondents (88.4%) had more than one risk behaviour, and most were seriously considering improving their risk behaviours (47.6% to 65.3%). The majority (80.4%) agreed that it would be acceptable to be provided support and advice to change such behaviours during their psychiatric inpatient stay. Some diagnoses were associated with smoking and hazardous alcohol consumption, interest in reducing alcohol consumption and increasing fruit and/or vegetable consumption, and acceptability of receiving advice and support. The findings reinforce the need and opportunity for psychiatric inpatient facilities to address the long-term disease risk behaviours of their patients. © 2017 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.
Laubjerg, Merete; Petersson, Birgit
and international research stressing that adoptees demonstrate reverse health outcomes. The cohort is in-ward patients (> 24 hours), born between 1973 and 2005. Correlation between various dependent and independent variables are analysed. The research makes different comparative statements of psychiatric admissions...... The aim is to highlight adoptees' and stepchildren's psychiatric contact and diagnoses compared to non-adoptees. The setting is Greenland and the methodology is a comparative in-ward patient register-based study. The background is the Greenlandic tradition for adoption and community child care...... and diagnoses related to adoptees and stepchildren compared to non-adoptees with respect to demographic and socio-economic indicators. The psychiatric data material is collected from 1992 to 2008 and the socio-economic indicators are included from 1996. The findings show, contrary to findings related...
Micucci, Joseph A
This study investigated the accuracy of various indices involving the MMPI-A scales, ACK, MAC-R, and PRO in diagnosing substance abuse in a sample of 79 psychiatric inpatients. In the full sample, 89.9% of the cases were accurately classified by at least one of the three scales. The overall accuracy of classification was similar among males, females, Caucasians, and African Americans, although there was a tendency for more false positive misclassifications among males. Profile code type moderated the accuracy of classification with greatest accuracy for code types including Scales 1, 2, 3, 5, or 0 and least accuracy for code types including Scales 4, 6, or 9. ACK, MAC-R, and PRO were better at screening out cases of substance abuse than in accurately identifying those adolescents who were using substances.
Sercu, Charlotte; Bracke, Piet
The study discusses the stigma experiences of service users in mental health care, within the debate on the role of the biomedical framework for mental health care and power relations in society. Interview data of inpatient users ( n = 42) and care providers ( n = 43) from two Belgian psychiatric hospitals were analyzed using a constructivist grounded theory approach: Findings offer insight into how stigma experiences are affected by social structure. Stigma seemed to be related to the relation between care providers and service users their social position. The concept "mental health literacy" is used to frame this finding. In paying attention to the specific cultural and normative context, which influences the relationship between mental health literacy and stigma, it is further possible to cast some light on the meaning of the biomedical model for the construction and maintenance of power relations in mental health care and broader society.
Yazici, Esra; Ulus, Fuat; Selvitop, Rabia; Yazici, Ahmet Bülent; Aydin, Nazan
This paper reports on the use of cinema therapy at a psychiatry clinic for inpatients. The program, "Watching Cinema Group Therapy," was used with over 500 inpatients over the course of one year. We found that using movies for group psychotherapy sessions encouraged the patients to talk about their beliefs, thoughts, and feelings while discussing the characters and stories. We also used the movies as a reward for patients who had developed a therapeutic alliance. It motivated the patients to be active instead of simply remaining in their rooms. As a follow-up to full-length films, it was more useful to show short scenes to patients who had been administered high doses of drugs. Movies can be an important, positive, and productive means of treatment and teaching.
Kontio, Raija; Pitkänen, Anneli; Joffe, Grigori; Katajisto, Jouko; Välimäki, Maritta
The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible. The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients. In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course. A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research.
Bichescu-Burian, D; Cerisier, C; Czekaj, A; Grempler, J; Hund, S; Jaeger, S; Schmid, P; Weithmann, G; Steinert, T
In Germany, in-patient treatment of patients with depressive, neurotic, anxiety, and somatoform disorders (ICD-10 F3, F4) is carried out in different settings in psychiatry and psychosomatics. Which patient characteristics determine referral to one or the other specialty is a crucial question in mental health policy and is a matter of ongoing controversy. However, comparative data on patient populations are widely lacking. In the study of Treatment Pathways of Patients with Anxiety and Depression (PfAD study), a total of 320 patients with ICD-10 F3/F4 clinical diagnoses were consecutively recruited from four treatment settings (psychiatric depression ward, psychiatric crisis intervention ward, psychiatric day hospitals, or psychosomatic hospital units; 80 participants per setting) and investigated. In all treatment settings, patients with considerable severity of illness and chronicity were treated. Female gender, higher education, and higher income predicted referral to psychosomatic units; male gender, transfer from another hospital or emergency hospitalization, co-morbidity with a personality disorder, higher general psychiatric co-morbidity, and danger to self at admission predicted referral to psychiatric unit. Patients in psychosomatic units had neither more psychosomatic disorders nor more somatic problems. There is considerable overlap between the clientele of psychiatric and psychosomatic units. Referral and allocation appears to be determined by aspects of severity and social status.
Nov 11, 2005 ... Predominantly risperidone and haloperidol in combination with valproate were used in treatment and at relatively high dosages. Conclusion: Amongst HIV positive service users acute psychiatric symptoms almost exclusively consisted of associated psychosis or manic symptoms rather than depression.
Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2012; changes in size and square footage of inpatient rehabilitation units and inpatient psychiatric units. Final rule.
This final rule will implement section 3004 of the Affordable Care Act, which establishes a new quality reporting program that provides for a 2 percent reduction in the annual increase factor beginning in 2014 for failure to report quality data to the Secretary of Health and Human Services. This final rule will also update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2012 (for discharges occurring on or after October 1, 2011 and on or before September 30, 2012) as required under section 1886(j)(3)(C) of the Social Security Act (the Act). Section 1886(j)(5) of the Act requires the Secretary to publish in the Federal Register on or before the August 1 that precedes the start of each FY the classification and weighting factors for the IRF prospective payment system (PPS) case-mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year. We are also consolidating, clarifying, and revising existing policies regarding IRF hospitals and IRF units of hospitals to eliminate unnecessary confusion and enhance consistency. Furthermore, in accordance with the general principles of the President's January 18, 2011 Executive Order entitled "Improving Regulation and Regulatory Review," we are amending existing regulatory provisions regarding ''new'' facilities and changes in the bed size and square footage of IRFs and inpatient psychiatric facilities (IPFs) to improve clarity and remove obsolete material.
Idenfors, Hans; Strömsten, Lotta M J; Renberg, Ellinor Salander
Many young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm. From a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for having been admitted with different diagnoses during the year preceding the self-harm admission. The study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma. Symptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated. Copyright © 2016 Elsevier Inc. All rights reserved.
Buus, Niels; Angel, Sanne; Traynor, Michael
This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision...... they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very...
Low, Tchern Kuang Lambert; Tay, Kai Hong; Fang, Tina; Fung, Daniel Shuen Sheng
Patients admitted to a psychiatric hospital commonly suffer from comorbid medical problems which sometimes require urgent medical attention. Twenty-two percent of emergency medical transfers from the Institute of Mental Health (IMH) to the emergency rooms of general hospitals were preventable and could be managed at IMH itself. We undertook a quality improvement project to understand the reasons behind such preventable referrals and implemented changes to address this. Using the model for improvement, we deconstructed our processes and analysed root causes for such preventable referrals. Thereafter changes were implemented with Plan-Do-Study-Act (PDSA) cycles to analyse their outcomes. During the 6-month study period, we achieved a 100% reduction in preventable referrals through strategies aimed at reducing pressure on our on-call physicians in the making of medical decisions, maximising usage of our medical resources, constant education and raising awareness of this issue. Reducing preventable transfer of inpatients from a psychiatric hospital to the emergency departments of general hospitals is a worthwhile endeavour. Such initiatives optimise use of healthcare resources, improve patient care and increase satisfaction.
Buus, Niels; Angel, Sanne; Traynor, Michael
Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in groupbased supervision and identifying psychosocial...... reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...... of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses....
Takahashi, H; Sassa, T; Shibuya, T; Kato, M; Koeda, M; Murai, T; Matsuura, M; Asai, K; Suhara, T; Okubo, Y
.... However, the neurobiological basis for this remains poorly understood. We aimed to examine the effect of sports participation on weight gain, psychiatric symptoms and brain activation during sports observation in schizophrenia patients...
Richter, J; Eisemann, M
With regard to information about parental rearing, retrospective data are exclusively available among adults. These data are vulnerable due to various biases. This study was performed in order to replicate the findings of overall stability of three perceived parental rearing factors of the EMBU (Swedish acronym for 'own memories of childhood upbringing') based on 14 rather detailed subscales. A consecutive sample of 220 depressive inpatients were investigated on admission and at discharge by means of the EMBU, the Beck Depression Inventory and the Dysfunctional Attitude Scale. Perceived parental rearing scores showed high stability despite clinically significant changes in the severity of depression, except for 'tolerance', 'guilt engendering', 'performance orientation' and 'shaming' parenting with probable gender-specific effects which were found to covary with dysfunctional attitudes. Recall of parenting should be taken as a subjective truth when it is assessed by standardised behaviour-oriented questionnaires like the EMBU. Copyright 2002 S. Karger AG, Basel
Full Text Available Paolo Stratta1, Ilaria Riccardi2, Annarita Tomassini2, Maria Marronaro2, Roberta Pacifico2, Alessandro Rossi2,31Department of Mental Health, A.U.S.L. 4 L’Aquila, Italy; 2Department of Experimental Medicine, University of L’Aquila, Italy; 3Clinical Psychology Unit at Villa Serena, c/o ‘Casa di Cura Villa Serena’, Viale L. Petruzzi, 19, Città S.Angelo, Pescara, ItalyAbstract: The diagnostic specificity of poor premorbid intelligence is controversial. We explored premorbid intelligence level in psychiatric patients with personality disorders, depressive disorders, bipolar disorders and schizophrenic disorders. 273 consecutively admitted patients and 81 controls were included in the study and tested with the ‘Test di Intelligenza Breve’, an Italian adaptation of the National Adult Reading Test. Significant differences between the clinical samples and the control subjects were found but not among the 4 clinical groups. The observation of premorbid IQ deficits in subjects with diagnoses other than schizophrenia suggests a common vulnerability diathesis, which is most likely to have a neurodevelopmental basis.Keywords: premorbid intelligence, psychiatric disorders, specificity
Bowers, Len; Allan, Teresa; Simpson, Alan; Jones, Julia; Van Der Merwe, Marie; Jeffery, Debra
Aggressive behaviour is a critical issue for modern acute psychiatric services, not just because of the adverse impact it has on patients and staff, but also because it puts a financial strain on service providers. The aim of this study was to assess the relationship of patient violence to other variables: patient characteristics, features of the service and physical environment, patient routines, staff factors, the use of containment methods, and other patient behaviours. A multivariate cross sectional design was utilised. Data were collected for a six month period on 136 acute psychiatric wards in 26 NHS Trusts in England. Multilevel modelling was conducted to ascertain those factors most strongly associated with verbal aggression, aggression toward objects, and physical aggression against others. High levels of aggression were associated with a high proportion of patients formally detained under mental health legislation, high patient turnover, alcohol use by patients, ward doors being locked, and higher staffing numbers (especially qualified nurses). The findings suggest that the imposition of restrictions on patients exacerbates the problem of violence, and that alcohol management strategies may be a productive intervention. Insufficient evidence is available to draw conclusions about the nature of the link between staffing numbers and violence.
Guinchat, Vincent; Cravero, Cora; Diaz, Lautaro; Périsse, Didier; Xavier, Jean; Amiet, Claire; Gourfinkel-An, Isabelle; Bodeau, Nicolas; Wachtel, Lee; Cohen, David; Consoli, Angèle
During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. We aimed to assess risk factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated neurobehavioral unit. We included retrospectively in 2008 and 2009 29 adolescents and young adults with ASD hospitalized for severe challenging behaviors and proposed a guideline (Perisse et al., 2010) that we applied prospectively for 29 patients recruited for the same indications between 2010 and 2012. In total, 58 patients were admitted (n=70 hospitalizations, mean age=15.66 (±4.07) years, 76% male). We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), comorbid organic conditions, etiologic diagnosis of the episode, and treatments. We explored predictors of Global Assessment Functioning Scale (GAFS) score and duration of hospitalization at discharge. All but 2 patients exhibited severe autistic symptoms and intellectual disability (ID), and two-thirds had no functional verbal language. During the inpatient stay (mean=84.3 (±94.9) days), patients doubled on average their GAFS scores (mean=17.66 (±9.05) at admission vs. mean=31.4 (±9.48) at discharge). Most common etiologies for acute behavioral crises were organic causes [n=20 (28%), including epilepsy: n=10 (14%) and painful medical conditions: n=10 (14%)], environmental causes [n=17 (25%) including lack of treatment: n=11 (16%) and adjustment disorder: n=6 (9%)], and non-ASD psychiatric condition [n=33 (48%) including catatonia: n=5 (7%), major depressive episode: n=6 (9%), bipolar disorder: n=4 (6%), schizophrenia: n=6 (9%), other/unknown diagnosis: n=12 (17%)]. We found no influence of age, gender, socio-economic status, migration, level of ID, or history of seizure on improvement of GAFS score at discharge
Burra, Tara A.; Hwang, Stephen W.; Rourke, Sean B.; Stergiopoulos, Vicky
This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender,…
Cheetham, John; Holttum, Sue; Springham, Neil; Butt, Kate
Research has shown interpersonal relationships influence experiences of inpatient psychiatric services. This study explored inpatient staff and service users' talk about relating, and consequences on available/limited social actions. A Foucauldian discourse analysis was used to analyse transcribed semi-structured interviews and focus groups with current inpatient staff members and members of a service-user involvement group. Two focus groups (service users n = 10; staff n = 6) and five interviews (service users n = 2; staff n = 3) were held, with participants responding to questions regarding the discursive object of 'experiences of relating on inpatient wards'. A dominant 'medical-technical-legal' discourse was seen, alongside a counter discourse of 'ordinary humane relating'. Through the tensions between these discourses emerged a discourse of 'collaborative exploration'. The medical-technical-legal discourse perpetuates notions of mental illness as impenetrable to relating. Staff fear of causing harm and positions of legal accountability generate mistrust which obstructs relating, whilst patients expect to be asked their opinions on their experiences and to be involved in deciding what treatment to accept, and experience frustration and alienation when this is not forthcoming. Ordinary humane relating was described as vital for service users in regaining a sense of self, although not considered enough in itself to promote recovery/wellness. 'Treatment for my problems' was constructed by service users as emerging through the collaborative exploration discourse, where therapeutic relationships can develop, enabling change and a return to safety. Discourse analysis of how we talk can help us understand the complexities of being, working, and relating on psychiatric inpatient units. Relating as constructed through the medical-technical-legal discourse is seen as the most legitimized but least fulfilling for staff and service users alike. Both staff and
Palic, Sabina; Kappel, Michelle; Nielsen, Monica
BACKGROUND: Currently, the mental health issues of traumatized refugees are mainly documented in terms of posttraumatic stress disorder, depression, and anxiety. Importantly, there are no reports of the level of psychiatric disability in treatment seeking traumatized refugees resettled in the West...... and social domains. The rate of pre- to post-treatment improvement on the HoNOS was smaller for the traumatized refugees than it was for the psychiatric inpatients. CONCLUSIONS: The level, and the versatile profile, of psychiatric disability on the HoNOS point to complex bio-psycho-social problems...... in resettled treatment seeking traumatized refugees. Thus, a broader assessment of symptoms and better cooperation between psychiatric, health care, and social systems is necessary in order to meet the treatment needs of this group....
Sendula-Jengić, Vesna; Bosković, Gordan; Dodig, Goran; Weiner-Crnja, Milica
In this study authors have analysed a group of patients (N=65) that were treated at the Department of Forensic Psychiatry, Psychiatric Hospital Rab, during the period of 1998-2000. Detailed analysis of all anamnestic and hetero-anamnestic data as well as the observations during the treatment separated few significant patterns of self-destructive behaviour of various intensity and different possible consequences. The results showed out that within the first group of patients with self-destructive behaviour was noticed a significant increased number of younger age patients who were diagnosed with personality disorder especially borderline and antisocial type. Additionally facing difficulties with alcohol abuse and drug addiction. In a second group there were older patients with serious attempt of suicide dominantly diagnosed with endogenous psychosis, especially schizophrenia.
Kristiansen, S. T.; Videbech, P.; Kragh, M.
Objective: To synthesize the evidence on how patients with serious mental disorders perceived patient education on psychiatric wards and to learn more about the patient perceived benefits and limitations related to patient education and how well patient education meets the perceived needs....... The results concerned the specific population with bipolar disorder or schizophrenia. Two explanatory syntheses were aggregated: (I) Benefits and perceived barriers to receiving education and (II) Educational needs of mental health patients. Patients reported mechanical information dissemination and lack...... of individual and corporative discussions. Patients preferred patient education from different educational sources with respect to individual needs. Conclusion: Patient education were most useful when it could be tailored to an individuaĺs specific needs and match patient preference for how to receive it...
Nathan, R J; Slovak, J P
Suicide, aggressive acting out, and increased numbers of AWOL patients are distinct possibilities if internal structures of psychiatric impatient units are altered-especially in units that offer intensive therapeutic experience on a short term basis to severely ill patients. One such time is when the directorship changes in this kind of unit. A sucessful unit is frequently thought to be the result of the charismatic leadership of its chief. With his departure, the unit loses its elan and becomes an uninspired pedestrian operation. Hence, such a unit loses personnel and even its program when the chief changes. In this paper, the authors give data to support the hypothesis that a unit with a specific philosophical treatment orientation will continue to function at a relatively high level of effectiveness and efficiency regardless of the difference between chiefs.
Brown, L K; Kessel, S M; Lourie, K J; Ford, H H; Lipsitt, L P
To investigate the associations between sexual abuse and human immunodeficiency virus (HIV)-related attitudes and behaviors of adolescents with a psychiatric disorder. HIV-related knowledge, attitudes, and behaviors were examined by self-report assessment of adolescents admitted to a psychiatric hospital (N = 100). A subsample (n = 30) completed a role-playing exercise regarding HIV-preventive behavior that was scored for the degree of effective communication by raters blind to the subjects' abuse history. HIV-related risk behaviors were prevalent, including unprotected sexual intercourse (67%) and multiple partners (27%) among the sexually active (71% of the total). Also frequent were alcohol and drug use (25%) and sharing cutting instruments (22%) among those engaged in self-cutting behavior (62%). The 38% of the sample identified as having a history of sexual abuse indicated significantly poorer self-efficacy concerning condom use than their peers. Abused females scored significantly lower on the self-efficacy of condom use scale and reported significantly more frequent alcohol use than nonabused females (p = .003). A hierarchical multiple regression that controlled for consistency of condom use and tolerance of people with acquired immunodeficiency syndrome found that abuse history uniquely accounted for 16% of the variance in condom use self-efficacy. Analysis of the videotaped role-play found that abused adolescents were significantly less competent and had more difficulty in effective communication than their peers (p = .003). A history of sexual abuse is associated with impaired safe sexual decision-making and HIV-preventive communication skills, even in this already at-risk group. This study also underscores the importance of actively addressing these issues in the context of clinical care.
Strous, Rael D; Ofir, Dana; Brodsky, Ori; Yakirevitch, Janna; Drannikov, Angela; Navo, Nadav; Kotler, Moshe
In the months before the Second Gulf War, the threat of biological and chemical warfare led many Israelis to experience significant stress and mood changes. In this study, we investigated whether this threat affected the subjective mood and behavior of inpatients with schizophrenia and compared the results with effects noted in their clinical staff. Subjects were evaluated at two points in time-2 months before the war and on day 1 of the war-with a specially designed questionnaire and with the Spielberger Scale for Trait Anxiety. Although the responses of the two groups did not differ radically before the war, on the first day of war, significant differences were noted, with patients demonstrating increases in anxiety and level of concern. Both groups reported similar effects on their mood. Patients were more concerned about the potential for the outbreak of World War III, whereas staff were more concerned about economic effects. Female subjects in both groups demonstrated greater anxiety and mood changes after the outbreak of war compared with before the war. Effects observed on the patients may be related to the decreased coping threshold resulting from their illness, which renders psychotic patients more vulnerable to any acute stressor; however, effects on the staff members should not be ignored.
Czyz, Ewa K; Berona, Johnny; King, Cheryl A
The challenge of identifying suicide risk in adolescents, and particularly among high-risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS)--with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self-injury--predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three-way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2-way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12-month attempts. Results suggest gender-specific associations between theory components and attempts. The time-limited effects of these associations point to TB and PB being dynamic and modifiable in high-risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively. © 2014 The American Association of Suicidology.
Huckshorn, Kevin Ann
The current study explored and described the experiences of individuals who either directed or participated in successfully reducing the use of restraint and seclusion (R/S) in two inpatient public mental health hospitals. A phenomenological methodology was used to capture the lived experiences of 21 study participants, including senior leaders, middle managers, and direct care staff, who were interviewed as key informants. Thirty-two themes were extracted and subsequently synthesized into five "meaning themes." The five meaning themes yielded six significant findings: (a) critical roles of leadership and staff in successful R/S reduction projects; (b) ability of leaders and staff to change their beliefs and behaviors; (c) ability of leaders and staff to build a shared vision that was critical to the reduction of R/S use in in-patient settings; (d) identification and resolution of key challenges staff and leaders experienced in reduction efforts; (e) use of a solid performance improvement lens to direct changes in practices; and (f) important lessons learned. Copyright 2014, SLACK Incorporated.
Selvin, Mikael; Almqvist, Kjerstin; Kjellin, Lars; Schröder, Agneta
The importance of patient participation is advocated in medical treatment and nursing care and has been linked to increased quality of care, increased patient satisfaction, and treatment adherence. Still, patients in forensic psychiatric care often report being unhappy with their experienced level of participation. The concept of patient participation is complex and has several definitions, thus it is important to investigate it from different perspectives in different contexts. The aim of this study was to describe patients' perceptions of the concept of patient participation in forensic psychiatric care. A qualitative design with a phenomenographic approach was used, and interviews with 19 participants in a Swedish setting were completed. The participants described the concept of patient participation in forensic psychiatric care as follows: influence, to have good communication and to be involved; confidence, to have mutual trust and to trust the care; and own responsibility, to participate in activities and to take the initiative. On the basis of the results of this study, improved patient participation in forensic psychiatric care may be achieved with active communication, by building up and maintaining trust for professional competence and by encouraging patients' own responsibility. It is important that knowledge about patients' views of the concept of patient participation is included in the planning and improvement of forensic care.
McCarthy, James B; Weiss, Shira R; Segovich, Kristin T; Barbot, Baptiste
Despite established differences in cognitive functioning of adults with mood disorder-related psychosis and those with non-affective psychotic disorders, there is limited evidence of the impact of psychotic symptoms on the cognitive functioning of children and adolescents with mood disorders. This study investigates IQ, working memory, and processing speed scores in 80 child and adolescent inpatients discharged from an intermediate care state psychiatric hospital, using a retrospective chart review. Associations between diagnosis based on DSM-IV criteria (7 with Major Depression- MDD; 43 with Bipolar Disorders-BD, and 30 with Mood Disorders Not Otherwise Specified-NOS), presence of current psychotic features, and cognitive functioning (WISC-IV IQ, Coding, Symbol Search, and Digit Span) were investigated using Multivariate Analyses of Variance. No differences were found in cognitive functioning between patients with MDD and BD, or between those with severe Mood Disorders (MDD or BD) and those with NOS, when controlling for age, gender, and presence of psychotic features. However, patients with severe mood disorders and psychotic features showed lower IQs and greater working memory deficits than those without psychotic features or NOS. Results are discussed in terms of treatment planning for children and adolescents at risk for developing psychotic symptoms and severe mood disorders. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Eren, Gökhan; Hiss, Barbara; Maeck, Lienhard; Stoppe, Gabriela
10-year follow-up of the psychogeriatric inpatient care at the University Psychiatric Hospitals Basel following the establishment of an outpatient care service for the elderly (ADA). Standardized chart review of a random sample of psychogeriatric cases (≥ 65 y) of the years 1997 and 2007 (n = 100 each) in terms of socio-demographic, diagnostic, therapeutic und administrative data. The number of patients with contact to both inpatient and outpatient services prior to admission increased. There was no change regarding the amount of unvoluntary admissions. As expected more complex cases were treated. The case management showed changes towards greater guideline conformity. The 10-year follow-up shows a better outpatient treatment and the provision of inpatient facilities for complex multimorbid and emergency patients. © Georg Thieme Verlag KG Stuttgart · New York.
Tuvesson, Hanna; Eklund, Mona; Wann-Hansson, Christine
The aims of this study were to investigate (1) perceived stress as felt by the nursing staff working in psychiatric inpatient care, (2) possible differences between nurses and nurse assistants, and (3) associations among individual characteristics, the ward atmosphere, the psychosocial work environment, and perceived stress. Ninety-three members of the nursing staff completed three instruments-one each measuring perceived stress, the ward atmosphere, and the psychosocial work environment. The...
The aim of this study was to investigate the association of compulsory measures (CM) with pathological Creatine Kinase (CK) levels in 317 patients admitted to a secure psychiatric ward. The assumptions is that CK-activity is increased prior to administration of CM because increases in CK-levels may represent aggressive behaviour as precursors of a higher chance of administrating CM. The CK-levels were assessed immediately following admission. During the course of the patients' stay the frequency of different CM was assessed by the use of the Staff Observation Aggression Scale. In a CHAID analysis pathological CK-levels were associated with subsequent administration of CM. Lifetime aggression and main diagnosis were associated with administration of CM as well. In a ROC analysis concerning pathological CK-activity the AUC for subsequent administration of CM was 70.5 % with a sensitivity of 73.5 % and a specifity of 67.5 %. Despite some methodological shortcomings the study indicates that it could be useful to measure CK-activity at the time of admission because pathological levels may indicate an increased probability of administration of CM subsequent to aggressive behaviour. © Georg Thieme Verlag KG Stuttgart · New York.
Blair, Ellen W; Woolley, Stephen; Szarek, Bonnie L; Mucha, Theodore F; Dutka, Olga; Schwartz, Harold I; Wisniowski, Jeff; Goethe, John W
The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010-September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008-September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.
Hasson-Ohayon, I; Pijnenborg, G H M; Ben-Pazi, A; Taitel, S; Goldzweig, G
Parents of children who are hospitalized in inpatient psychiatric units must cope with significant challenges. One of these challenges relates to the way in which they cope with illness-related information. The current study examined the relationship between two such coping styles - monitoring and blunting - and family burden among parents of children in a psychiatric inpatient unit. Moreover, the possible moderating roles played by hope and self-stigma in these associations were also examined. Questionnaires regarding coping with information style, self-stigma, hope and family burden were administered to 70 parents. A main positive effect of hope and a main negative effect of self-stigma were uncovered. An interaction between self-stigma and monitoring was also revealed, suggesting that for parents with high self-stigma, compared to those with low self-stigma, more monitoring was related to more burden. Tailoring family interventions according to coping style and self-stigma is highly recommended as a mean to reduce the family burden of parents whose child is hospitalized in a psychiatric inpatient unit. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Shinozaki, Gen; Romanowicz, Magdalena; Passov, Victoria; Rundell, James; Mrazek, David; Kung, Simon
The serotonin transporter gene polymorphism (5HTTLPR) and child abuse history have been associated with an increased suicide risk for general population, but such association is not clear among psychiatric depressed inpatients. A chart review identified 422 depressed inpatients genotyped for 5HTTLPR. Child abuse and suicide attempt history were recorded. The relationship between 5HTTLPR, child abuse, and suicide attempts were analyzed. There was a significant relationship between 5HTTLPR and history of suicide attempt (the long/long versus the short carriers, 47.9% versus 31.8%, p=0.0015). There was also a significant main effect from child abuse history (abused versus not abused, 45.1% versus 28.6%, p=0.0001). The likelihood ratio test showed a significant result for the l/l genotype group with child abuse history (odds ratio 4.11, χ2 = 23.5, pchild abuse history and suicide attempt history is needed. The rs25531 variant among a long allele (long-A and long-G) of 5HTTLPR was not genotyped. In addition to the direct effect from 5HTTLPR and child abuse history, an interaction between the 5HTTLPR gene and child abuse history influenced psychiatric profiles of depressed inpatients. Contrary to the widely recognized "reactivity" associated with the short allele, our patients with the l/l genotype and child abuse history showed significantly severer psychiatric pathology than short carriers with child abuse history. Published by Elsevier B.V.
Conradie, Maria; Erwee, Danelle; Serfontein, Isabel; Visser, Maré; Calitz, Frikkie J W; Joubert, Gina
Nursing staff working with intellectually disabled in-patients experience unique stress factors that can influence their personal well-being and work performance. To compile a profile of stress factors experienced by nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex (FSPC). This descriptive study included 89 nursing staff members from this environment. A questionnaire was used to collect socio-demographic information and determine personal and occupational stressors. The data were summarised by frequencies and percentages (categorical variables) and means or percentiles (numerical variables). Most participants were aged between 46 and 55 (41.2%), female (93.2%) and black (93.2%), and 76.7% had children or dependant minors. The main stressors among participants were pressure providing financially for their children and dependant minors (71.2%), caring for them (39.4%) and fearing them moving away (25.8%). Occupational stressors included high workload (66.3%), lack of decision-making by superiors (58.1%), underpayment (53.5%), endangerment of physical health (52.3%) and safety (50.0%), working hours (51.2%), pressure of expectations from superiors (48.8%), uncertainty of employment (48.8%), work responsibilities (47.7%) and perceiving that skills and training were not appreciated. They experienced stress regarding health issues such as hyper- and hypotension (35.3%). Because of stress 34.5% of participants took leave, 34.5% developed depression and 14.3% had panic attacks. Most of the respondents experienced personal and occupational stress that influenced their health, which poses serious challenges for the management of the FSPC. Security should be upgraded, medical and psychological support for the staff and care facilities for their dependants should be provided, and financial problems experienced by these staff members should be addressed. The workload of the nursing staff at FSPC needs urgent attention. This
Full Text Available Introduction: Nursing staff working with intellectually disabled in-patients experience unique stress factors that can influence their personal well-being and work performance. Objectives: To compile a profile of stress factors experienced by nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex (FSPC. Methods: This descriptive study included 89 nursing staff members from this environment. A questionnaire was used to collect socio-demographic information and determine personal and occupational stressors. The data were summarised by frequencies and percentages (categorical variables and means or percentiles (numerical variables. Results: Most participants were aged between 46 and 55 (41.2%, female (93.2% and black (93.2%, and 76.7% had children or dependant minors. The main stressors among participants were pressure providing financially for their children and dependant minors (71.2%, caring for them (39.4% and fearing them moving away (25.8%. Occupational stressors included high workload (66.3%, lack of decision-making by superiors (58.1%, underpayment (53.5%, endangerment of physical health (52.3% and safety (50.0%, working hours (51.2%, pressure of expectations from superiors (48.8%, uncertainty of employment (48.8%, work responsibilities (47.7% and perceiving that skills and training were not appreciated. They experienced stress regarding health issues such as hyper- and hypotension (35.3%. Because of stress 34.5% of participants took leave, 34.5% developed depression and 14.3% had panic attacks. Conclusion: Most of the respondents experienced personal and occupational stress that influenced their health, which poses serious challenges for the management of the FSPC. Security should be upgraded, medical and psychological support for the staff and care facilities for their dependants should be provided, and financial problems experienced by these staff members should be addressed. The workload of
Subica, Andrew M; Allen, Jon G; Frueh, B Christopher; Elhai, Jon D; Fowler, J Christopher
Little is known about depression-anxiety comorbidity and its association with personality traits and suicide/self-harm in adult psychiatric inpatients with serious mental illness (SMI), impacting clinical assessment and treatment. This study sought to determine the symptom structure of depression-anxiety comorbidity and its relation to neuroticism, extraversion, and suicide/self-harm behaviour in this high-risk population. Nine hundred and sixty-two adults receiving inpatient care at a private psychiatric hospital completed questionnaires at admission. Confirmatory factor analyses compared a bifactor solution specifying a general distress factor and two specific depression and anxiety factors against unidimensional and correlated factors solutions. The bifactor solutions' factors were subsequently correlated with neuroticism and extraversion subscales and pre-hospitalization suicide/self-harm behaviours. The bifactor model rendered superior fit to sample data and a robust general factor - accounting for 77.61% of common item variance - providing the first evidence for a tripartite structure of depression and anxiety among adult inpatients. The bifactor solution-outputted independent general distress, depression, and anxiety factors positively correlated with neuroticism, the personality dimension corresponding to trait negative affectivity. The general distress and depression factors associated with recent self-harm, but factors showed no associations with prior suicidal behaviour. In adult psychiatric inpatients, general distress substantially underlies comorbid depression and anxiety symptom variation and may contribute to recent incidence of self-harm. Transdiagnostic assessments and interventions targeting general distress may temper depression, anxiety, and self-harm in adult inpatients. Clinical implications Depression-anxiety comorbidity symptomology in adult psychiatric inpatients is primarily composed of general distress. General distress and specific
De Lange, G.; Rademaker, M.; Boks, Marco P M; Palmen, Saskia J M C
BACKGROUND: Human brain tissue is crucial to study the molecular and cellular basis of psychiatric disorders. However, the current availability of human brain tissue is inadequate. Therefore, the Netherlands Brain Bank initiated a program in which almost 4.000 participants of 15 large Dutch
de Lange, Geertje M.; Rademaker, Marleen; Boks, Marco P.; Palmen, Saskia J.M.C.
Background: Human brain tissue is crucial to study the molecular and cellular basis of psychiatric disorders. However, the current availability of human brain tissue is inadequate. Therefore, the Netherlands Brain Bank initiated a program in which almost 4.000 participants of 15 large Dutch
Schroeder, Katrin; Schätzle, Anja; Kowohl, Pauline; Leske, Lisa; Huber, Christian G; Schäfer, Ingo
Psychotic-like symptoms are found in a subgroup of borderline patients (BPD). Reported prevalence is heterogeneous (up to 50% affected). Investigations in Germany have not been conducted so far. Furthermore, the precise phenomenology of the psychotic symptoms and the effects on suicidal behavior and the use of inpatient psychiatric treatment are unclear. The aim of the study was to investigate prevalence rates and phenomenology of psychotic-like symptoms. Associations between the latter and suicidality as well as the use of inpatient psychiatric treatment were examined. Further influencing factors were taking into account. Psychotic-like symptoms were assessed with the Structured Clinical Interview-I in 95 BPD patients. To investigate the associations between psychotic-like symptoms and suicidality as well as the use of inpatient psychiatric treatment, correlation and regression analyzes were calculated, considering severity of PTSD, BPD and depression. 36% of the patients reported alterations of perception and 21% delusions, both multiform and long lasting. The number of suicide attempts was associated with delusions, alterations of perception and severity of PTSD, BPS, and depression. Only delusions and severity of PTSD explained together 25.8% of the variance for the prediction of the number of suicide attempts. Age of initial hospitalization showed fewer and number of hospitalizations no associations at all. Psychotic-like symptoms should not be trivialized, which may happen by using terms such as pseudo-hallucinations or transient paranoid ideas, and may be particularly associated with suicidal tendencies complicating the clinical course. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Abstract Background In the development of borderline personality disorder (BPD both genetic and environmental factors have important roles. The characteristic affective disturbance and impulsive aggression are linked to imbalances in the central serotonin system, and most of the genetic association studies focused on serotonergic candidate genes. However, the efficacy of dopamine D2 receptor (DRD2 blocking antipsychotic drugs in BPD treatment also suggests involvement of the dopamine system in the neurobiology of BPD. Methods In the present study we tested the dopamine dysfunction hypothesis of impulsive self- and other-damaging behaviors: borderline and antisocial traits were assessed by Structured Clinical Interview for Diagnosis (SCID for DSM-IV in a community-based US sample of 99 young adults from low-to-moderate income families. For the BPD trait analyses a second, independent group was used consisting of 136 Hungarian patients with bipolar or major depressive disorder filling out self-report SCID-II Screen questionnaire. In the genetic association analyses the previously indicated polymorphisms of the catechol-O-methyl-transferase (COMT Val158Met and dopamine transporter (DAT1 40 bp VNTR were studied. In addition, candidate polymorphisms of the DRD2 and DRD4 dopamine receptor genes were selected from the impulsive behavior literature. Results The DRD2 TaqI B1-allele and A1-allele were associated with borderline traits in the young adult sample (p = 0.001, and p = 0.005, respectively. Also, the DRD4 -616 CC genotype appeared as a risk factor (p = 0.02. With severity of abuse accounted for in the model, genetic effects of the DRD2 and DRD4 polymorphisms were still significant (DRD2 TaqIB: p = 0.001, DRD2 TaqIA: p = 0.008, DRD4 -616 C/G: p = 0.002. Only the DRD4 promoter finding was replicated in the independent sample of psychiatric inpatients (p = 0.007. No association was found with the COMT and DAT1 polymorphisms. Conclusions Our results
Latvala, E; Vuokila-Oikkonen, P; Janhonen, S
This paper describes videotaped recording as a data collection method when conducting participant observation in a psychiatric nursing study. The videotaped episodes were part of the daily life of psychiatric nursing in a hospital environment. The advantages and limitations of using videotaped recording in nursing research will be discussed. This paper is based on two studies. The data consisted of 21 videotaped episodes of nursing report sessions or interdisciplinary team meetings in the psychiatric clinic of a university hospital. The participants consisted of patients, their significant others, nurses, doctors, social workers and physiotherapists. All videotaped material was transcribed verbatim. An essential advantage of videotaping is that most potentially useful interaction and behaviour can be captured. The advantage in terms of the credibility of videotaping was that the investigator was able to review the same videotaped situations again and again. Videotaped material is rich and provides several possibilities for analysing the data. In these studies data and source triangulation enabled the researchers to reduce personal influence on the results. The investigator must also be aware of the limitations concerning this method. The most essential limitations are mechanical problems and the influence of videotaping on behaviour. Careful ethical considerations are important concerning personal privacy, informed consent and respect for the self-determination of psychiatric patients.
Aziz, Victor M; Hill, Natalie; Kumar, Sugandha
Aims and method To explore the use of the STOPP/START toolkit in older psychiatric in-patients with dementia. Clinical records and current drug charts were reviewed against STOPP/START criteria for all in-patients (n = 86) on six specialist dementia wards. Benzodiazepines, antipsychotics and opiates were most commonly prescribed inappropriately. The most common unprescribed medication groups were statins, calcium supplements and vitamin D supplements. There was an overall reduction of 7% in comorbidities and 8% in the number of prescriptions. t-test showed a significant drop in average comorbidities between both audits, t(1) = 23.920, P = 0.027, and in average prescriptions per patient, t(1) = 28.808, P = 0.022. There was no difference in the number of patients receiving polypharmacy, t(1) = 7.500, P = 0.084, or receiving medication with a high risk of adverse drug reactions, t(1) = 6.857, P = 0.092. Clinical implications The STOPP/START toolkit highlighted the importance of collaborative working between doctors, clinical pharmacists and nursing staff, and could provide old age psychiatrists with a structured tool to identify inappropriate prescribing of non-psychiatric medications. Declaration of interests None.
Patterson, Sue; Duhig, Michael; Darbyshire, Chris; Counsel, Robin; Higgins, Niall; Williams, Ian
We aimed to assess the feasibility of delivering a music therapy program on adolescent psychiatric wards. We undertook a mixed-methods evaluation of a pilot program. Various active and receptive techniques were employed in group music therapy sessions delivered as part of a structured clinical program. Data collected in interviews with participants and staff and feedback questionnaires were thematically and descriptively analysed and triangulated. Data from 62 questionnaires returned by 43 patients who took part in 16 music therapy sessions, and seven staff, evidenced strong support for music therapy. Patients typically reported experiencing sessions as relaxing, comforting, uplifting, and empowering; >90% would participate by choice and use music therapeutically in the future. Staff endorsed music therapy as valuable therapeutically, reporting that patients engaged enthusiastically and identified sessions as improving their own moods and ward milieu. Integration of music therapy in inpatient treatment of adolescents is feasible and acceptable, and is valued by staff and patients as a complement to 'talking therapies'. Participation is enjoyed and associated with outcomes including improvement in mood, expression of feelings and social engagement consistent with recovery. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Polcin, Douglas L; Zemore, Sarah
Although helping others is a critical part of Alcoholics Anonymous (AA) and many treatment programs, measures for assessing helping and describing its relationship with sobriety are lacking. A sample of 200 subjects completed a Helper Therapy Scale including three subscales: Recovery Helping (alpha = 0.78), Life Helping (alpha = 0.62), and Community Helping (alpha = 0.60). A previous analysis using structural equation modeling found that length of sobriety predicted measures of spirituality, helping, and AA participation. The analysis reported here examined whether psychiatric severity was associated with these variables. Results indicated significant relationships between psychiatric severity and measures of spirituality (Self Transcendence, Forgiveness, Positive Coping, and Negative Coping) and AA Achievement (defined as completing the 12 steps and serving as a sponsor). However, no relationships were found between psychiatric severity and length of sobriety, the three Helper Therapy subscales, or AA involvement. The findings suggest that individuals with higher psychiatric severity may need assistance from their peers or professional service providers to develop a spiritual life, serve as a sponsor for others, or complete the steps of AA.
Bryson, Stephanie A; Gauvin, Emma; Jamieson, Ally; Rathgeber, Melanie; Faulkner-Gibson, Lorelei; Bell, Sarah; Davidson, Jana; Russel, Jennifer; Burke, Sharlynne
Many young people who receive psychiatric care in inpatient or residential settings in North America have experienced various forms of emotional trauma. Moreover, these settings can exacerbate trauma sequelae. Common practices, such as seclusion and restraint, put young people at risk of retraumatization, development of comorbid psychopathology, injury, and even death. In response, psychiatric and residential facilities have embraced trauma-informed care (TIC), an organizational change strategy which aligns service delivery with treatment principles and discrete interventions designed to reduce rates of retraumatization through responsive and non-coercive staff-client interactions. After more than two decades, a number of TIC frameworks and approaches have shown favorable results. Largely unexamined, however, are the features that lead to successful implementation of TIC, especially in child and adolescent inpatient psychiatric and residential settings. Using methods proposed by Pawson et al. (J Health Serv Res Policy 10:21-34, 2005), we conducted a modified five-stage realist systematic review of peer-reviewed TIC literature. We rigorously searched ten electronic databases for peer reviewed publications appearing between 2000 and 2015 linking terms "trauma-informed" and "child*" or "youth," plus "inpatient" or "residential" plus "psych*" or "mental." After screening 693 unique abstracts, we selected 13 articles which described TIC interventions in youth psychiatric or residential settings. We designed a theoretically-based evaluative framework using the active implementation cycles of the National Implementation Research Network (NIRN) to discern which foci were associated with effective TIC implementation. Excluded were statewide mental health initiatives and TIC implementations in outpatient mental health, child welfare, and education settings. Interventions examined included: Attachment, Self-Regulation, and Competency Framework; Six Core Strategies
...; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the inpatient clinical record is available to the hospice at the time of discharge; (4) That... care directly as specified in § 418.110. (2) A Medicare-certified hospital or a skilled nursing...
Schwarz, Karoline; Fuchs, Martin; Veraar, Maria; Menz, Wolfgang; Kemmler, Georg; Simma, Burkhard
Clinical experience has repeatedly shown evidence for continuity between mental disorders in children and adolescents and mental disorders in adulthood. Up to now, Austria has had no epidemiologic data on psychiatric diseases in children and adolescents and their development into adulthood. How often do children and adolescents with psychiatric diseases have psychiatric diseases in adulthood? Is there any association between psychiatric diagnoses in childhood/adolescence and adulthood? Electronic medical records provided us with data on 2210 children and adolescents who were admitted to any hospital in the State of Vorarlberg, Austria, between 1997 and 2012 because of psychiatric diseases. In this cross-sectional study, diagnoses were coded according to ICD-10 and ICD-9 criteria. The three main reasons for admission of children and adolescents were substance abuse, emotional disorders and conduct disorders. Of the admitted children and adolescents, 9.8 % were readmitted to a psychiatric institution in adulthood. The main reason for readmission in adulthood appears to be disorders due to psychoactive substances (42.1 %). Of young patients with psychoactive substance use, 9.7 % were rehospitalized in adulthood, 70.8 % of them showed a diagnosis in the same category (F1) on admission. Children and adolescents admitted for schizophrenia, schizotypal, and delusional disorders (F2) were significantly more likely to be readmitted in adulthood (40.9 %) compared to any other child psychiatric diagnosis. This study once again shows the continuity of psychiatric disorders from childhood and adolescence to adulthood. It also gives further information about the transmission of diagnoses when patients reached the age of 18 years and their outcome. Until now, there is hardly any information about the outcome of children and adolescents with psychiatric diagnoses in Austria. We want to bring up more knowledge on that issue. Research findings may improve prevention and clinical
Yu, Junhan; Ross, Colin A.; Keyes, Benjamin B.; Li, Ying; Dai, Yunfei; Zhang, TianHong; Wang, Lanlan; Fan, Qing; Xiao, Zeping
The purpose of the study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study consisted of 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria for Mental Disorders, Version 3 (CCMD-3). All participants completed a self-report measure of dissociation, the Dissociative Experiences...
Hamilton, Bridget; Manias, Elizabeth
Remarks such as 'she's manipulative' and 'he's right off' are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the diverse discourses implicated in nurses' writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses' oral and written language. A prominent debate in the literature surrounds nurses' use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses' use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses' use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as diverse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses' everyday language and explore what it produces for nurses, patients and society.
Vries Robbé, M. de; Vogel, V. de; Douglas, K.S.; Nijman, H.L.I.
Empirical studies have rarely investigated the association between improvements on dynamic risk and protective factors for violence during forensic psychiatric treatment and reduced recidivism after discharge. The present study aimed to evaluate the effects of treatment progress in risk and
Jansen, GJ; Dassen, TWN; Burgerhof, JGM; Middel, B
Professional skills to adequately manage patient aggression are a prerequisite for nurses working in psychiatric hospitals. These 'technical' skills, however, are necessary but not sufficient for effective nurse intervention. 'The attitude of nurses' towards client aggression also contributes to
Kelly, EL; Fenwick, K; Brekke, JS; Novaco, RW
© 2015, Springer Science+Business Media New York. Psychiatric staff are faced with multiple forms of hostility, aggression, and assault at work, collectively referred to as workplace violence, which typically is activated by patients but can also come from coworkers and supervisors. Whether workplace violence adversely affects staff well-being may be related not only to its presence, but also to an individual’s stress reactivity. At a large public psychiatric hospital, an online survey was co...
Full Text Available OBJECTIVE: To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient and setting-specific rehabilitation outcomes. METHODS: The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years. Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%. The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale, pain intensity (numeric analog scale, health-related quality of life (Short Form 36 Health Survey, subjective prognosis of gainful employment (SPE-scale as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. RESULTS: The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%. Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%. Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56% compared to only one third of the inpatient rehabilitees (33% returned to work three months after disc surgery (p<.001. CONCLUSION: The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures
Dyl, Jennifer; Kittler, Jennifer; Phillips, Katharine A.; Hunt, Jeffrey I.
Background: This study assessed prevalence and clinical correlates of body dysmorphic disorder (BDD), eating disorders (ED), and other clinically significant body image concerns in 208 consecutively admitted adolescent inpatients. It was hypothesized that adolescents with BDD would have higher levels of depression, anxiety, and suicidality.…
Sato, Makiko; Noda, Toshie; Sugiyama, Naoya; Yoshihama, Fumihiro; Miyake, Michi; Ito, Hiroto
Aggressive behaviour by psychiatric patients is a serious issue in clinical practice, and adequate management of such behaviour is required, with careful evaluation of the factors causing the aggression. To examine the characteristics of aggressive incidents by ward type, a cross-sectional descriptive study was conducted for 6 months between April 2012 and June 2013 using the Staff Observation Aggression Scale - Revised, Japanese version (SOAS-R) in 30 wards across 20 Japanese psychiatric hospitals. Participating wards were categorized into three types based on the Japanese medical reimbursement system: emergency psychiatric, acute psychiatric, and standard wards (common in Japan, mostly treating non-acute patients). On analyzing the 443 incidents reported, results showed significant differences in SOAS-R responses by ward type. In acute and emergency psychiatric wards, staff members were the most common target of aggression. In acute psychiatric wards, staff requiring patients to take medication was the most common provocation, and verbal aggression was the most commonly used means. In emergency psychiatric wards, victims felt threatened. In contrast, in standard wards, both the target and provocation of aggression were most commonly other patients, hands were used, victims reported experiencing physical pain, and seclusion was applied to stop their behaviour. These findings suggest that ward environment was an important factor influencing aggressive behaviour. Ensuring the quality and safety of psychiatric care requires understanding the characteristics of incidents that staff are likely to encounter in each ward type, as well as implementing efforts to deal with the incidents adequately and improve the treatment environment. © 2016 Australian College of Mental Health Nurses Inc.
Zimri S Yaseen
Full Text Available BACKGROUND: The greatly increased risk of suicide after psychiatric hospitalization is a critical problem, yet we are unable to identify individuals who would attempt suicide upon discharge. The Suicide Trigger Scale v.3 (STS-3, was designed to measure the construct of an affective 'suicide trigger state' hypothesized to precede a suicide attempt (SA. This study aims to test the predictive validity of the STS-3 for post-discharge SA on a high-risk psychiatric-inpatient sample. METHODS: The STS-3, and a psychological test battery measuring suicidality, mood, impulsivity, trauma history, and attachment style were administered to 161 adult psychiatric patients hospitalized following suicidal ideation (SI or SA. Receiver Operator Characteristic and logistic regression analyses were used to assess prediction of SA in the 6-month period following discharge from hospitalization. RESULTS: STS-3 scores for the patients who made post-discharge SA followed a bimodal distribution skewed to high and low scores, thus a distance from median transform was applied to the scores. The transformed score was a significant predictor of post-discharge SA (AUC 0.731, and a subset of six STS-3 scale items was identified that produced improved prediction of post-discharge SA (AUC 0.814. Scores on C-SSRS and BSS were not predictive. Patients with ultra-high (90(th percentile STS-3 scores differed significantly from ultra-low (10(th percentile scorers on measures of affective intensity, depression, impulsiveness, abuse history, and attachment security. CONCLUSION: STS-3 transformed scores at admission to the psychiatric hospital predict suicide attempts following discharge among the high-risk group of suicidal inpatients. Patients with high transformed scores appear to comprise two clinically distinct groups; an impulsive, affectively intense, fearfully attached group with high raw STS-3 scores and a low-impulsivity, low affect and low trauma-reporting group with low raw
van Niekerk, Lana
In this article constructions of identity, occupation, and performance are explored with a particular focus on the interrelatedness of these concepts. Insights were derived from a study in which the influences that impact on the work-lives of people with a psychiatric disability were explored. An interpretive biography design was utilised. Data construction took the form of narrative interviews and a combination of paradigmatic narrative analysis and narrative analysis was used. Participants, selected by means of purposive maximum variation sampling, had been diagnosed with psychiatric impairment and lived in the Western Cape, South Africa. Identity construction processes were explored, with a particular focus on how these impacted on decisions regarding participation in work. Performance elements of identity, called forth by occupational demands, occurring within work environments were found to be shaped through, and expressed as, doing. The notion of Punctualized Identity was shown to provide a lens that is able to capture the dynamic interplay of identity constructs and provide a synthesised perspective on participation.
Moreno-Poyato, Antonio R; Montesó-Curto, Pilar; Delgado-Hito, Pilar; Suárez-Pérez, Raquel; Aceña-Domínguez, Rosa; Carreras-Salvador, Regina; Leyva-Moral, Juan M; Lluch-Canut, Teresa; Roldán-Merino, Juan F
To study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital. Narrative literature review. Content analysis. The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting. Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Barrigón, Maria Luisa; Brandt, Sara A; Nitzburg, George C; Ovejero, Santiago; Alvarez-Garcia, Raquel; Carballo, Juan; Walter, Michel; Billot, Romain; Lenca, Philippe; Delgado-Gomez, David; Ropars, Juliette; de la Calle Gonzalez, Ivan; Courtet, Philippe; Baca-García, Enrique
Background Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management. Objective The aim of our study was to develop a novel Web- and mobile phone–based application to provide a dynamic CDSS by monitoring and analyzing practitioners’ antipsychotic prescription habits and simultaneously linking these data to inpatients’ symptom changes. Methods We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio. Results MEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines. Conclusions MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use. PMID:28126703
Krüger, C; Rosema, D
The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence, and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April - September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables, using two-way tables and Chi-Square or Fisher's Exact Tests. The prevalence of violence among the long-term patients was 16%. Fighting among patients was the most common form of violence (58%). The most significant risk factors of violence among the long-term patients are: A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay >12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement. The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a isproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms, but more in their cognitive ability, coping skills and inappropriate admission circumstances. Efforts should be directed - at a provincial level - towards their community placement.
De Vries Robbé, Michiel; de Vogel, Vivienne; Douglas, Kevin S; Nijman, Henk L I
Empirical studies have rarely investigated the association between improvements on dynamic risk and protective factors for violence during forensic psychiatric treatment and reduced recidivism after discharge. The present study aimed to evaluate the effects of treatment progress in risk and protective factors on violent recidivism. For a sample of 108 discharged forensic psychiatric patients pre- and posttreatment assessments of risk (HCR-20) and protective factors (SAPROF) were compared. Changes were related to violent recidivism at different follow-up times after discharge. Improvements on risk and protective factors during treatment showed good predictive validity for abstention from violence for short- (1 year) as well as long-term (11 years) follow-up. This study demonstrates the sensitivity of the HCR-20 and the SAPROF to change and shows improvements on dynamic risk and protective factors are associated with lower violent recidivism long after treatment.
Müller, Matthias Johannes; Kundermann, Bernd; Cabanel, Nicole
Background Chronotype and insomnia have been related to the development and to an unfavourable course of depression. However, the mutual relationship of both risk factors is as yet unclear, especially in acute, clinically manifest depressive disorders. Aims The present study was carried out to elucidate the separate direct and indirect influence of chronotype and poor sleep quality on depression severity in patients hospitalized for depression. Methods Depression severity (BDI-II), chronotype (Morningness-Eveningness Questionnaire), and subjective sleep quality (Pittsburgh Sleep Quality Index total score) were assessed concurrently in inpatients with a depressive syndrome and insomnia during routine treatment. Correlations, multiple regression and bootstrapping methods for testing mediation models were applied to assess the independent direct and indirect effects of chronotype and sleep quality on depression severity, after adjusting for effects of age and gender. Results Data from 57 consecutively admitted patients (88% with major depression) were analyzed (68% women, mean age 41 ± 13 years). Significant correlations between morningness-eveningness (p sleep quality (p sleep quality, age and gender, only chronotype (p sleep disturbances (p poor subjective sleep quality were independently and directly associated with higher depression severity in inpatients with depressive syndromes. Chronotype and sleep quality should be taken into account not only in risk assessment and prevention but also in hospitalized patients to develop and improve treatment options.
Brown, Christiane; Fraser, Julia E; Inness, Elizabeth L; Wong, Jennifer S; Middleton, Laura E; Poon, Vivien; McIlroy, William E; Mansfield, Avril
To determine whether attending an aerobic fitness program during inpatient stroke rehabilitation is associated with increased participation in physical activity after discharge. This was a prospective cohort study. Patients who received inpatient stroke rehabilitation and were discharged into the community (n = 61; mean age, 65 years) were recruited. Thirty-five participants attended a standardized aerobic fitness program during inpatient rehabilitation, whereas 26 did not. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and adherence to the American College of Sports Medicine (ACSM) guidelines were assessed up to 6 months after discharge. Participants in the fitness group had PASIPD scores and adherence to ACSM guidelines similar to those of participants in the nonfitness group up to 6 months after discharge. There was no significant correlation between volume of exercise performed during the inpatient program and amount of physical activity after discharge. Participation in an inpatient fitness program did not increase participation in physical activity after discharge in individuals with stroke. A new model of care that encourages patients to pursue physical activity after discharge and reduces the potential barriers to participation should be developed.
Smith, Phillip; Poindexter, Erin; Cukrowicz, Kelly
The effect of engaging in an intensive research protocol that inquired extensively about psychiatric and suicide symptoms and exposed participants to a number of images, including suicide-related content was explored. Individuals experiencing a major depressive episode were called at 1 and 3 months after the initial protocol. Participants were…
[Social integration and contacts to reference persons of the normal social environment in inpatient treatment in the psychiatric hospital. A prospective catamnestic study of patients admitted for the first time with schizophrenic and cyclothymic psychoses].
Böcker, F M
Fifty first-admission inpatients (27 women, 23 men; mean age 35.1 years) with schizophrenia (n = 35) or affective disorders (n = 15) participated in a standardized, half-open interview about contact with people outside the hospital. The frequency of contact was compared with outcome, as based on a 1-year follow-up. Nearly all patients (48 of 50) had "direct" contact with relatives and friends during the week (means = 3/week): 45 patients had visitors, 13 went home on weekends. Thirty-five patients had contact with the outside by telephone, and 21 by letter; only 12 patients indicated no "indirect" contact. The frequency of contact had no relationship to sex, age or diagnosis. The significant factors were: structure of the patient's family, his/her educational and occupational level, social network, means of admission, conditions of hospitalization, and length of stay. The distance between the patient's residence and the hospital markedly influenced the frequency of visits and weekend holidays. The importance of frequent interaction with the usual social environment was verified by follow-up: 11 patients with rare or only average contact had unfavorable results (readmission or suicide by 1 year after discharge or long-term hospitalization); on the other hand, none of the patients with frequent direct contact outside the hospital showed poor results. There is no reason for indiscriminate criticism of the relatives of psychiatric inpatients according to etiological hypotheses of "family research"; above all, patients without relationships with a family or friends have to be regarded as at risk.(ABSTRACT TRUNCATED AT 250 WORDS)
Rhoda, Anthea; Cunningham, Natalie; Azaria, Simon; Urimubenshi, Gerard
The provision of rehabilitation differs between developed and developing countries, this could impact on the outcomes of post stroke rehabilitation. The aim of this paper is to present provision of in-patient stroke rehabilitation. In addition the challenges experienced by the individuals with participation post discharge are also presented. Qualitative and quantitative research methods were used to collect data. The quantitative data was collected using a retrospective survey of stroke patients admitted to hospitals over a three- to five-year period. Quantitative data was captured on a validated data capture sheet and analysed descriptively. The qualitative data was collected using interviews from a purposively and conveniently selected sample, audio-taped and analysed thematically. The qualitative data was presented within the participation model. A total of 168 medical folders were reviewed for a South African sample, 139 for a Rwandan sample and 145 for a Tanzanian sample. The mean age ranged from 62.6 (13.78) years in the South African sample to 56.0 (17.4) in the Rwandan sample. While a total of 98 % of South African stroke patients received physiotherapy, only 39.4 % of Rwandan patients received physiotherapy. From the qualitative interviews, it became clear that the stroke patients had participation restrictions. When conceptualised within the Participation Model participation restrictions experienced by the stroke patients were a lack of accomplishment, inability to engage in previous roles and a perception of having health problems. With the exception of Rwanda, stroke patients in the countries studied are admitted to settings early post stroke allowing for implementation of effective acute interventions. The participants were experiencing challenges which included a lack of transport and the physical geographic surroundings in the rural settings not being conducive to wheelchair use. Stroke patients admitted to hospitals in certain African countries
Eriksson, Robert; Werge, Thomas; Jensen, Lars Juhl
all indication areas.The aim of this study was to take advantage of techniques for temporal data mining of EPRs in order to detect ADRs in a patient- and dose-specific manner.We used a psychiatric hospital’s EPR system to investigate undesired drug effects. Within one workflow the method identified...... patient-specific adverse events (AEs) and links these to specific drugs and dosages in a temporal manner, based on integration of text mining results and structured data. The structured data contained precise information on drug identity, dosage and strength.When applying the method to the 3,394 patients......Data collected for medical, filing and administrative purposes in electronic patient records (EPRs) represent a rich source of individualised clinical data, which has great potential for improved detection of patients experiencing adverse drug reactions (ADRs), across all approved drugs and across...
Likelihood of obtaining Structured Interview of Reported Symptoms (SIRS) and SIRS-2 elevations among forensic psychiatric inpatients with screening elevations on the Miller Forensic Assessment of Symptoms Test.
Glassmire, David M; Tarescavage, Anthony M; Gottfried, Emily D
The Miller Forensic Assessment of Symptoms Test (M-FAST) was designed as a screening measure for feigned psychiatric symptoms. When M-FAST Total Scores are elevated (raw score ≥6), the test manual recommends follow-up with a more comprehensive measure of feigning, such as the widely used and researched Structured Interview of Reported Symptoms (SIRS) or the revised version of the test (SIRS-2). The purpose of the current study was to evaluate how often M-FAST screening elevations are associated with subsequent elevations on the SIRS or SIRS-2. The sample included archival data from 100 forensic psychiatric inpatients who obtained M-FAST Total Score elevations ≥6 during screening and were subsequently administered the SIRS (that was also rescored using SIRS-2 criteria). Among examinees who elevated the M-FAST over the recommended cutoff, 66.0% met standard SIRS feigning criteria, 42% met SIRS-2 criteria for feigning, and 81.0% obtained at least 1 SIRS/SIRS-2 elevation in the Probable Feigning range or higher. These results are consistent with the M-FAST manual guidelines, which support the use of the ≥6 M-FAST cutoff score to screen for potential feigning (but not as an independent marker of feigning). A higher M-FAST cutoff score of ≥16 was associated with subsequently meeting full SIRS criteria for feigning in 100.0% of protocols. Because the SIRS criteria were designed to have very low false positive rates, these findings indicate that more confident assertions about feigning can be made when elevations reach this level on the MFAST. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Snorrason, Jón; Grímsdóttir, Gudrún Ulfhildur; Sigurdsson, Jón Fridrik
Special observation (constant observation) of patients is common on psychiatric wards, both in Iceland and abroad, but very few studies have been conducted on their therapeutic value. The objective was to investigate the extent and nature of special observation on emergency wards at the division of psychiatry at the Landspitali-University Hospital in Iceland as well as the attitudes of patients and staff toward special observation. Information about patients on special observation was recorded over a three months period. Patients were interviewed with a standardised eleven questions interview shortly after the observation finished in order to investigate their attitudes toward the observation. Also, members of staff from each ward were asked to answer eight questions about their attitudes toward special observation in general. The Ethics Committee of Landspitali - University Hospital gave its permission for the study. During the research period observation was used for 157 patients, which is 31% of the total number of patients admitted during that period. Most of the patients (83%) were on 5-15 minutes observation, 25 per cent on close observation and 11 percent on suicide or constant observation. The majority of the patients claimed that security was the most important aspect of being on special observation, independent of which type of observation they were, and only one fifth felt that the company of staff was most important. The staff members on the other hand claimed that concern for the patient, respect and companionship were most important for the patients, independent of the type of observation used. The extent, nature and process of observation on acute inpatient wards in Iceland seems to be comparable to other studies from abroad. In view of the importance of special observations in psychiatric emergency care and their influence on patients' private life it is important to develop and implement clinical guidelines about their use.
Morghen, Sara; Morandi, Alessandro; Guccione, Andrew A; Bozzini, Michela; Guerini, Fabio; Gatti, Roberto; Del Santo, Francesco; Gentile, Simona; Trabucchi, Marco; Bellelli, Giuseppe
To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91). This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.
Zeng, Ruifan; Cohen, Lisa J; Tanis, Thachell; Qizilbash, Azra; Lopatyuk, Yana; Yaseen, Zimri S; Galynker, Igor
Suicidal behavior often accompanies both borderline personality disorder (BPD) and severe mood disorders, and comorbidity between the two appears to further increase suicide risk. The current study aims to quantify the risk of suicidality conferred by comorbid BPD diagnosis or features in three affective disorders: major depressive disorder (MDD), bipolar disorder (BP) and schizoaffective disorder. One hundred forty-nine (149) psychiatric inpatients were assessed by SCID I and II, and the Columbia Suicide Severity Rating Scale. Logistic regression analyses investigated the associations between previous suicide attempt and BPD diagnosis or features in patients with MDD, BP, and schizoaffective disorder, as well as a history of manic or major depressive episodes, and psychotic symptoms. Comorbid BPD diagnosis significantly increased suicide risk in the whole sample, and in those with MDD, BP, and history of depressive episode or psychotic symptoms. Each additional borderline feature also increased risk of past suicide attempt in these same groups (excepting BP) and in those with a previous manic episode. Of the BPD criteria, only unstable relationships and impulsivity independently predicted past suicide attempt. Overall, among patients with severe mood disorders, the presence of comorbid BPD features or disorder appears to substantially increase the risk of suicide attempts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Gonzales, Lauren; Yanos, Philip T; Stefancic, Ana; Alexander, Mary Jane; Harney-Delehanty, Brianna
This study examined the association between neighborhood characteristics, stigma related to mental illness reported by local community members, and measures of perceived stigma and community participation among individuals with psychiatric disabilities living in independent scattered-site housing or in congregate housing in three neighborhoods in the New York City metropolitan area. Neighborhood characteristics were drawn from the 2010 U.S. Census. Surveys focusing on attitudes and intended behavior toward people with mental illness were administered to 608 general community members, and clinical interviews were conducted with 343 persons with psychiatric disabilities. Of neighborhood characteristics, both greater socioeconomic disadvantage and more "suburban values" (lower housing density and greater political conservativism) predicted more perpetrated stigma reported by community members. There was no significant relationship between stigma reported by community members and perceived stigma among participants with psychiatric disabilities. Community stigma predicted vocational involvement and demonstrated interaction effects with housing, such that persons living in congregate housing demonstrated more community participation in communities with more stigma, whereas persons living in scattered-site housing demonstrated less participation in these communities. Perceived stigma was significantly negatively related to community participation. Findings suggest that effects of neighborhood characteristics and community stigma on people with psychiatric disabilities are complex and are partly conditioned by housing context.
Sugai, Takuro; Suzuki, Yutaro; Yamazaki, Manabu; Shimoda, Kazutaka; Mori, Takao; Ozeki, Yuji; Matsuda, Hiroshi; Sugawara, Norio; Yasui-Furukori, Norio; Minami, Yoshitake; Okamoto, Kurefu; Sagae, Toyoaki; Someya, Toshiyuki
Objectives To clarify the prevalence of underweight and overweight/obesity, and laboratory data for nutritional status in Japanese outpatients and inpatients with schizophrenia. Design Cross-sectional study. Setting A questionnaire conducted in inpatient and outpatient facilities in Japan. Participants The population of adult patients with schizophrenia in Japan (N=23 116). Main outcome measures The prevalence of underweight and undernutrition in Japanese inpatients and outpatients with schizophrenia. Results We conducted a large-scale investigation of the prevalence of underweight and undernutrition in 520 outpatient facilities and 247 inpatient facilities belonging to the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7655 outpatients and 15 461 inpatients with schizophrenia. There was a significant difference in the distribution of three body mass index levels between outpatients and inpatients (punderweight inpatients with schizophrenia was significantly higher than that among outpatients (punderweight individuals aged ≥40 years was higher in inpatients than in outpatients and in the general Japanese population. The proportion of individuals with hypocholesterolaemia was significantly higher in inpatients with schizophrenia than in outpatients (punderweight between outpatients and inpatients with schizophrenia; the proportion of severe underweight in inpatients was twofold higher than in outpatients. Conclusions The prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia was higher than in outpatients and the general population. Therefore, the physical risk of inpatients should be carefully considered in clinical practice. PMID:26656016
Short-term effects of media exposure to the thin ideal in female inpatients with an eating disorder compared to female inpatients with a mood or anxiety disorder or women with no psychiatric disorder.
Loeber, Sabine; Burgmer, Ramona; Wyssen, Andrea; Leins, Judith; Rustemeier, Martina; Munsch, Simone; Herpertz, Stephan
Previous research demonstrated that the exposure to media portrayals of the thin body ideal negatively affects body satisfaction and mood of healthy women and thus represents a sociocultural risk factor for the development of eating disorders. However, at present, it is not known whether negative effects of the thin ideal are pronounced in eating-disordered patients. Female inpatients with a current diagnosis of anorexia nervosa (N = 36), bulimia nervosa (N = 32), or mood or anxiety disorder (N = 31), and women with no current psychiatric diagnosis were randomly assigned to exposure to magazine pictures depicting the thin female body ideal or landscape scenes in two experimental phases (leafing through a magazine followed by instructed imagination of a picture from the magazine). The groups were compared on measures of body satisfaction and mood that were collected before and after the two phases. Leafing through a fashion magazine was not associated with negative effects on body satisfaction or mood in all groups. Imagining the thin ideal resulted in a decrease in body satisfaction and a decrease in positive mood. We found no diagnosis-specific effects indicating no stronger negative impact of the thin ideal on eating-disorder patients. Given the lacking differences between eating-disordered patients and controls, these findings underline the importance of future research to enhance our understanding of what happens when patients are exposed to external or internal stimuli of media images of the thin ideal. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:708-715). © 2016 Wiley Periodicals, Inc.
Stokes, John M; Pogge, David L; Archer, Robert P
This study explored the association between the Minnesota Multiphasic Personality Inventory (MMPI)-Adolescent-Restructured Form (MMPI-A-RF) and the MMPI-Adolescent (MMPI-A) form in a sample of 3,516 adolescents receiving inpatient psychiatric treatment, including 2,798 adolescents meeting validity inclusion cutoffs for both measures. There was 92.5% agreement rate with respect to global identification of cases as valid or invalid and some empirical support for lowering interpretive cutoffs for validity scales on the MMPI-A-RF. The MMPI-A-RF Demoralization Scale (RCd) was shown to correlate significantly less strongly with Restructured Clinical (RC) scales than with MMPI-A clinical scales. RC scales also demonstrated significantly lower mean interscale correlations than MMPI-A clinical scales. As expected, this greater level of scale independence resulted in significantly fewer profiles with multiple scale elevations. As was anticipated, with the exception of RC1 predicting MMPI-A hypochondriasis, correlational and classification agreement analyses suggested moderate associations between the RC and MMPI-A clinical scales, but somewhat stronger agreement between comparable PSY-5 scales. Changes in interpretive cutoff procedures for the RC scales, including RCd, also resulted in 5.5% fewer "within normal limits" profiles than the use of MMPI-A with all 10 clinical scales. Finally, stepwise linear regression analyses indicated that MMPI-A-RF Higher-Order scales were best predicted by those MMPI-A clinical scale combinations that they are purported to be linked with in the MMPI-A-RF manual. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Klotzbaugh, Ralph; Glover, Eileen
To develop an understanding of lesbian-, gay-, bisexual-, transgender-specific mental health and substance abuse needs in rural populations and to improve data about sexual orientation and gender identity. Existing literature on mental health needs for lesbian, gay, bisexual and transgender populations has continued to reveal higher levels of need. Research has also demonstrated that few mental health providers have expertise or comfort in treating lesbian, gay, bisexual and transgender clients. Descriptive correlational study. A sample (n = 456) of patient records admitted to a rural lesbian, gay, bisexual and transgender inpatient psychiatric clinic over 12 months were examined using descriptive statistics. Patient zip code information was used to determine the levels of rurality. Chi-square analysis was used to determine relationships between sexual orientation, rural/urban distinctions and concomitant drug use. Unexpectedly, those who identified as heterosexual were significantly more likely to concomitantly abuse alcohol and heroin than those who identified as lesbian, gay, bisexual and transgender. Patients residing in small or isolated rural areas were more likely to abuse alcohol or synthetics than those residing in urban or micropolitan areas. Results of this study concerning substance abuse among lesbian, gay, bisexual and transgender individuals are not reflective of prior studies. LGBT patients did not demonstrate a higher proportion of substance abuse compared with those identifying as heterosexual. Increased substance abuse among those from rural isolated areas does support prior studies. The context of gathering demographic information on sexual orientation was thought by staff to increase the number of those identifying as heterosexual. Context in which sensitive questions are asked may affect the accuracy of demographic data. Lack of information regarding patients' sexual orientation or gender identity may impact perceived need for
Frauenfelder, F.; Muller-Staub, M.; Needham, I.; Achterberg, T. van
The successful application of the Nursing Interventions Classification (NIC) in inpatient psychiatry depends on whether the classification adequately describes nursing care in this setting. The present study aimed to identify nursing interventions mentioned in journal articles on psychiatric
Abstinence phenomena of chronic cannabis-addicts prospectively monitored during controlled inpatient detoxification (Part II): Psychiatric complaints and their relation to delta-9-tetrahydrocannabinol and its metabolites in serum.
Bonnet, Udo; Borda, Thorsten; Scherbaum, Norbert; Specka, Michael
To investigate the impact of inpatient detoxification treatment on psychiatric symptoms of chronic cannabis addicts and to analyze the influence of serum cannabinoid levels on the severity of these symptoms. Thirty five treatment-seeking, not active co-morbid chronic cannabis dependents (ICD-10) were studied on admission and on abstinence days 8 and 16, using several observational and self-report scales, such as Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), and the Symptom Checklist-90-Revised (SCL-90-R). Simultaneously obtained serum was analyzed with regard to levels of delta-9-tetrahydrocannabinol (THC) and its main metabolites 11-hydroxy-delta-9-tetrahydrocannabinol (THC-OH) and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). At admission, nearly 90% of the patients were not, or only mildly, affected by depression, anxiety or manic symptoms. In contrast, patients' self-description indicated a strong psychiatric burden in approximately 60% of the cases. All patients improved significantly within 16 days of the treatment. Effect sizes ranged from 0.7 to 1.4. (Cohen's d) for the respective scales. Serum THC-levels were positively associated with impairment of cognition in HAMA and motor retardation in BPRS. All other test results were not significantly related to the serum levels of the measured cannabinoids. Effects of the cannabis withdrawal syndrome and executive dysfunctions might explain the discrepancy between the observer ratings and self-reported psychiatric burden. Inpatient cannabis detoxification treatment significantly improved psychiatric symptoms. Serum THC-levels were not associated with affective symptoms and anxiety but predicted cognitive impairment and motor retardation. Copyright © 2015. Published by Elsevier Ireland Ltd.
Frauenfelder, F.; Muller-Staub, M.; Needham, I.; Achterberg, T. van
Little is known about the question if the nursing diagnosis classification of North American Nursing Association-International (NANDA-I) describes the adult inpatient psychiatric nursing care. The present study aimed to identify nursing phenomena mentioned in journal articles about the psychiatric
The paper describes the current provision of psychiatric services in Algeria - in particular, in-patient and out-patient facilities, child psychiatry and human resources. Education, training, associations and research in the field of mental health are also briefly presented. The challenges that must dealt with to improve psychiatric care and to comply with international standards are listed, by way of conclusion.
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 clarifying studies concerning prevalence and nature of medication errors in psychiatric care, as well as studies concerning associations related to medication errors. This is the basis for quality improving interventions in relation to medication safety in psychiatric care. The aim of this study was to asses...... 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...
In order to avoid threatening social disintegration, it is important for children and adolescents with chronic mental disorders and also for physically disabled children to diagnose disturbances of social participation in an early stage and to commence rehabilitation measures. The need for rehabilitation, the ability to rehabilitate and the rehabilitation prognosis are important for identifying the individual rehabilitation goals. A multi-axial diagnosis according to the ICF with a determination of adaptability, a behavioural analysis, skills, activity and participation is required. For disabled children, there are only a few ICF check lists for diagnosing social participation. Because of this, the ICF check list CASP (Child & Adolescent Scale of Participation) for measuring social participation according to Bedell was translated, which is shown in the appendix.
Scherer, Edson Arthur; Campos, Maria Auxiliadora; Scherer, Zeyne Alves Pires
This naturalistic study was realized through observation and aimed to characterize general staff meetings held at a day hospital regarding theme and the professionals' participation in the use of time...
Capri, Charlotte; Buckle, Chanellé
Background: Migrating nursing labour inadvertently reinforces South Africa's care drain, contributes to a global care crisis and forces us to reconsider migration motivation. This paper highlights issues that complicate psychiatric intellectual disability nursing care and identifies loci for change in an attempt to redress this care challenge.…
Full Text Available Cognitive deficits in old-age depression vary as a function of multiple factors; one rarely examined factor is long-term psychiatric history. We investigated effects of psychiatric history on cognitive performance in old-age depression and in remitted persons. In the population-based SNAC-K study, older persons (≥60 years without dementia were tested with a cognitive battery and matched to the Swedish National Inpatient Register (starting 1969. Participants were grouped according to current depression status and psychiatric history and compared to healthy controls (n=96. Group differences were observed for processing speed, attention, executive functions and verbal fluency. Persons with depression and psychiatric inpatient history (n=20 and late-onset depression (n=49 performed at the lowest levels, whereas cognitive performance in persons with self-reported recurrent unipolar depression (n=52 was intermediate. Remitted persons with inpatient history of unipolar depression (n=38 exhibited no cognitive deficits. Heart disease burden, physical inactivity, and cumulative inpatient days modulated the observed group differences in cognitive performance. Among currently depressed persons, those with inpatient history and late onset performed at the lowest levels. Importantly, remitted persons showed no cognitive deficits, possibly reflecting the extended time since the last admission (m=15.6 years. Thus, the present data suggest that cognitive deficits in unipolar depression may be more state- than trait-related. Information on profiles of cognitive performance, psychiatric history, and health behaviors may be useful in tailoring individualized treatment.
Thyssen, Gunvor Dichmann; Beck, Anne
Patient participation is known to improve patients' motivation, compliance, treatment results, and satisfaction with the received care. It is well known that the physical environment is of great importance in supporting patient involvement. A systematic literature search has shown a lack of articles on the subject of "surroundings" in relation to patient participation, for all patient groups. We aimed to investigate how patients with intestinal failure experience their hospital surroundings in relation to patient participation. The study included eight patients admitted for at least 2 weeks at the Intestinal Failure Unit, H8, Salford Royal NHS Foundation Trust, Manchester, United Kingdom. Included patients had a good level of consciousness with no confusion. The included patients participated in a semistructured interview. The interviews were analyzed using Malterud's principles of systematic text condensation. The patients described that the surroundings enabled them to participate in their treatment and care. The surroundings made it possible for them and encouraged them to participate through: the possibility to seek and get information and the possibility to participate in daily activities. This led to a feeling of independence, reassurance, normality, control, responsibility, and confidence. The findings in this study indicate that the hospital surroundings are essential for the patients with respect to their ability to participate in their own care and treatment. The surroundings, in relation to patient participation, should be considered when planning and organizing nursing care. Further research is needed to increase the understanding of the surroundings in relation to patient participation - this research could, for eg, include the nurse's perspective.
Full Text Available Gunvor Dichmann Thyssen, Anne BeckDepartment of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, DenmarkIntroduction: Patient participation is known to improve patients' motivation, compliance, treatment results, and satisfaction with the received care. It is well known that the physical environment is of great importance in supporting patient involvement. A systematic literature search has shown a lack of articles on the subject of “surroundings” in relation to patient participation, for all patient groups.Aim: We aimed to investigate how patients with intestinal failure experience their hospital surroundings in relation to patient participation.Methods: The study included eight patients admitted for at least 2 weeks at the Intestinal Failure Unit, H8, Salford Royal NHS Foundation Trust, Manchester, United Kingdom. Included patients had a good level of consciousness with no confusion. The included patients participated in a semistructured interview. The interviews were analyzed using Malterud's principles of systematic text condensation.Results: The patients described that the surroundings enabled them to participate in their treatment and care. The surroundings made it possible for them and encouraged them to participate through: the possibility to seek and get information and the possibility to participate in daily activities. This led to a feeling of independence, reassurance, normality, control, responsibility, and confidence.Conclusion: The findings in this study indicate that the hospital surroundings are essential for the patients with respect to their ability to participate in their own care and treatment. The surroundings, in relation to patient participation, should be considered when planning and organizing nursing care. Further research is needed to increase the understanding of the surroundings in relation to patient participation - this research could, for eg, include the nurse's perspective
Ibáñez, Agustín; Aguado, Jaume; Baez, Sandra; Huepe, David; Lopez, Vladimir; Ortega, Rodrigo; Sigman, Mariano; Mikulan, Ezequiel; Lischinsky, Alicia; Torrente, Fernando; Cetkovich, Marcelo; Torralva, Teresa; Bekinschtein, Tristan; Manes, Facundo
It is commonly assumed that early emotional signals provide relevant information for social cognition tasks. The goal of this study was to test the association between (a) cortical markers of face emotional processing and (b) social-cognitive measures, and also to build a model which can predict this association (a and b) in healthy volunteers as well as in different groups of psychiatric patients. Thus, we investigated the early cortical processing of emotional stimuli (N170, using a face and word valence task) and their relationship with the social-cognitive profiles (SCPs, indexed by measures of theory of mind, fluid intelligence, speed processing and executive functions). Group comparisons and individual differences were assessed among schizophrenia (SCZ) patients and their relatives, individuals with attention deficit hyperactivity disorder (ADHD), individuals with euthymic bipolar disorder (BD) and healthy participants (educational level, handedness, age and gender matched). Our results provide evidence of emotional N170 impairments in the affected groups (SCZ and relatives, ADHD and BD) as well as subtle group differences. Importantly, cortical processing of emotional stimuli predicted the SCP, as evidenced by a structural equation model analysis. This is the first study to report an association model of brain markers of emotional processing and SCP. © The Author (2013). Published by Oxford University Press. For Permissions, please email: firstname.lastname@example.org.
Aguado, Jaume; Baez, Sandra; Huepe, David; Lopez, Vladimir; Ortega, Rodrigo; Sigman, Mariano; Mikulan, Ezequiel; Lischinsky, Alicia; Torrente, Fernando; Cetkovich, Marcelo; Torralva, Teresa; Bekinschtein, Tristan; Manes, Facundo
It is commonly assumed that early emotional signals provide relevant information for social cognition tasks. The goal of this study was to test the association between (a) cortical markers of face emotional processing and (b) social-cognitive measures, and also to build a model which can predict this association (a and b) in healthy volunteers as well as in different groups of psychiatric patients. Thus, we investigated the early cortical processing of emotional stimuli (N170, using a face and word valence task) and their relationship with the social-cognitive profiles (SCPs, indexed by measures of theory of mind, fluid intelligence, speed processing and executive functions). Group comparisons and individual differences were assessed among schizophrenia (SCZ) patients and their relatives, individuals with attention deficit hyperactivity disorder (ADHD), individuals with euthymic bipolar disorder (BD) and healthy participants (educational level, handedness, age and gender matched). Our results provide evidence of emotional N170 impairments in the affected groups (SCZ and relatives, ADHD and BD) as well as subtle group differences. Importantly, cortical processing of emotional stimuli predicted the SCP, as evidenced by a structural equation model analysis. This is the first study to report an association model of brain markers of emotional processing and SCP. PMID:23685775
Kayhan, Fatih; Cıcek, Erdinc; Uguz, Faruk; Karababa, Ibrahim Fatih; Kucur, Rahim
The aim of the study was to assess the prevalence of mood and anxiety disorders among inpatients and the relationship between sociodemographic factors, medical illnesses and treatments. In the present study, we selected 650 inpatients from all clinics except psychiatry and pediatrics in a general hospital by a simple random sampling method. Based on the exclusion criteria, 57 patients were excluded. Mood and anxiety disorders were determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Of the participants, 226 (37.5%) had a psychiatric disorder, 87 (14.4) had a mood disorder and 146 (24.2%) had an anxiety disorder. The most common specific diagnoses were not otherwise specified as anxiety disorder (9.5%), major depression (8.6%) and generalized anxiety disorder (7.6%). While the overall prevalence was highest in the hematology clinic (60.0%), it was lowest in the clinic of infectious diseases (22.7%). Logistic regression analysis indicated that the independent factors associated with psychiatric disorders were being of the female gender and a personal history of psychiatric disorders. In conclusion, results of the present study suggest that mood and anxiety disorders were frequently observed among inpatients, particularly in female patients and those with an individual history of psychiatric disorder. Successful treatment of these disorders may positively contribute to the course of the disease in inpatients. However, this assumption should be confirmed by further studies. Copyright © 2013 Elsevier Inc. All rights reserved.
Langton, Calvin M; Hogue, Todd E; Daffern, Michael; Mannion, Aisling; Howells, Kevin
The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales provides specialized care to high-risk offenders with mental disorders. This study investigated the predictive utility of personality traits, assessed using the Psychopathy Checklist-Revised (PCL-R) and the International Personality Disorder Examination, with 44 consecutive admissions to the DSPD unit at a high-security forensic psychiatric hospital. Incidents of interpersonal physical aggression (IPA) were observed for 39% of the sample over an average 1.5-year period following admission. Histrionic personality disorder (PD) predicted IPA, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive (2+ incidents of) IPA. PCL-R Factor 1 and Facets 1 and 2 were also significant predictors of IPA. PCL-R Factor 1 and Histrionic PD scores were significantly associated with imminence of IPA. Results were discussed in terms of the utility of personality traits in risk assessment and treatment of specially selected high-risk forensic psychiatric patients in secure settings.
Frauenfelder, F.; Achterberg, T. van; Needham, I.; Staub, M. Muller
PURPOSE: This study explored how well NANDA-I covers the reality of adult inpatient psychiatric nursing care. METHODS: Patient observations documented by registered nurses in records were analyzed using content analysis and mapped with the classification NANDA-I. FINDINGS: A total of 1,818 notes
Yu, Junhan; Ross, Colin A.; Keyes, Benjamin B.; Li, Ying; Dai, Yunfei; Zhang, Tianhong; Wang, Lanlan; Fan, Qing; Xiao, Zeping
The purpose of the study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study consisted of 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria for Mental Disorders, Version 3 (CCMD-3). All participants completed a self-report measure of dissociation, the Dissociative Experiences Scale (DES) and none had a prior diagnosis of a dissociative disorder. Ninety-six randomly selected participants were interviewed with a structured interview, the Dissociative Disorders Interview Schedule (DDIS) and a clinical interview. These 96 patients did not differ significantly from the 473 patients who were not interviewed on any demographic measures or on the self-report measure dissociation. A total of 28 (15.3%, after weighting of the data) patients received a clinical diagnosis of a dissociative disorder based on DSM-IV-TR criteria. Dissociative identity disorder was diagnosed in 2 (0.53%, after weighting) patients. Compared to the patients without a dissociative disorder, patients with dissociative disorders were significantly more likely to report childhood abuse (57.1% versus 22.1%), but the two groups did not differ significantly on any demographic measures. Dissociative disorders were readily identified in an inpatient psychiatric population in China. PMID:20603768
Yu, Junhan; Ross, Colin A; Keyes, Benjamin B; Li, Ying; Dai, Yunfei; Zhang, Tianhong; Wang, Lanlan; Fan, Qing; Xiao, Zeping
The purpose of this study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study were 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, Version 3. All participants completed a self-report measure of dissociation (the Dissociative Experiences Scale), and none had a prior diagnosis of a dissociative disorder. A total of 96 randomly selected participants were interviewed with a structured interview (the Dissociative Disorders Interview Schedule) and a clinical interview. These 96 patients did not differ significantly from the 473 patients who were not interviewed on any demographic measures or who did not complete the self-report dissociation measure. A total of 28 patients (15.3%, after weighting of the data) received a clinical diagnosis of a dissociative disorder based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria. Dissociative identity disorder was diagnosed in 2 patients (0.53%, after weighting). Compared to the patients without a dissociative disorder, patients with dissociative disorders were significantly more likely to report childhood abuse (57.1% vs. 22.1%), but the 2 groups did not differ significantly on any demographic measures. Dissociative disorders were readily identified in an inpatient psychiatric population in China.
Paulo José Ribeiro Teixeira
Full Text Available OBJECTIVE: Metabolic syndrome is a highly prevalent disorder among the general population. Studies show an even higher prevalence among psychiatric patients. The objective of this study is to assess the prevalence of metabolic syndrome among inpatients of a psychiatric ward of a general hospital in Brazil and correlate it with their respective psychiatric diagnoses and with the antipsychotics and mood stabilizers used. METHOD: 170 inpatients (mean age: 45.6 years were evaluated according to the National Cholesterol Education Program criteria for metabolic syndrome, with a modification of the criteria for blood pressure and fasting glucose. RESULTS: The prevalence found was 29.4%, being higher in women (43.6% versus 20.8%, p = 0.002. The prevalence stratified by psychiatric diagnostic was 48.1% for depression, 38.3% for bipolar disorder, 31.8% for schizophrenia and schizoaffective disorder, 5.1% for alcoholism, and 23.1% for "other mental disorders". The prevalence for alcoholism was significantly lower than the prevalence rates associated with other diagnostic categories (p = 0.035. After using the multivariate analysis, female gender and use of lithium remained as factors associated with a diagnosis of metabolic syndrome. CONCLUSIONS: The prevalence found was 29.4%. Gender (female and use of lithium were factors significantly associated with the diagnosis of metabolic syndrome.OBJETIVO: A síndrome metabólica é um transtorno de alta prevalência na população em geral. Estudos demonstram prevalência ainda maior em pacientes psiquiátricos. O objetivo deste trabalho é avaliar a prevalência de síndrome metabólica em pacientes internados em uma enfermaria psiquiátrica de um hospital geral no Brasil e correlacioná-la com os diagnósticos psiquiátricos e com o uso de medicamentos antipsicóticos e moduladores do humor. MÉTODO: Cento e setenta pacientes (idade média: 45,6 anos foram avaliados de acordo com os critérios do National
Larsen, Tina Gram; Valbak, Lone; Perto, Gurli; Reinert, Kjeld
In Denmark the number of forensic psychiatric patients is increasing. The objective of this study was to explore whether the increased number of forensic psychiatric patients has been reflected in the use of psychiatric inpatient facilities. Furthermore, we wanted to investigate differences in the treatment of various diagnostic groups of forensic patients and of forensic and non-forensic patients with schizophrenia. Information about admissions and outpatient contact was extracted from the Danish Psychiatric Central Research Register for all Danish patients sentenced to psychiatric treatment in the period 1994-2003. Furthermore, a group of first-admission forensic patients suffering from schizophrenia was compared to a control group of first-admission non-forensic patients with schizophrenia, matched for sex, age and time of admission. The number of forensic psychiatric patients increased markedly in the period 1994-2003; at the same time, the use of inpatient facilities for this group of patients did not increase to a similar degree but actually decreased. Forensic patients in the group F20-F29 spent more time in hospital than did forensic patients with affective disorders and personality disorders. Forensic psychiatric patients with schizophrenia had significantly longer periods of hospitalization than did non-forensic patients with schizophrenia. Forensic psychiatric patients' use of psychiatric inpatient facilities during the last 10 years did not increase to the extent expected relative to the increasing number of forensic psychiatric patients. This raises the question of whether these patients are receiving necessary and sufficient treatment.
Betancourt Galeano, Wendy; Castrillón Muñoz, Eduardo; Godoy Jaimes, Kristy Alejandra; Matheus Lamus, Johanna; Ramírez Rivera, Sandra Milena; Ríos Castañeda, Sandra Viviana
Simulation has been used as a learning tool in different disciplines and professions, including medicine and its specialties. Its usefulness is directly related to the integration of objectives, contents, methodologies and specific resources in each area of knowledge. To describe the development of an educational experience implemented in the Pontificia Universidad Javeriana Cali (Cali, Colombia) with medical students of Human Behavior II program, between 2012 and 2013. This experience was performed with simulated patients played by actors of the Altergesto theater group, that were interviewed by students under the supervision of psychiatrists and teachers of the subject, using the Simulated Hospital of the University. A historical development recall of the teaching sequence was made from the first half of 2012 to the second half of 2013, a statement of pedagogical objectives, and a description of the teaching-learning strategies. 158 interviews were conducted over a period of two years during which it was necessary to raise methodological solutions to adapt this teaching sequence to the content and objectives of the subject. The high-fidelity simulation, integrating actors who represent psychiatric patients mixed with the technology of a Simulated Hospital was useful to achieve compliance with the objectives proposed in the course of Human Behavior II, as a part of the program of Medicine at the Pontificia Universidad Javeriana Cali. In parallel, the construction of experience as an interdisciplinary project and the practical approach of this strategy may impact on cognitive, emotional, behavioral dimensions of the participants, encouraging meaningful learning. An easy access database for the collected material and the study of the effects of this strategy in the formation of long-term students is needed. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
This 1-year ethnographic study, conducted in an inpatient adolescent psychiatric unit, was guided by the research question, "What is it like for patients, families, and staff to be participants in an adolescent psychiatric program?" Verbal irony was observed to be a prominent communicative behavior among the staff and patients, suggesting a general freedom of expression and flexible boundaries. This form of expression, using nonliteral language skills encompassing a variety of humor and sarcasm, was found to promote professional solidarity and adolescent self-esteem, accelerate adolescent social skills, and offer a means of coping with the stigma of emotional and behavioral disorders.
Kawano, Rumiko; Ishida, Mayumi; Kimura, Eiichiro; Matsumoto, Hideki; Arai, Heii
Schizophrenia patients have an elevated prevalence of stroke and cardiovascular risk factors, such as elevated body mass index, hypertension, and hyperlipidaemia. This pilot study investigated the influence of a low-sodium diet using umami seasoning on food intake and clinical parameters in schizophrenia patients. A single-blind crossover intervention study was conducted in 15 clinical schizophrenia patients given a low-sodium diet with or without umami seasoning, monomagnesium di-L-glutamate, for 2 weeks. After the initial 2-week intervention, there was a 2-week washout period, and then the interventions were switched. Daily body weight, body mass index, abdominal circumference, blood pressure, and nutrient intake for each subject were determined. The results showed that subjects given monomagnesium di-L-glutamate had an approximately 25.9% reduction in dietary sodium. Furthermore, daily energy intake did not decrease, and no significant changes in body weight, body mass index, abdominal circumference, blood pressure, and nutrient intake were observed. The use of umami seasonings, such as monomagnesium di-L-glutamate, might be an effective long-term strategy for psychiatric patients requiring restricted sodium intake. © 2014 The Authors. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.
Scanlan, Justin Newton
In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction programmes. A total of 29 papers were included in the review. Seven key strategy types emerged from the analysis: (i) policy change/leadership; (ii) external review/debriefing; (iii) data use; (iv) training; (v) consumer/family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment. The development of new seclusion and restraint reduction programmes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.
Gowers, Simon G; Rowlands, Laura
Inpatient services constitute the most highly specialized child and adolescent mental health provision and cater for the most severe disorders in this age group. In view of a number of mapping and audit initiatives in the UK in recent years and changing influences on admission policies worldwide, it is timely to review their function and effectiveness. Recent attention has focused on describing service configurations and auditing against standards. National surveys of cost, referral processes and patient satisfaction are in progress in the UK. There seems to be an international trend toward a more severe, comorbid and aggressive patient group being admitted to inpatient services. There is a shortage of quality research into clinical outcomes of inpatient treatment, but controlled trials comparing hospital treatment with intensive community management are emerging. Inpatient descriptive studies and uncontrolled outcome studies predominate in the literature. Although many children and adolescents benefit from admission to mental health inpatient facilities, the specific advantages of admission over intensive community management are uncertain.
... IOM Institute of Medicine IPF Inpatient psychiatric facility IPPS inpatient prospective payment system... 2012, FY 2013, and FY 2014 Payment Determinations 6. RHQDAPU Program Disaster Extensions and Waivers 7...
Olsson, Helen; Audulv, Åsa; Strand, Susanne; Kristiansen, Lisbeth
Semi-structured interviews with 13 forensic psychiatric inpatients that had decreased their assessed risk of violence were analyzed using interpretive description. The main contribution from this study is a detailed description of patients' own strategies to avoid violence. Participants described having an ongoing inner dialog in which they encouraged themselves, thereby increasing their self-esteem and trying to accept their current situation. An unsafe and overcrowded ward with uninterested and nonchalant staff increased the risk of aggressive behavior. In the process of decreasing violence, the patients and the forensic psychiatric nursing staff interacted to create and maintain a safe environment. Copyright © 2015 Elsevier Inc. All rights reserved.
Inpatient violence constitutes a major concern for staff, patients, and administrators. Violence can cause physical injury and psychological trauma. Although violence presents a challenge to inpatient clinicians, it should not be viewed as inevitable. By looking at history of violence, in addition to clinical and other historical factors, clinicians can identify which patients present the most risk of exhibiting violent behavior and whether the violence would most likely flow from psychosis, impulsivity, or predatory characteristics. With that information, clinicians can provide environmental and treatment modifications to lessen the likelihood of violence. Copyright © 2016 Elsevier Inc. All rights reserved.
Ibáñez, Agustín; Aguado, Jaume; Baez, Sandra; Huepe, David; Lopez, Vladimir; Ortega, Rodrigo; Sigman, Mariano; Mikulan, Ezequiel; Lischinsky, Alicia; Torrente, Fernando; Cetkovich, Marcelo; Torralva, Teresa; Bekinschtein, Tristan; Manes, Facundo
It is commonly assumed that early emotional signals provide relevant information for social cognition tasks. The goal of this study was to test the association between (a) cortical markers of face emotional processing and (b) social-cognitive measures, and also to build a model which can predict this association (a and b) in healthy volunteers as well as in different groups of psychiatric patients. Thus, we investigated the early cortical processing of emotional stimuli (N170, using a face an...
The ethical landscape of professional care in everyday practice as perceived by staff: A qualitative content analysis of ethical diaries written by staff in child and adolescent psychiatric in-patient care
Full Text Available Abstract Background Although there has been some empirical research on ethics concerning the attitudes and approaches of staff in relation to adult patients, there is very little to be found on child and adolescent psychiatric care. In most cases researchers have defined which issues are important, for instance, coercive care. The aim of this study was to provide a qualitative description of situations and experiences that gave rise to ethical problems and considerations as reported by staff members on child and adolescent psychiatric wards, although they were not provided with a definition of the concept. Methods The study took place in six child and adolescent psychiatric wards in Sweden. All staff members involved with patients on these wards were invited to participate. The staff members were asked to keep an ethical diary over the course of one week, and data collection comprised the diaries handed in by 68 persons. Qualitative content analysis was used in order to analyse the diaries. Results In the analysis three themes emerged; 1 good care 2 loyalty and 3 powerlessness. The theme ‘good care’ contains statements about the ideal of commitment but also about problems living up to the ideal. Staff members emphasized the importance of involving patients and parents in the care, but also of the need for professional distance. Participants seldom perceived decisions about coercive measures as problematic, in contrast to those about pressure and restrictions, especially in the case of patients admitted for voluntary care. The theme ‘loyalty’ contains statements in which staff members perceived contradictory expectations from different interested parties, mainly parents but also their supervisor, doctors, colleagues and the social services. The theme ‘powerlessness’ contains statements about situations that create frustration, in which freedom of action is perceived as limited and can concern inadequacy in relation to patients and
The ethical landscape of professional care in everyday practice as perceived by staff: A qualitative content analysis of ethical diaries written by staff in child and adolescent psychiatric in-patient care.
Pelto-Piri, Veikko; Engström, Karin; Engström, Ingemar
Although there has been some empirical research on ethics concerning the attitudes and approaches of staff in relation to adult patients, there is very little to be found on child and adolescent psychiatric care. In most cases researchers have defined which issues are important, for instance, coercive care. The aim of this study was to provide a qualitative description of situations and experiences that gave rise to ethical problems and considerations as reported by staff members on child and adolescent psychiatric wards, although they were not provided with a definition of the concept. The study took place in six child and adolescent psychiatric wards in Sweden. All staff members involved with patients on these wards were invited to participate. The staff members were asked to keep an ethical diary over the course of one week, and data collection comprised the diaries handed in by 68 persons. Qualitative content analysis was used in order to analyse the diaries. In the analysis three themes emerged; 1) good care 2) loyalty and 3) powerlessness. The theme 'good care' contains statements about the ideal of commitment but also about problems living up to the ideal. Staff members emphasized the importance of involving patients and parents in the care, but also of the need for professional distance. Participants seldom perceived decisions about coercive measures as problematic, in contrast to those about pressure and restrictions, especially in the case of patients admitted for voluntary care. The theme 'loyalty' contains statements in which staff members perceived contradictory expectations from different interested parties, mainly parents but also their supervisor, doctors, colleagues and the social services. The theme 'powerlessness' contains statements about situations that create frustration, in which freedom of action is perceived as limited and can concern inadequacy in relation to patients and violations in the workplace. The ethical considerations described by
Understanding the management of people seeking voluntary psychiatric hospitalization who do not meet the criteria for inpatient admission: a qualitative study of mental health liaison nurses working in accident and emergency departments in the north of England.
Hepworth, Iain; McGowan, Linda
Mental health liaison nurses assess people who self-present at accident and emergency departments seeking inpatient admission, however not all presentations meet the criteria for admission. Little is known about how liaison nurses manage this client group. This qualitative study explored how liaison nurses manage this client group. This study used the think aloud technique to recreate clinical scenarios of clients requesting admission who do not meet the criteria for such admission. Participants were then subsequently interviewed. Eighteen liaison nurses working in hospitals across the North of England participated. Data were analysed using framework analysis methods. Findings indicate that the liaison nurses use a variety of therapeutic skills and methods in managing this client group. Liaison nurses were found to 'sell' crisis and home-based treatment as an equivalent, or superior in quality, to hospital care. However, the existing evidence base does not fully support this assertion. Liaison nurses face numerous difficulties in this role. In the absence of any formalized training, liaison nurses rely on their own clinical knowledge and expertise. Implications for future service provision and further research are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.
van Duc, L.; Vree, M.; Cobelens, F. G.; Phuc, L. T.; Sy, D. N.
Little is known about tuberculosis (TB) prevalence in psychiatric hospitals in Vietnam, but prevalence may be higher than in the general population. We assessed the TB prevalence among in-patients of a psychiatric hospital in 2005 in Danang City, Vietnam. Of 300 in-patients, 70 had an abnormal X-ray
Zisman-Ilani, Yaara; Roe, David; Elwyn, Glyn; Kupermintz, Haggai; Patya, Noa; Peleg, Ido; Karnieli-Miller, Orit
Shared decision making (SDM) is an effective health communication model designed to facilitate patient engagement in treatment decision making. In mental health, SDM has been applied and evaluated for medications decision making but less for its contribution to personal recovery and rehabilitation in psychiatric settings. The purpose of this pilot study was to assess the effect of SDM in choosing community psychiatric rehabilitation services before discharge from psychiatric hospitalization. A pre-post non-randomized design with two consecutive inpatient cohorts, SDM intervention (N = 51) and standard care (N = 50), was applied in two psychiatric hospitals in Israel. Participants in the intervention cohort reported greater engagement and knowledge after choosing rehabilitation services and greater services use at 6-to-12-month follow-up than those receiving standard care. No difference was found for rehospitalization rate. Two significant interaction effects indicated greater improvement in personal recovery over time for the SDM cohort. SDM can be applied to psychiatric rehabilitation decision making and can help promote personal recovery as part of the discharge process.
Thomsen, Christoffer; Starkopf, Liis; Hastrup, Lene Halling
PURPOSE: Reducing the use of coercion among patients with mental disorders has long been a political priority. However, risk factors for coercive measures have primarily been investigated in smaller studies. To reduce the use of coercion, it is crucial to identify people at risk which we aim to do...... measure (21.9%). Clinical characteristics were the foremost predictors of coercion and patients with organic mental disorder had the highest increased risk of being subjected to a coercive measure (OR = 5.56; 95% CI = 5.04, 6.14). The risk of coercion was the highest in the first admission and decreased...... with the number of admissions (all p income countries (all p
Pelletier, Jean-François; Rowe, Michael; François, Nathe; Bordeleau, Julie; Lupien, Sonia
Despite the increasing pervasiveness of mobile computational technologies, knowledge about psychiatric patients' preferences regarding the design and utility of mobile applications is very poor. This paper reports on a pilot-study that involved 120 psychiatric patients in the development of a mobile application (app) that is being used for data entry into the Signature Project data bank at the Institut universitaire en santé mentale de Montréal (IUSMM), Canada. Participants were invited to comment on the 'look and feel' of the Signature App. Their input also extended the procedures for data collection. These suggestions may contribute to increased mental health literacy and empowerment of persons with mental illness receiving services at the IUSMM. Participants were recruited to fill out a questionnaire on a tablet computer while waiting at the Emergency Room (ER, n = 40), Psychotic Disorders outpatient clinic (n = 40) or Anxiety and Mood Disorders outpatient clinic (n = 40) of IUSMM. Nine patients from each of these sub-groups participated in a focus group to review the results and to discuss how the design and use of the Signature App could be improved to better meet the needs of patients. This study (n = 120) indicated that psychiatric patients are clearly capable of using a tablet computer to fill out questionnaires for quantitative data entry, and that they enjoyed this experience. Results from the focus groups (n = 27) highlight that the app could also be used by patients to communicate some personal and contextual qualitative information. This would support a holistic and person-centered approach, especially at the ER where people acutely need to describe their recent history and receive emotional support. This pilot-study has confirmed the necessity of involving patients not only in the testing of a new mobile application, but also as active contributors in the entire research and development process of a person-centered information and communication
Franza, Francesco; Del Buono, Gianfranco; Pellegrino, Ferdinando
The capacity to work productively is a key component of health and emotional well-being. People who work in health care can be exposed to the fatigue of care. Compassion fatigue has been described as an occupational hazard specific to clinical work related severe emotional distress. In our study, we have evaluated compassion fatigue in a mental health group (47 psychiatric staff) and its relationship with inpatients (237 inpatients) affected by some psychiatric disorders. At baseline, the more significant data indicate a high percentage of Job Burnout and Compassion Fatigue in psychiatric nurses (respectively, 39.28%, 28.57%). Significant Compassion Fatigue percentage is present also in psychologist group (36.36%). Finally, in psychiatrists, the exposure to patients increased vicarious trauma (28.57%), but not job burnout. After a year of participation in Balint Groups, the psychiatric staff presented an overall reduction in total mean score in any administered scale (CBI: pBurnout: pfatigue causes concern among mental health professionals, and Balint Groups may represent a therapeutic strategy to help health professionals to face difficulties in challenging work environments.
Jansson, Susanne; Fridlund, Bengt
A therapeutic alliance with a continuing collaboration between a patient and psychiatric staff is a resource for helping patients cope with the demands of coercive legislation. Knowledge exists describing coercion in inpatient care while the knowledge regarding the perceptions of creating a therapeutic alliance with patients on Community Treatment Orders (CTO) among psychiatric staff is scarce. To describe perceptions among psychiatric staff of creating a therapeutic alliance with patients on CTOs, an exploratory design using a phenomenographic method was employed. Thirteen semi-structured audio-taped interviews were conducted with psychiatric staff responsible for patients on CTOs. The staff worked in five different outpatient clinics and the interviews were conducted at their workplaces. The analysis resulted in in four metaphors: the persevering psychiatric staff, the learning psychiatric staff, the participating psychiatric staff, and the motivating psychiatric staff. Patients on CTOs were more time-consuming for psychiatric staff in care and treatment. Long-term planning is required in which the creation of a therapeutic alliance entails the patient gradually gaining greater self-awareness and wanting to visit the outpatient clinic. The professional-patient relationship is essential and if a therapeutic alliance is not created, the patient's continued care and treatment in the community is vulnerable.
Shumway, Martha; Mangurian, Christina; Carraher, Noah; Momenzadeh, Amanda; Leary, Mark; Lee, Emily K; Dilley, James W
People with serious mental illness (SMI) are at elevated risk of HIV infection, but do not receive HIV tests regularly. Inpatient psychiatric admissions provide opportunities for HIV testing. This study retrospectively examined the impact of three sequential interventions designed to increase HIV testing on an acute inpatient psychiatry service: (1) advocacy by an administrative champion, (2) an on-site HIV counselor, and (3) a clinician championing HIV testing. Demographic and HIV testing data were extracted from hospital data systems for 11,360 admissions of HIV-negative patients to an inpatient psychiatry service between 2006 and 2012. Relationships among interventions, length of stay, patient demographics, and receipt of an HIV test were examined using general estimating equation methods. In the year prior to the intervention, 7.2% of psychiatric inpatients received HIV tests. After 1 year of administrative advocacy, 11.2% received tests. Following the HIV counseling intervention, 25.1% of patients were tested. After the counseling intervention ended, continued administrative and clinical advocacy was associated with further increases in testing. In the final year studied, 30.3% of patients received HIV tests. Patients with shorter inpatient stays and those of Black or Asian race/ethnicity were less likely to be tested. Further, 1.6% of HIV tests were positive. Three interventions of varying intensity were associated with a 5-fold increase in HIV testing on an acute inpatient psychiatry service. Nonetheless, 70% of inpatients were not tested. Continued efforts are needed to increase HIV testing in inpatient psychiatric settings. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
Marshall, Max; Crowther, Ruth; Sledge, William Hurt; Rathbone, John; Soares-Weiser, Karla
Background Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. Objectives To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. Search methods We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. Selection criteria Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. Data collection and analysis Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. Main results Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days
Thorne, Catherine B.
This qualitative research study was designed to follow-up with ten participants in a relapse prevention program at an inpatient psychiatric unit with a diagnosis of major depression for the purpose of determining their experiences post-discharge in practicing relapse prevention and in pursuing and maintaining wellness in their mental health. It relied upon narrative theory, theories of self-efficacy, and theories of depression to guide the research process as well as the field of knowledge a...
Chiou, Yu-Jie; Chiu, Nien-Mu; Wang, Liang-Jen; Li, Shau-Hsuan; Lee, Chun-Yi; Wu, Ming-Kung; Chen, Chien-Chih; Wu, Yi-Shan; Lee, Yu
Clinical practice guidelines suggest routine screening for distress among cancer patients for immediate early psychiatric care. However, previous studies focusing on routine screening for psychological distress among cancer inpatients in Taiwan are scant. Thus, the aim of this study was to evaluate the prevalence and related factors of psychological distress and mental illness among cancer inpatients in Taiwan. This study was conducted as a retrospective chart review in a general hospital in southern Taiwan. Cancer inpatients were regularly screened by nursing staff using the Distress Thermometer and the 12-item Chinese Health Questionnaire. Positive screening results on either instrument were followed by a non-commanded referral to psychiatrists for clinical psychiatric diagnosis and treatment. Of the 810 participants in this study, 179 (22.1%) were recognized as having psychological distress. Younger age (odds ratio [OR] =1.82), having head and neck cancer (OR =2.43), and having not received chemotherapy (OR =1.58) were significantly related to psychological distress. Among the 56 patients (31.3%) with psychological distress who were referred to psychiatrists, the most common mental illness was adjustment disorder (n=22, 39.2%), followed by major depressive disorder (n=13, 23.2%), depressive disorder not otherwise specified (n=6, 10.7%), and anxiety disorder not otherwise specified (n=4, 7.1%). Our study indicated that cancer inpatients with psychological distress were more likely to be younger in age, have head and neck cancer, and have not received chemotherapy. The most common psychiatric disorder was adjustment disorder. Early detection of psychological distress and prompt psychiatric consultation and management are very important for cancer inpatients.
... Medicine IPF Inpatient psychiatric facility IPPS inpatient prospective payment system IRF Inpatient... IQR Program Disaster Extensions or Waivers 11. Electronic Health Records (EHRs) a. Background b... Wage Index 1. Secretary's Report to Congress on Wage Index Reform 2. Institute of Medicine (IOM) Study...
Lykke, Jørn; Oestrich, Irene; Austin, Stephen
milieu therapy (CMT) among a group of dual diagnosis inpatients. CMT is an integrated treatment for both mental illness and substance abuse based on cognitive behavioral principles and carried out within a supportive inpatient environment. A convenience sample of dual diagnosis inpatients (N = 136......Dual diagnosis is chronic psychiatric condition involving serious mental illness and substance abuse. Experts recommend the integration of treatment for concurrent substance abuse and serious psychiatric problems. The following pragmatic trial examined the implementation and outcomes of cognitive...
Restek-Petrović, Branka; Majdančić, Ana; Molnar, Sven; Grah, Majda; Ivezić, Ena; Filipčić, Igor; Bogović, Anamarija; Grošić, Vladimir; Mayer, Nina; Kezić, Slobodanka; Pavlović, Irena
Psychiatric hospital "Sveti Ivan" in Zagreb, Croatia, offers an outpatient Early intervention programme for patients with psychotic disorders (RIPEPP), consisting of psychoeducational workshops and group psychodynamic psychotherapy. The aim of this study was to describe sociodemographic and baseline characteristics of the participants, in order to provide better understanding of this population, and to assist with the development of more effective therapeutic approaches. Since 2008, a total of 245 patients with first episodes of psychosis and their family members participated in the programme. They filled out several questionnaires within the framework of the programme evaluation, but for the purposes of this study, only data collected on sociodemographic questionnaire and the Health of the Nation Outcome Scales (HoNOS) are presented. Majority of the participants were male (66%), at the average age of 28 (SD=6.6), living with their parents (73.5%). Most of them finished secondary school (45.7%) but almost a quarter of the sample (23.7%) is currently studying at university. The average duration of untreated period was 101.60 days, with a median of 30 days. According to results of HONOS questionnaire, upon entry into the programme, the patients most often listed cognitive functioning (attention, concentration, memory) and professional issues (performance of work tasks and activities tied to work) as the most problematic areas. The findings of this study provide more detailed description of the beneficiaries of the RIPEPP programme, which can contribute to forming future programmes for the prevention of psychotic disorders.
U.S. Department of Health & Human Services — The State Inpatient Databases (SID) contain the universe of hospital inpatient discharge abstracts in States participating in HCUP that release their data through...
Alice Guimarães Bottaro de Oliveira
Full Text Available A reforma psiquiátrica no Brasil articula várias dimensões - conceitual, técnica-assistencial, administrativa, legislativa e cultural - com o objetivo de superar o paradigma psiquiátrico que se estruturou em torno do isolamento e exclusão dos doentes mentais. Articula-se ao SUS e pressupõe hierarquização, municipalização, participação e controle social. Em Mato Grosso, apesar do avanço na dimensão administrativa, observa-se a sua realização em contextos de gestão centralizados, numa aparente contradição às suas raízes críticas. Nosso objetivo é analisar os processos participativos na construção da reforma psiquiátrica em Cuiabá e Mato Grosso, por meio do estudo de documentos dos Conselhos e Conferências de Saúde produzidos no período de 2000 a 2005. A fragilidade dos processos políticos dos Conselhos de Saúde dificulta a sua constituição como espaços articuladores de novas práticas. O processo de mudança rumo à reforma psiquiátrica se conforma como um novo desenho administrativo de gestão, determinado pelos novos modelos de financiamento - redução de internações e desospitalização -, sendo possível sua realização em processos centralizados de gestão, pois não resulta de crítica à lógica manicomial representada nas instâncias do SUS analisadas.The psychiatric reform in Brazil articulates several dimensions - conceptual, technical, administrative, legislative and cultural. It is aimed at overcoming the psychiatric paradigm based on isolation and exclusion of the mentally ill. The Reform makes part of the Brazilian Health System and presupposes a hierarchical system, municipality, participation and social control. Besides the advances made in the administrative dimension, in the state of Mato Grosso the reform takes place in centralized management contexts, revealing an apparent contradiction. Aim: Analyzing the participative processes in the construction of the psychiatric reform in Cuiab
Ladouceur, Robert; Sylvain, Caroline; Sévigny, Serge; Poirier, Lynda; Brisson, Laurent; Dias, Carlos; Dufour, Claudie; Pilote, Pierrette
Several researchers and clinicians have questioned the advantages and disadvantages of inpatient and outpatient treatment for people suffering from pathological gambling. This study compares the characteristics of pathological gamblers seeking inpatient and outpatient treatment. A total of 233 pathological gamblers (inpatients = 134, outpatients = 99) participated in the study. Results show that inpatients have more severe gambling problems than those receiving outpatient services. Similar results were obtained on most other related variables such as anxiety, depression, alcohol consumption, and comorbidity. These results are discussed in terms of the costs and benefits of these two treatment modalities.
Liu, Xiaoqin; Agerbo, Esben; Ingstrup, Katja G
in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models.Results Overall, psychiatric disorders were diagnosed in 32 400 children. The adjusted 15 year cumulative incidence of psychiatric......Objective To investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.Design Population based cohort study.Setting Danish national registers.Participants 905 383 liveborn singletons born during 1998-2012 in Denmark and followed from birth until July...... disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group. The antidepressant continuation group had an increased...
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.
Kröger, Christoph; Roepke, Stefan; Röepke, Stefan; Kliem, Sören
Although one of the main aims of dialectical behavior therapy (DBT) for borderline personality disorder (BPD) is to increase the retention rates, premature termination rates for DBT inpatient programs were found to be over 30%. The aim of the study was to identify the reasons for, and to analyze, patient characteristics that are associated with premature termination. We studied 541 inpatients with BPD, who were consecutively admitted for an open-door 3-month DBT inpatient treatment in Berlin, Germany. All participants completed several self-rating measures and participated in clinical interviews. Fourteen percent, who did not complete the full 84 days of assigned treatment, were expelled, mainly due to treatment-disturbing behaviors, or substance abuse or possession. Nearly 19% dropped out of treatment, mostly due to lack of motivation, arguments with others, and poor tolerance of emotional distress. Using non-parametric conditional inference trees, expulsion was associated with anorexia nervosa and alcohol abuse, whereas more than 9 suicide attempts, antisocial personality disorders, and more than 86 weeks in a psychiatric hospital were risk factors for dropout. We discussed measures and interventions that might lead to an adaptation of DBT inpatient programs. Future research should examine the symptom course and utilization of health-care services of non-completers. Copyright © 2014 Elsevier Ltd. All rights reserved.
Ruiz-Quintanilla, S Antonio; Weathers, Robert R; Melburg, Valerie; Campbell, Kimberly; Madi, Nawaf
The New York WORKS demonstration project was designed to improve employment outcomes for persons with psychiatric disabilities receiving Supplemental Security Income (SSI) disability payments. This article shows how the individual characteristics of participants were related to outcomes at each stage of the multistage recruitment process used in the project and how those characteristics contributed to enrollment. The findings are important to program administrators who are interested in ensuring that SSI recipients receive equal access to employment-related services and who want to improve recruitment strategies for future demonstration projects. The New York WORKS recruitment process used administrative records from the Social Security Administration (SSA) to identify the population of over 68,000 SSI recipients with a diagnosis of a psychiatric disability in Erie County and New York City. Staff involved in the project documented the results of each stage of the recruitment process. The New York WORKS project included four stages: (1) the provision of information (sending a letter and information packet); (2) demonstrated awareness of the project (response to a letter containing an overview of the project); (3) expression of interest (indication of interest in the project, using a postmarked form returned to New York WORKS project staff); and (4) participation (actual enrollment in the program). The project staff members were also able to identify data from administrative records that described the characteristics of the population, including age, sex, type of psychiatric diagnosis, the number of months that the person collected benefits before the recruitment process, employment experience before the recruitment process, and annual earnings in the year before the recruitment process. The data on outcomes at each stage of the recruitment process and the characteristics of SSI recipients were analyzed using an empirical method recently suggested by Heckman and
Ramirez-Bermudez, Jesus; Aguilar-Venegas, Luis C; Crail-Melendez, Daniel; Espinola-Nadurille, Mariana; Nente, Francisco; Mendez, Mario F
The authors describe the frequency and characteristics of Cotard syndrome among neurological and psychiatric inpatients at a tertiary referral center. All inpatients from the National Institute of Neurology of Mexico (March 2007-May 2009) requiring neuropsychiatric consultation were reviewed. Among 1,321 inpatient consultations, 63.7% had neurological disease and one (0.11%) had viral encephalitis and Cotard syndrome. Of inpatients, 36.2% had pure psychiatric disorders and three (0.62%) had Cotard syndrome, associated with psychotic depression, depersonalization, and penile retraction (koro syndrome). This review discusses potential mechanisms for Cotard syndrome, including the role of a perceptual-emotional dissociation in self-misattribution in the deliré des negations.
Reiss, Neele; Vogel, Friederike; Nill, Marco; Graf-Morgenstern, Mechthild; Finkelmeier, Britta; Lieb, Klaus
Patients with severe and chronic psychiatric disorders, such as Borderline Personality Disorder (BPD), are hospitalized frequently, but we often find a high ambivalence regarding treatment in this group of patients. 31 patients with severe BPD participated in an inpatient Schema Therapy (ST) treatment program and evaluated both the intensive ST treatment program and group therapy elements regarding their treatment -satisfaction. A high global treatment satisfaction with the ST treatment program was demonstrated and we found a higher treatment satisfaction in patients with than without BPD specific symptom reductions. Remarkable differences in treatment satisfaction showed when looking at the evaluation of group therapies. The results of the present study demonstrate treatment satisfaction of BPD patients in inpatient ST and give directions for the future development of these programs. © Georg Thieme Verlag KG Stuttgart · New York.
Objective: To determine the prospective and retrospective consistency of diagnoses among readmitted psychiatric in-patients at the Moi Teaching and Referral Hospital in Eldoret, Kenya. Method: Admission and discharge diagnoses among a consecutive sample of 114 psychiatric in-patients readmitted at the Moi Teaching ...
Lin, Yi-Chun; Lai, Chien-Liang; Chan, Hung-Yu
The correlation between different rehabilitation programs and the prevalence of metabolic syndrome in people with schizophrenia is unclear. We tested the association in chronic inpatients with schizophrenia of a psychiatric hospital in Taiwan. Patients with schizophrenia and age from 20 to 65 years old were included. The criteria of metabolic syndrome were according to the adapted Adult Treatment Protocol for Asians. According to different types of rehabilitations, patients were divided into work group, occupational therapy group and daily activities group. A total of 359 chronic inpatients with schizophrenia were recruited. Participants had a mean age of 45.9 years and the prevalence of metabolic syndrome was 37.3%. There was a significantly higher prevalence of metabolic syndrome in the work group than in the daily activity group (adjusted odds ratio (aOR) = 1.91, 95% CI = 1.019-3.564, p metabolic syndrome included old age, female gender, low psychotic symptoms severity and clozapine user. This study identified a high prevalence of metabolic syndrome in chronic inpatients with schizophrenia especially in patients with good occupational function. Further investigation of the relationship between the occupational function and metabolic syndrome is necessary for chronic inpatients with schizophrenia. Copyright © 2017 Elsevier B.V. All rights reserved.
Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service. ©2017 Frontline Medical Communications.
The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors
Dijkgraaf Marcel G
Full Text Available Abstract Background The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical pharmacists in medical teams. Within the current Hospital Pharmacy organisation in the Netherlands, such on-ward service is less feasible and therefore not yet established. However, given the substantial incidence of preventable ADEs in Dutch hospitals found in recent studies, appears warranted. Therefore, "Ward-Oriented Pharmacy", an on-ward service tailored to the Dutch hospital setting, will be developed. This service will consist of multifaceted interventions implemented in the Internal Medicine wards by hospital pharmacists. The effect of this service on preventable ADEs in elderly inpatients will be measured. Elderly patients are at high risk for ADEs due to multi-morbidity, concomitant disabilities and polypharmacy. Most studies on the incidence and preventability of ADEs in elderly patients have been conducted in the outpatient setting or on admission to a hospital, and fewer in the inpatient setting. Moreover, recognition of ADEs by the treating physicians is challenging in elderly patients because their disease presentation is often atypical and complex. Detailed information about the performance of the treating physicians in ADE recognition is scarce. Methods/Design The design is a multi-centre, interrupted time series study. Patients of 65 years or older, consecutively admitted to Internal Medicine wards will be included. After a pre-measurement, a Ward-Oriented Pharmacy service will be introduced and the effect of this service will be assessed during a post-measurement. The primary outcome measures are the ADE prevalence on admission and ADE incidence during hospital stay. These outcomes will be assessed using structured
Brand, Serge; Colledge, Flora; Beeler, Nadja; Pühse, Uwe; Kalak, Nadeem; Sadeghi Bahmani, Dena; Mikoteit, Thorsten; Holsboer-Trachsler, Edith; Gerber, Markus
Physical activity and exercise programs (PAEPs) are an important factor in increasing and maintaining physical and mental health. This holds particularly true for patients with psychiatric disorders undergoing treatment in a psychiatric hospital. To understand whether the benefits reported in the literature are mirrored in current treatment modalities, the aim of the present study was to assess the current state of PAEPs in psychiatric hospitals in the German-speaking part of Switzerland. All psychiatric hospitals (N=55) in the German-speaking part of Switzerland were contacted in spring 2014. Staff responsible for PAEPs were asked to complete an online questionnaire covering questions related to PAEPs such as type, frequency, staff training, treatment rationale, importance of PAEPs within the treatment strategy, and possible avenues to increase PAEPs. Staff members of 48 different psychiatric hospitals completed the survey. Hospitals provided the following therapeutic treatments: relaxation techniques (100%), sports therapy (97%), activity-related psychotherapeutic interventions (95%), physiotherapy (85%), body therapies (59%), far-east techniques (57%), and hippotherapy (22%). Frequencies ranged from once/week to five times/week. Approximately 25% of patients participated in the PAEPs. Interventions were offered irrespective of psychiatric disorders. PAEP providers wanted and needed more vocational training. All participating psychiatric hospitals offer a broad variety of PAEPs in their treatment curricula. However, the majority of inpatients do not participate in PAEPs. Furthermore, those who do participate cannot continue to do so following discharge. PAEP providers need specific extended vocational trainings and believe that the potential of PA should be improved.
Wetterling, Tilman; Schneider, Barbara
Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms. © Georg Thieme Verlag KG Stuttgart · New York.
Brand, S; Härter, M; Sitta, P; van Calker, D; Menke, R; Heindl, A; Herold, K; Kudling, R; Luckhaus, C; Rupprecht, U; Sanner, Dirk; Schmitz, D; Schramm, E; Berger, M; Gaebel, W; Schneider, F
Several quality assurance initiatives in health care have been undertaken during the past years. The next step consists of systematically combining single initiatives in order to built up a strategic quality management. In a German multicenter study, the quality of inpatient depression treatment was measured in ten psychiatric hospitals. Half of the hospitals received comparative feedback on their individual results in comparison to the other hospitals (bench marking). Those bench markings were used by each hospital as a statistic basis for in-house quality work, to improve the quality of depression treatment. According to hospital differences concerning procedure and outcome, different goals were chosen. There were also differences with respect to structural characteristics, strategies, and outcome. The feedback from participants about data-based quality circles in general and the availability of bench-marking data was positive. The necessity of carefully choosing quality circle members and professional moderation became obvious. Data-based quality circles including bench-marking have proven to be useful for quality management in inpatient depression care.
... medical education I-O Input-Output IOM Institute of Medicine IPF Inpatient psychiatric facility IPPS... Determinations 6. RHQDAPU Program Disaster Extensions and Waivers 7. Proposed Chart Validation Requirements for...
Full Text Available Abstract Background While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital. Methods We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed. Results 728 out of 1550 eligible patients (47% participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08, average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005, the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P P Conclusion Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients. However, if comparison across medical services or hospitals is desired, using a generic questionnaire might be advantageous.
Eriks-Hoogland, Inge; de Groot, Sonja; Snoek, Govert; Stucki, Gerold; Post, Marcel; van der Woude, Lucas
To examine whether musculoskeletal shoulder pain and limitations in shoulder range of motion (ROM) at discharge from first rehabilitation are associated with activities and participation restrictions 5 years later in persons with spinal cord injury (SCI). Prospective cohort study. Eight specialized SCI rehabilitation centers. Subjects (N=138) with an SCI admitted for first rehabilitation. Not applicable. Peak power output (POpeak), Wheelchair Skills Test (WST), FIM motor score, ability to transfer, Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), mobility range and social behavior subscales of the Sickness Impact Profile 68 (SIPSOC), and employment status. Mean age of the subjects at discharge was 39 years, 72% were men, 32% had tetraplegia, and in 65% the SCI was motor complete. At discharge, 39% reported shoulder pain and 32% had a limited shoulder ROM. In the analyses of variance, shoulder ROM limitation, but not shoulder pain, was associated with all but 1 outcome at 5 years. In the regression analyses, ROM limitations of the shoulder were negatively associated with the ability to transfer (P=.004), FIM motor scores (PRehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Rafael Henriques Candiago
Full Text Available OBJETIVO: Descrever a construção e o teste de rotina para análise das interna-ções psiquiátricas pelo Sistema Único de Saúde, a partir de seu banco de dados (Datasus, e analisar as características e tendências dessas internações. MÉTODOS: Foram extraídos dados das autorizações de internação hospitalar dos anos de 2000 a 2004, no Rio Grande do Sul. Os dados referentes a 91.233 internações foram processados por meio de sintaxes pelo programa SPSS, tendo sido testada a confiabilidade das rotinas. Foram descritas as freqüências das internações em hospitais gerais e psiquiátricos, e os principais diagnósticos, com análise de tendências por modelos de regressão polinomial. RESULTADOS: As confiabilidades intra e interavaliador foram de 100%. Observou-se tendência de crescimento na proporção das internações por transtornos de humor e de diminuição naquelas por esquizofrenia e por transtornos orgânicos. A proporção de internações por transtorno por uso de substâncias manteve-se estável. Houve tendência crescente na proporção do número de internações psiquiátricas em hospitais gerais, apresentando um crescimento de 97,7% no período. CONCLUSÕES: Foram evidenciadas a confiabilidade e a viabilidade das rotinas apresentadas, sugerindo o uso dos arquivos do Sistema de Informações Hospitalares como fonte de dados para a avaliação contínua das internações psiquiátricas pelo Sistema Único de Saúde. As alterações observadas nas proporções de internações psiquiátricas podem ter sido devido às mudanças: no tipo de pacientes; no padrão de diagnósticos, conhecido como viés de diagnóstico orientado pelo tratamento; e na legislação.OBJECTIVE: To describe the construction and testing of a routine to assess psychiatric hospitalizations in the Brazilian Health System based on its database (DATASUS, and to assess characteristics and trends of these hospitalizations. METHODS: Data were extracted
Louwerse, A.; Eussen, M. L. J. M.; Van der Ende, J.; de Nijs, P. F. A.; Van Gool, A. R.; Dekker, L. P.; Verheij, C.; Verheij, F.; Verhulst, F. C.; Greaves-Lord, K.
The current 7-year follow-up study investigated: (1) the stability of ASD severity, and (2) associations of ASD severity in adolescence with (a) childhood and concurrent psychiatric comorbidity, and (b) concurrent societal functioning. The Autism Diagnostic Observation Schedule (ADOS) and the Diagnostic Interview Schedule for Children were…
FINAL REPORT DATES COVERED (From - To) JULY 2008 TO AUG 2009 4. TITLE AND SUBTITLE lnpatient Mental Health Recapture 5a. CONTRACT NUMBER 5b...provides 28 Medical/Surgical inpatient beds, 6 ICU beds, and full spectrum outpatient clinical services (Table l). EACH maintained inpatient mental health...Global War on Terrorism (GWOT), EACH experienced a significant increase in the amount of inpatient mental health purchased in the Colorado Springs
... I-O Input-Output IOM Institute of Medicine IPF Inpatient psychiatric facility IPFQR Inpatient... Disorders of the Circulatory System) a. Discharge/Transfer to Designated Disaster Alternative Care Site b... Program e. Proposed Disaster/Extraordinary Circumstance Waivers under the Hospital VBP Program 10...
Objective: The aim of this report was to establish a profile of patients with borderline personality disorder (BPD) admitted to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over the course of 1 year. Methods: A retrospective record review was conducted to investigate the ...
Sourander, Andre; Gyllenberg, David; Brunstein Klomek, Anat; Sillanmäki, Lauri; Ilola, Anna-Marja; Kumpulainen, Kirsti
Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear. To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age. Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015. Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment. Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years
Ayala, Leilanie Marie; Wang, Jichuan; Anderson, Stephanie; Brevard, Alexis; Ruiz, Michael; Bannerman, Reginald; Robertson, Barbara; Cheng, Yao Iris; Hinds, Pamela
Adolescents with a mental health diagnosis are at risk of involvement in bullying. We tested the feasibility of a bullying awareness group intervention in an established inpatient psychiatric unit milieu. Adolescents admitted to an urban inpatient adolescent psychiatric unit were eligible to attend two sequential 1-hour Bullying Awareness intervention group sessions. Data were collected before the first session (T1), post-both sessions (T2), and following discharge from the unit (T3). A total of 65 adolescents were enrolled; most were female (66.2%), African-American (60%), and in grades 10 to 12 (57%). Intervention feasibility was achieved as >80% of participants completed all components of the intervention and 100% completed all study questionnaires at T1 and T2. Feasibility of the follow-up (T3) was not achieved. Bullying knowledge scores improved significantly from T1 to T2. The intervention is feasible to implement in an inpatient adolescent psychiatry unit and can improve adolescents' bullying knowledge. Copyright © 2015 Elsevier Inc. All rights reserved.
To determine the magnitude and pattern of aggressive behaviour among psychiatric in-patients and identity associated socio-demographic and clinical factors. The studywas cross-sectional in design. Among patients admitted to theNeuro-psychiatricHospital, Aro (and its Lantoro annex), Abeokuta between January 1 to ...
Stone, Lindsey Beth; Liu, Richard; Yen, Shirley
Adolescents with a history of suicidal behavior are especially vulnerable for future suicide attempts, particularly following discharge from an inpatient psychiatric admission. This study is the first to test whether adolescents’ tendency to generate stress, or report more dependent events to which they contributed, was predictive of prospective suicide events. Ninety adolescent psychiatric inpatients who were admitted for recent suicide risk, completed diagnostic interviews, assessments of history of suicidal behavior, and a self-report questionnaire of major life events at baseline. Participants were followed over the subsequent 6 months after discharge to assess stability vs. onset of suicide events. Cox proportional hazard regressions were used to predict adolescents’ time to suicide events. Results supported hypothesis, such that only recent greater dependent events, not independent or overall events, predicted risk for prospective suicide events. This effect was specific to adolescent girls. Importantly, dependent events maintained statistical significance as a predictor of future suicide events after co-varying for the effects of several established risk factors and psychopathology. Results suggest that the tendency to generate dependent events may contribute unique additional prediction for adolescent girls’ prospective suicide risk, and highlight the need for future work in this area. PMID:24893759
Stone, Lindsey B; Liu, Richard T; Yen, Shirley
Adolescents with a history of suicidal behavior are especially vulnerable for future suicide attempts, particularly following discharge from an inpatient psychiatric admission. This study is the first to test whether adolescents׳ tendency to generate stress, or report more dependent events to which they contributed, was predictive of prospective suicide events. Ninety adolescent psychiatric inpatients who were admitted for recent suicide risk, completed diagnostic interviews, assessments of history of suicidal behavior, and a self-report questionnaire of major life events at baseline. Participants were followed over the subsequent 6 months after discharge to assess stability vs. onset of suicide events. Cox proportional hazard regressions were used to predict adolescents׳ time to suicide events. Results supported hypothesis, such that only recent greater dependent events, not independent or overall events, predicted risk for prospective suicide events. This effect was specific to adolescent girls. Importantly, dependent events maintained statistical significance as a predictor of future suicide events after co-varying for the effects of several established risk factors and psychopathology. Results suggest that the tendency to generate dependent events may contribute unique additional prediction for adolescent girls׳ prospective suicide risk, and highlight the need for future work in this area. Published by Elsevier Ireland Ltd.
Falcone, Tatiana; Janigro, Damir; Lovell, Rachel; Simon, Barry; Brown, Charles A; Herrera, Mariela; Myint, Aye Mu; Anand, Amit
Serum levels of the astrocytic protein S100B have been reported to indicate disruption of the blood-brain barrier. In this study, we investigated the relationship between S100B levels and childhood trauma in a child psychiatric inpatient unit. Levels of S100B were measured in a group of youth with mood disorders or psychosis with and without history of childhood trauma as well as in healthy controls. Study participants were 93 inpatient adolescents admitted with a diagnosis of psychosis (N = 67), or mood disorder (N = 26) and 22 healthy adolescents with no history of trauma or psychiatric illness. Childhood trauma was documented using the Life Events Checklist (LEC) and Adverse Child Experiences (ACE). In a multivariate regression model, suicidality scores and trauma were the only two variables which were independently related to serum S100B levels. Patients with greater levels of childhood trauma had significantly higher S100B levels even after controlling for intensity of suicidal ideation. Patients with psychotic diagnoses and mood disorders did not significantly differ in their levels of S100B. Patients exposed to childhood trauma were significantly more likely to have elevated levels of S100B (p trauma, and patients with trauma had significantly higher S100B levels (p Childhood trauma can potentially affect the integrity of the blood-brain barrier as indicated by associated increased S100B levels. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available Abstract Background Childhood stress and trauma have been related to adult psychopathology in different psychiatric disorders. The present study aimed at verifying this relationship for stressful experiences during developmental periods by screening stress load across life in adult psychiatric inpatients with different diagnoses compared to healthy subjects. In addition, a relationship between the amount of adverse experiences and the severity of pathology, which has been described as a 'building block' effect in posttraumatic stress disorder (PTSD, was explored for non-traumatic events in psychiatric disorders other than PTSD. Methods 96 patients with diagnoses of Major Depressive Disorder (MDD, schizophrenia, drug addiction, or personality disorders (PD and 31 subjects without psychiatric diagnosis were screened for adverse experiences in childhood (before the age of six years, before onset of puberty, and in adulthood using the Early Trauma Inventory and the Posttraumatic Stress Diagnostic Scale. Effects of stress load on psychopathology were examined for affective symptoms, PTSD, and severity of illness by regression analyses and comparison of subgroups with high and low stress load. Results High stress load in childhood and before puberty, but not in adulthood, was related to negative affect in all participants. In patients, high stress load was related to depressive and posttraumatic symptoms, severity of disorder, and the diagnoses of MDD and PD. Conclusion Results support the hypothesis of stress-sensitive periods during development, which may interact with genetic and other vulnerability factors in their influence on the progress of psychiatric disorders. A 'dose' effect of stress load on the severity of psychopathology is not restricted to the relationship between traumata and PTSD.
Full Text Available Background: This study examined the tendency and suicidal behavior rates of Chinese adult inpatients with different types of mental disorders from 2010 to 2015. The aim was to provide some interesting clues for further studies. Methods: Adult patients with mental disorders who were hospitalized in Beijing Anding hospital from 1 January 2010 to 31 December 2015 were included. Chi-square tests were used to compare the difference among inpatients with mental disorders by gender and year. Frequency, trend and suicidal behavior rates of inpatients with mental disorders were graphed. Results: A total of 17,244 psychiatric adult inpatients were included in our study. About 53.2% of the inpatients had mood disorders, followed by schizophrenia, which accounted for 34.6%. The proportion of female inpatients with mental disorders was larger than that of males (52.6% to 47.4%. Of the total, 3296 psychiatric inpatients were recognized as having suicidal behaviors. The rate of suicidal behavior among all inpatients was 19.1%, and it varied over the years. The suicidal behavior rate of female inpatients with mood disorders was much higher than that of the corresponding male inpatients. Conclusions: The presence of suicidal behavior varied among people with different types of mental disorders. For each type of mental illness, identifying the risk of specific suicide behavior would help tailor-make preventive efforts accordingly.
Gao, Qi; Fan, Hua; Di, Fei; Xia, Xue; Long, Haiying; Zhu, Huiping
Background: This study examined the tendency and suicidal behavior rates of Chinese adult inpatients with different types of mental disorders from 2010 to 2015. The aim was to provide some interesting clues for further studies. Methods: Adult patients with mental disorders who were hospitalized in Beijing Anding hospital from 1 January 2010 to 31 December 2015 were included. Chi-square tests were used to compare the difference among inpatients with mental disorders by gender and year. Frequency, trend and suicidal behavior rates of inpatients with mental disorders were graphed. Results: A total of 17,244 psychiatric adult inpatients were included in our study. About 53.2% of the inpatients had mood disorders, followed by schizophrenia, which accounted for 34.6%. The proportion of female inpatients with mental disorders was larger than that of males (52.6% to 47.4%). Of the total, 3296 psychiatric inpatients were recognized as having suicidal behaviors. The rate of suicidal behavior among all inpatients was 19.1%, and it varied over the years. The suicidal behavior rate of female inpatients with mood disorders was much higher than that of the corresponding male inpatients. Conclusions: The presence of suicidal behavior varied among people with different types of mental disorders. For each type of mental illness, identifying the risk of specific suicide behavior would help tailor-make preventive efforts accordingly.
Lykke, Jørn; Oestrich, I.; Austin, Stephen
) was assessed pre- and post-intervention from an inpatient setting where CMT was the mode of treatment. Psychopathology was measured using the Brief Psychiatric Rating Scale and substance abuse measured with the DrugCheck scale, breath/urine samples, and the Severity of Dependence Scale. Functioning......Dual diagnosis is chronic psychiatric condition involving serious mental illness and substance abuse. Experts recommend the integration of treatment for concurrent substance abuse and serious psychiatric problems. The following pragmatic trial examined the implementation and outcomes of cognitive...... milieu therapy (CMT) among a group of dual diagnosis inpatients. CMT is an integrated treatment for both mental illness and substance abuse based on cognitive behavioral principles and carried out within a supportive inpatient environment. A convenience sample of dual diagnosis inpatients (N = 136...
Krumm, Silvia; Kilian, Reinhold; Becker, Thomas
There is an increasing awareness of gender-related issues in psychiatry. However, empirical findings on attitudes of psychiatric staff towards patient gender are limited. Gender-related issues are particularly relevant in the debate about mixed versus segregated sex wards, yet while the appropriateness of mixed-sex wards is questioned in Great Britain this is not the case in Germany. To investigate attitudes of psychiatric staff towards both patient gender and mixed versus segregated sex wards, we conducted a case study using focus groups with members of professional teams. We evaluated the transition process from two single-sex wards to two mixed-sex wards in a 330-bed psychiatric hospital in a rural area in south Germany. Staff described female patients as more externally oriented, motivating of others, demanding, and even sexually aggressive. Male patients, on the other hand, were described as more quiet, modest, or lazy. Furthermore, participants described the mixing process as a positive development whereas they did not see a need for gender-separated wards in order to protect vulnerable female patients. Some gender descriptions by professionals are "reversed" in comparison with gender stereotypes supposed to be present in wider society. The perception of crossed gender norms may affect staff attitudes towards the vulnerability of female patients in psychiatric settings and the provision of single-sex wards in in-patient psychiatric care. Practical implications are discussed against the background of a high rate of female patients with sexual abuse histories.
Dressing, Harald; Scheuble, Barbara; Gass, Peter
The present study was designed to to investigate lifetime prevalence and types of stalking victimization in a sample of psychiatric in-patients. 300 consecutively admitted patients of the psychiatric clinic of the Central Institute of Mental Health were included and examined with a standardized stalking victimisation questionnaire. The cohort of psychiatric in-patients had a lifetime prevalence of being a stalking victim of 21.3 % . The percentage of men and women affected was equal. The course of stalking was more difficult to handle and more violent compared to a representative cohort of the general population of Mannheim. In most cases, the psychiatric disorder had been present before the stalking victimization started. The attending psychiatrists were only aware of the stalking victimization in four cases. Stalking seems to be a relevant problem in psychiatric patients. The results indicate that there is urgent need for advanced educational programs for patients and psychiatrists. Georg Thieme Verlag KG Stuttgart. New York.
Swenson, Lance P.; Esposito-Smythers, Christianne; Hunt, Jeffrey I.; Hollander, Beth L. G.; Dyl, Jennifer; Rizzo, Christie J.; Steinley, Douglas L.; Spirito, Anthony
A study was conducted to examine the concurrent validity of the Children's Interview for Psychiatric Syndromes (ChIPS) for adolescent inpatients aged 12 to 18. The results reveal moderate agreement between ChIPS diagnoses and Schedule for Affective Disorder sand Schizophrenia for School-Age Children-Present and Lifetime version diagnoses.
Sullivan, Patrick F; Agrawal, Arpana; Bulik, Cynthia M
into biologically, clinically, and therapeutically meaningful insights. The emerging findings suggest that we are entering a phase of accelerated genetic discovery for multiple psychiatric disorders. These findings are likely to elucidate the genetic portions of these truly complex traits, and this knowledge can...... then be mined for its relevance for improved therapeutics and its impact on psychiatric practice within a precision medicine framework. [AJP at 175: Remembering Our Past As We Envision Our Future November 1946: The Genetic Theory of Schizophrenia Franz Kallmann's influential twin study of schizophrenia in 691...
U.S. Department of Health & Human Services — A list of inpatient rehabilitation facilities with data on the number of times people with Medicare who had certain medical conditions were treated in the last year.
Webster, Steven L; Sheitman, Brian B; Barboriak, Peter N; Harmon, Susan H; Paesler, Betty T; Gordon, Pamela A; Kelly, Shirley Y; Geller, Jeffrey L
This brief report presents outcome data from a 350-bed state psychiatric hospital that integrated its adult forensically and civilly committed inpatient populations within one rehabilitative program. Dorothea Dix Hospital, located in Raleigh, North Carolina, used the "treatment mall" model to offer all of its resources to all adult patients in a centralized setting. Program participation of 100 patients from two long-term civil units was compared with program participation of 94 patients from the hospital's medium- and maximum-security forensic units. The forensic patients were significantly less likely to refuse to join or to leave a group, and they were better engaged in their treatment. The use of restrictive interventions and the incidence of assault were minimal for both groups. The experience at Dorothea Dix Hospital suggests that integrating these populations in rehabilitative programming is not only fiscally responsible but also clinically promising, with no evidence of greater disruptiveness attributable to forensic patients.
This paper reports a study illuminating the factors that either facilitate or constrain the ability of community psychiatric nurses, in their role as care co-ordinators, to meet service users' and carers' needs. The Care Programme Approach is the key policy underpinning community-focused mental health services in England, but has been unevenly implemented and is associated with increased inpatient bed use. The care co-ordinator role is central to the Care Programme Approach and is most often held by community psychiatric nurses, but there has been little research into how this role is performed or how it affects the work of community psychiatric nurses and their ability to meet the needs of service users. A multiple case study of seven sectorised community mental health teams was employed over 2 years using predominantly qualitative methods including participant observation, semi-structured interviews and document review. The data were collected in one National Health Service trust in south England between 1999 and 2001. Additional duties and responsibilities specifically associated with the care co-ordinator role and multidisciplinary working, combined with heavy workloads, produced 'limited nursing', whereby community psychiatric nurses were unable to provide evidence-based psychosocial interventions that are recognized to reduce relapse amongst people with severe mental illness. The role of the Care Programme Approach care co-ordinator was not designed to support the provision of psychosocial interventions. Consequently, community psychiatric nurses in the co-ordinator role are faced with competing demands and are unable to provide the range of structured, evidence-based interventions required. This may partially account for the increased inpatient bed use associated with the Care Programme Approach.
Fernando Madalena Volpe
Full Text Available OBJECTIVE: To describe the clinical practices on the treatment of mania in a Brazilian hospital, and to compare them to other international similar reports and practice guidelines. METHODS: Chart revision of 425 consecutive admissions (269 patients for the treatment of manic or mixed episodes (ICD-10 criteria in a private psychiatric hospital of Belo Horizonte, Brazil, from 1996 to 2000. The rates of utilization of each antimanic medication and ECT were compared to those reported in similar international observational studies (X², bicaudate, alpha =0.05. RESULTS: The observed frequencies of use of each treatment modality were: lithium (71.5%; carbamazepine (34.8%; valproate (9.4%; antipsychotics (83.3%; benzodiazepines (62.4%; antidepressants (7.5% and ECT (33.2%. The differences detected between local practice and international guidelines were: lower rate of valproate and higher rate of carbamazepine prescription; the use of sine wave devices for ECT; frequent concomitant use of ECT with lithium (72.3%, benzodiazepines (46.8% and/or carbamazepine (31.2%. CONCLUSION: These results suggest the need to develop national practice guidelines for the treatment of mania and for the use of ECT, and to promote their propagation through specific medical educational programs, aiming at the standardization of practices based on the available scientific evidence.OBJETIVO: Descrever as práticas clínicas no tratamento da mania em um hospital brasileiro e compará-las com aquelas descritas e recomendadas nas publicações internacionais. MÉTODOS: Revisão dos prontuários de 425 internações consecutivas (269 pacientes para episódios maníacos ou mistos (CID-10 em um hospital psiquiátrico privado de Belo Horizonte (MG, de 1996 a 2000. As freqüências de utilização dos diversos medicamentos e de ECT foram comparadas com as descritas em estudos observacionais estrangeiros (X², bicaudado, alfa =0,05. RESULTADOS: As freqüências observadas de uso de
Müller, Matthias J; Olschinski, Christiane; Kundermann, Bernd; Cabanel, Nicole
Sleep complaints and sleep disturbances are highly prevalent in patients with psychiatric disorders. During hospitalization the patients? condition may be even worse but little is known about the subjective sleep quality in psychiatric hospitals. Thus, we have investigated subjective sleep quality and mean sleep duration in patients with different psychiatric disorders at the end of hospitalization. For a period of one year, inpatients of a psychiatric hospital with diagnosis of substance use...
Lin, Huang-Li; Chou, Hung-Hsueh; Liu, Chia-Yih; Hsu, Shi-Chieh; Hsiao, Mei-Chun; Juang, Yeong-Yuh
The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.
van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K
Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry.
Hoffmann, P; Tiggemann, H G
Psychiatric care has gradually been shifting in Germany from its original inpatient basis to outpatient and complementary treatment. This shift of emphasis resulted in a transfer of psychiatry-political responsibility to communal bodies and hence also to communal public health services. Sociopsychiatric service ranks high in communal psychiatric care setups, since it promotes cooperation and helps to coordinate efforts in individual cases in respect of focal points on which such care is centered. For the future, an expert commission has suggested that the various institutions actively engaged in community psychiatric care should team up in each region. This applies in particular to mobile services visiting the patients in their homes, and to the offices providing contracts to sociopsychiatric services of public health offices. Despite positive outlooks there are also quite a few negative aspects of present-day practice. One of them is poor definition of tasks and functions of communal sociopsychiatric services, whereas another one are the unsatisfactory quantitative and qualitative means at their disposal. It is also too often overlooked that psychiatric patients and disabled persons are entitled to compensation insurance payments to promote their rehabilitation, as provided for by individual legislation in the various German laender. To tap these sources sufficiently well, sociopsychiatric services must be better equipped in every respect. The professional competence of social workers and physicians, as well as of the relevant staff, must be safeguarded by continuing education and specialist training measures.
Full Text Available Context: Substance Use Disorders (SUDs are highly prevalent among inpatient adolescents with psychiatric disorders. In this population, substance use and other psychiatric outcomes can reinforce one another. Despite the need for integrated interventions in youths with dual diagnoses, few specific instruments are available. App-based technologies have shown promising results to help reduce substance use in adolescents, but their applicability in youths with associated severe psychiatric disorders is poorly documented. We aim to evaluate the feasibility of an ecological momentary assessment (EMA intervention for all substance users, and of a smart-phone application for cannabis users (Stop-Cannabis, for outpatient treatment after hospital discharge. Methods and analysis: All inpatient adolescents with psychiatric disorders hospitalized between 2016 and 2018 in a university hospital will be systematically screened for SUD and, if positive, will be assessed by an independent specialist addiction team. Participants with confirmed SUDs will be invited and helped to download an EMA app and, if required, the Stop-Cannabis app the week preceding hospital discharge. Information about the acceptability and use of both apps and the validity of EMA data in comparison to clinical assessments will be assessed after 6 months and one year.Discussion: This research has been designed to raise specific issues for consideration regarding the sequence between substance use, contextual factors, and other psychiatric symptoms among adolescents with comorbid severe psychiatric disorders. A better understanding of the mechanisms involved will inform the development of integrated treatment for dual disorders at that age.Ethics and dissemination: The study has already been approved and granted. Dissemination will include presentations at international congresses as well as publications in peer-reviewed journals.Trial registration: European Clinical Trials Database: Number
Benarous, Xavier; Edel, Yves; Consoli, Angèle; Brunelle, Julie; Etter, Jean-François; Cohen, David; Khazaal, Yasser
Substance use disorders (SUDs) are highly prevalent among inpatient adolescents with psychiatric disorders. In this population, substance use and other psychiatric outcomes can reinforce one another. Despite the need for integrated interventions in youths with dual diagnoses, few specific instruments are available. App-based technologies have shown promising results to help reduce substance use in adolescents, but their applicability in youths with associated severe psychiatric disorders is poorly documented. We aim to evaluate the feasibility of an ecological momentary assessment (EMA) intervention for all substance users, and of a smartphone application for cannabis users (Stop-Cannabis), for outpatient treatment after hospital discharge. All inpatient adolescents with psychiatric disorders hospitalized between 2016 and 2018 in a university hospital will be systematically screened for SUD and, if positive, will be assessed by an independent specialist addiction team. Participants with confirmed SUDs will be invited and helped to download an EMA app and, if required, the Stop-Cannabis app, the week preceding hospital discharge. Information about the acceptability and use of both apps and the validity of EMA data in comparison to clinical assessments will be assessed after 6 months and 1 year. This research has been designed to raise specific issues for consideration regarding the sequence between substance use, contextual factors, and other psychiatric symptoms among adolescents with comorbid severe psychiatric disorders. A better understanding of the mechanisms involved will inform the development of integrated treatment for dual disorders at that age. The study has already been approved and granted. Dissemination will include presentations at international congresses as well as publications in peer-reviewed journals. European Clinical Trials Database: Number 2016-001999-30.
Ong, Yong Lock; Yap, Hwa Ling
We report the case of a 29-year-old mixed-race woman suffering from recurrent major depressive episodes, with suicidal ideation and risk, involving several inpatient admissions. A comorbid diagnosis of borderline personality disorder was also recorded in one of her previous inpatient admissions. During her last inpatient admission, a multidisciplinary case discussion and review of the patient's life highlighted several possible intercultural trigger factors that could have contributed to the exacerbation of her psychiatric illness. We emphasise the need to explore intercultural predisposing and precipitating factors for a more complete psychodynamic understanding of psychiatric illnesses among the multiracial population of Singapore. This also adds to the discussion on the management of such patients with the option of formal in-depth psychotherapy in adjunct to medication. This may prevent recurrent relapses, modify suicide intent and reduce the necessity for inpatient treatment, which will be cost-effective and result in efficacious treatment.
Huffman, Jeff C; DuBois, Christina M; Healy, Brian C; Boehm, Julia K; Kashdan, Todd B; Celano, Christopher M; Denninger, John W; Lyubomirsky, Sonja
The objective was to assess the feasibility and acceptability of nine positive psychology exercises delivered to patients hospitalized for suicidal thoughts or behaviors, and to secondarily explore the relative impact of the exercises. Participants admitted to a psychiatric unit for suicidal ideation or behavior completed daily positive psychology exercises while hospitalized. Likert-scale ratings of efficacy (optimism, hopelessness, perceived utility) and ease of completion were consolidated and compared across exercises using mixed models accounting for age, missing data and exercise order. Overall effects of exercise on efficacy and ease were also examined using mixed models. Fifty-two (85.3%) of 61 participants completed at least one exercise, and 189/213 (88.7%) assigned exercises were completed. There were overall effects of exercise on efficacy (χ(2)=19.39; P=.013) but not ease of completion (χ(2)=11.64; P=.17), accounting for age, order and skipped exercises. Effect (Cohen's d) of exercise on both optimism and hopelessness was moderate for the majority of exercises. Exercises related to gratitude and personal strengths ranked highest. Both gratitude exercises had efficacy scores that were significantly (P=.001) greater than the lowest-ranked exercise (forgiveness). In this exploratory project, positive psychology exercises delivered to suicidal inpatients were feasible and associated with short-term gains in clinically relevant outcomes. © 2014.
Vanessa de Albuquerque Citero
Full Text Available ABSTRACT CONTEXT: An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders. OBJECTIVE: To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity. TYPE OF STUDY: Descriptive study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: 319 patients referred 412 times to the consultation-liaison psychiatry service. PROCEDURES: From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do Câncer, and also all referrals registered at the consultation-liaison psychiatry service. MAIN MEASUREMENTS: The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service. RESULTS: Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders. CONCLUSION: A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated
Lloyd-Evans, Brynmor; Howard, Louise M; Slade, Mike; Johnson, Sonia; Gregoire, Alain; Elkin, Amanda; Gilburt, Helen
This study identified all mother and baby units (MBUs) (defined in this study as inpatient psychiatric units where mothers and babies could be admitted that had at least four beds and were separate from other wards...
Harris, J Irene; Farchmin, Leah; Stull, Laura; Boyd, Jennifer; Schumacher, Marianne; Drapalski, Amy L
Interventions addressing internalized stigma are a new area of research, and it is important to identify the types of clientele who derive benefit from existing interventions. Information was provided by 235 veterans attending a partial psychiatric hospitalization program, regarding their levels of internalized stigma on admission and discharge from a 3-week program that included interventions targeting internalized stigma. Upon discharge, veterans receiving disability benefits demonstrated less reduction in internalized stigma than those not receiving disability benefits. Time of service moderated the relationship between disability status and change in internalized stigma, such that veterans serving in the more recent Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) cohort who received disability benefits had a more difficult time resolving internalized stigma. Further analyses suggested that OEF/OIF/OND cohort veterans receiving disability benefits have more difficulty developing effective stigma resistance, and more difficulty resolving stigma-related alienation, than other veterans. Based on this research, particular attention should be devoted to internalized stigma among OEF/OIF/OND veterans. (c) 2015 APA, all rights reserved).
de Niet, Gerrit; Tiemens, Bea; Hutschemaekers, Giel
This article describes a pilot study that was carried out to in order to gain an indication as to whether mental healthcare nurses can apply evidence-based interventions for sleep problems effectively in inpatient mental health care. The study had a pre-test/post-test design and a comparison group was used. The study was performed on three psychiatric admission wards, located in three different towns in one province of The Netherlands. The participants were inpatients (18-60 years old) admitted owing to severe mental health problems like psychotic, mood or anxiety disorders. Of the newly admitted patients, 62.8% perceived having a sleep problem. Two brief, evidence-based interventions were introduced on two of the wards: the first with stimulus control (SC) as active component; the second with music-assisted relaxation (MAR). A third ward, with no interventions other than usual care, served as a point of comparison. Sleep quality was monitored using the Richards-Campbell Sleep Questionnaire (RCSQ). The change score means of the treatment groups were compared with the mean score of the comparison group by means of a t-test. Estimates of effect were calculated. The results of this study showed that MAR produced a statistically significant improvement of sleep quality and showed a large effect size. The total RCSQ score did not improve significantly. SC failed to produce statistically significant improvement of sleep quality, nor of the RCSQ total score. This pilot study provided a strong indication that mental health nurses can apply MAR effectively. No such indication was found for stimulus control.
Baruch, Y; Swartz, M; Sirkis, S; Mirecki, I; Barak, Y
Mental health professionals are at a high risk of burnout. Positive psychology outcomes of staff in acute in-patient psychiatric wards are poorly researched and unclear. To quantify the satisfaction with life and work-life satisfaction of mental health staff at a large university-affiliated tertiary psychiatric centre. We utilized the Satisfaction with Life Scale (SWLS) and the Work-Life Satisfaction Questionnaire (WLSQ). Two hundred and nine out of 450 staff members (46%) participated; mean age 48.2 + 9.9 years; 63% were male. On average the participants had been practising their speciality for 21.1 + 9.8 years (range: 2-48). The mean total SWLS scores differed significantly between professions (P happiness were reported by psychologists and social workers, followed by the administrative staff, the psychiatrists and finally the nursing staff. Staff scored the highest for work as a 'calling' followed by work as a 'career' and the lowest rating for work as a 'job'. The mean total WLSQ score differed between professions, (P happiness may contribute to increase in moral and counter burnout.
Simon, Joan B.; Savina, Elena A.
Over a quarter of a million U.S. students each year reside for a period of time in a psychiatric inpatient hospital setting to receive mental health treatment. Following inpatient treatment, most children are transitioned from the hospital into a regular school setting. Little is known about how these transitions are managed by hospital or school…
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. © 2013.
Lee, Myung-Soo; Lim, Hee-Young; Kim, Youngki; Lee, Yong-Suk
.... In contrast to there are many components which leads to long length of stay of psychiatric patients in Korean situation such as low and fixed medical fee for psychiatric inpatient treatment, shortage...
Chan, Oliver; Chow, Kavin Kit-wan
Institutional aggression in forensic psychiatric setting is an under-researched subject, despite the magnitude of the problem. No studies have been conducted on the assessment of risk and the examination of predictors of aggression among the Chinese forensic psychiatric population. Our study aimed to examine the determinants of aggression in the only forensic psychiatric institution in Hong Kong, and to test the psychometric properties of a risk-assessment instrument, the Dynamic Appraisal of Situational Aggression (DASA). We recruited a representative sample of 530 consecutively admitted detainees. Qualified nurses completed two risk-assessment instruments, the DASA and the Brøset Violence Checklist (BVC), once daily during the participants׳ first 14 days of admission. Aggressive incidents were recorded using the revised Staff Observation Aggression Scale (SOAS-R), and participants׳ data were collected for multivariate analyses. We showed that female gender, diagnoses of personality disorder and substance-related disorder, and admission at other correctional institutions were associated with institutional aggression. Aggression was perpetrated by 17.7% of the participants, and the DASA was demonstrated to have good psychometric properties in assessing and predicting aggressive incidents. Our findings preliminarily support the use of daily in-patient risk-assessment and affirm the role of dynamic factors in institutional aggression. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Schory, Thomas J; Piecznski, Natasha; Nair, Sunil; el-Mallakh, Rif S
Associations between human behaviour and psychiatric decompensation and weather variables have been inconsistent. We studied the association of certain weather variables (specifically, humidity, wind speed, and barometric pressure) with emergent psychiatric presentations, psychiatric admissions, incidence of violent crimes, and suicides in a metropolitan area. We performed a retrospective study for the year 1999 in a mid-sized city. We included all documented emergent psychiatric visits to the city's psychiatric emergency room. We obtained violence data from the city police department and suicide data from the country medical examiner. The data suggest that total numbers of acts of violence and emergency psychiatry visits are significantly associated with low barometric pressure. Psychiatric inpatient admissions and suicides are not associated with any of the weather variables investigated. While alternate conclusions can be drawn, we propose that the data support the interpretation that low barometric pressure is associated with an increase in impulsive behaviours. Additional investigation is warranted.
McMillen, J Curtis; Fedoravicius, Nicole; Rowe, Jill; Zima, Bonnie T; Ware, Norma
This study examined child welfare and mental health professionals' views of the quality of psychiatric services received by consumers of the child welfare system and explored root causes of perceived quality problems. One hundred and thirty child welfare, mental health and court professionals participated in qualitative interviews individually or in groups. Data analyses identified perceived problems in quality and perceived causes of quality problems. Participants in member checking groups were then asked to comment on and further clarify the results. The participants reported concerns related to overuse of psychotropic medication, overmedicated children, short inpatient stays, and continuity of psychiatric care. Overuse of psychotropic medications and overmedication were perceived to be driven by short evaluations, liability concerns, short inpatient stays and a lack of clinical feedback to psychiatrists from child welfare partners. Medicaid reimbursement policies were at the heart of several quality concerns. These problems contributed to a distrust of psychiatric practices among child welfare professionals. These findings underscore the adverse effects of modern marketplace medicine coupled with low Medicaid reimbursement rates on quality of care for vulnerable groups. Child welfare and mental health professionals and their associated stakeholders may together possess substantial clout to advocate for a reimbursement system and structure that promotes quality service. The findings also point to a crisis of credibility toward psychiatric practice among social service and other non-psychiatrist mental health professionals. Efforts are needed to increase the capacity for psychiatrists and child welfare professionals to communicate effectively with each other and for psychiatrists to receive the information that they need from their child welfare partners to ensure accurate diagnosis and effective treatment.
Taylor, Mark; Jenkins, Kym
To investigate the psychological impact on Australian hospital patients of the media coverage of the September 11 (9/11) terrorist attack. Thirty psychiatry and 26 matched medical and surgical inpatients were assessed. Both reported and observed distress was common. Women reported significantly more distress than men. Individuals with psychiatric illness were significantly more varied in their attribution of cause for 9/11. Seven patients (29%) with pre-existing psychosis became delusional surrounding the events, but there were no significant differences between the psychiatry and the medical and surgical inpatients. Clinical impressions were confirmed, namely, that a large proportion of hospital inpatients were adversely affected by TV footage of the 9/11 terrorist attack. Most vulnerable were those already with a mental disorder, particularly those with a pre-existing psychotic illness.
Emons, Barbara; Haussleiter, Ida Sybille; Kalthoff, Jörg; Schramm, Anja; Hoffmann, Knut; Jendreyschak, Jasmin; Schaub, Markus; Armgart, Carina; Juckel, Georg; Illes, Franciska
Germany provides a wide range of highly developed mental health care to its citizens. The aim of this study was to identify factors influencing the voluntariness of admissions to psychiatric hospitals. Especially the impact of demographic factors of the region, characteristics of the psychiatric hospitals and characteristics of the psychosocial services was analyzed. A retrospective analysis of hospital admission registers from 13 German adult psychiatric hospitals in 2009 was conducted. Public data on the regional psychiatric accommodation and demographic situation were added. Hospitals were dichotomously divided according to their index of involuntary admissions. Group comparisons were performed between the clinics with low and high involuntary admission indices. Analysis was conducted with clinical, psychiatric provision and demographic data related to inpatients in the Landschaftsverbands Westfalen-Lippe (LWL)-PsychiatryNetwork. Especially the range of services provided by the social-psychiatric services in the region such as number of supervised patients and home visits had an influence on the proportion of involuntary admissions to a psychiatric hospital. Some demographic characteristics of the region such as discretionary income showed further influence. Contrary to our expectations, the characteristics of the individual hospital seem to have no influence on the admission rate. Social-psychiatric services show a preventive impact on involuntary acute psychiatry interventions. Sociodemographic factors and patient variables play a role with regard to the number of involuntary hospitalizations, whereas characteristics of hospitals seemed to play no role. © The Author(s) 2013.
Conclusion: Increased screening should be conducted for older underweight male patients (for chronic respiratory or infectious diseases that might cause cachexia) and of patients with cognitive disorders or who have fallen (for treatable risk factors for falling and preventative measures). More patients should be referred for ...
followed by mood disorders and substance-related disorders. A quarter of the sample had a diagnosis of personality disorder.5. A study conducted by Wennberg and Daderman6 in Sweden found that ... certain personality disorders (especially antisocial personality disorder), history of substance abuse, low intelligence and.
Feb 1, 2008 ... Patients with obsessive-compulsive (00) symptoms often meet the life time criteria for another anxiety disorder as OCD often co—exists with panic disorder, social phobia, simple phobia, and generalized anxiety disorder as well as depression, alcohol and drug use disorders.'*-8. A number of studies based ...
van Doorn, S.; Jansen, L.M.C.; Vermeiren, R.R.J.M.; Hamerlynck, S.M.J.J.; Doreleijers, T.A.H.
Several studies have shown high rates of psychopathology among female adolescents in detention. Although rates of mental health problems have been called alarming, it is unknown whether mental health needs in females in juvenile justice differ substantially from those of females in mental health
2007). Harlow and Newcomb (1986) found that men were more likely to use substances to cope with depression or self-derogation while women are more...long-term outcomes following a return to duty for this sample can provide valuable information regarding suicide intervention effectiveness, stigma ...J.D. (1999). Moderating influence of social support on suicidal ideation in a sample of Mexican immigrants . Psychological Reports, 85(1), 78-79
Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete
is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment...
Conclusion: At follow-up, almost half of the discharged depressive patients were still depressed. Screening for predictive factors of chronic depressive morbidity facilitates better outcome by considering the heterogeneity of psychopathology that can lead to failure in the treatment plan.
Edel, Marc-Andreas; Blackwell, Brian; Schaub, Markus; Emons, Barbara; Fox, Tanja; Tornau, Friederike; Vieten, Bernward; Roser, Patrik; Haussleiter, Ida Sibylle; Juckel, Georg
Despite marked costs and limited evidence regarding effectiveness, occupational therapy (OT) is widely applied in psychiatric settings and financed by health insurance companies in European countries. This pilot study investigated the antidepressive effects of adjuvant OT for patients with major depression in a 6-week inpatient setting, stratified for females and males. A total of 114 inpatients with major depression were assigned to either a standard OT group (using basic handcraft) or an active control group that played board games (2 h daily, 5 days a week). HAMD-21 scores were assessed as the primary outcome parameter after 3-6 weeks. The OT intervention was not superior to "board game" (BG) activities in reducing depressive symptoms. However, significant interaction effects were found in favor of the OT group regarding anxiety measures and other variables. Male participants displayed more significant interaction effects than female participants. OT as an adjuvant short-term treatment for inpatients with major depression may be more efficacious than game interventions in terms of reducing anxiety and other symptoms, particularly in males. Trial registration The study was registered in the EU Clinical Trials Register as a multicenter trial (EudraCT Number 2009-016463-10; https://www.clinicaltrialsregister.eu/ctr-search/trial/2009-016463-10/DE#A) However, because of the elaborate setting requirements, the original study design with four centers was transformed into a solution with those two centers facilitating the pertinent resources. Furthermore, "mono-therapy with mirtazapine" was changed into "preferably mono-therapy with any antidepressant drug".
Family intervention for co-occurring substance use and severe psychiatric disorders: participant characteristics and correlates of initial engagement and more extended exposure in a randomized controlled trial.
Mueser, Kim T; Glynn, Shirley M; Cather, Corinne; Zarate, Roberto; Fox, Lindy; Feldman, James; Wolfe, Rosemarie; Clark, Robin E
Clients with severe mental illness and substance use disorder (i.e., dual disorders) frequently have contact with family members, who may provide valuable emotional and material support, but have limited skills and knowledge to promote recovery. Furthermore, high levels of family conflict and stress are related to higher rates of relapse. The present study was a two-site randomized controlled trial comparing a comprehensive, behaviorally-based family intervention for dual disorders program (FIDD) to a shorter-term family psychoeducational program (FPE). The modal family was a single male son in his early 30s diagnosed with both alcohol and drug problems and a schizophrenia-spectrum disorder participating with his middle-aged mother, with whom he lived. Initial engagement rates following consent to participate in the study and the family intervention programs were moderately high for both programs (88% and 84%, respectively), but rates of longer term retention and exposure to the core elements of each treatment model were lower (61% and 55%, respectively). Characteristics of the relatives were the strongest predictors of successful initial engagement in the family programs with the most important predictor being relatives who reported higher levels of benefit related to the relationship with the client. Subsequent successful exposure to the family treatment models was more strongly associated with client factors, including less severity of drug abuse and male client gender. The results suggest that attention to issues of motivating relatives to participate in family intervention, and more focused efforts to address the disruptive effects of drug abuse on the family could improve rates of engagement and retention in family programs for dual disorders.
Peytremann-Bridevaux, Isabelle; Scherer, Frédy; Peer, Laurence; Cathieni, Federico; Bonsack, Charles; Cléopas, Agatta; Kolly, Véronique; Perneger, Thomas V; Burnand, Bernard
While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital. We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed. 728 out of 1550 eligible patients (47%) participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08), average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005), the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P < 0.001) and the Perceptions of Care questionnaire showed the highest ceiling effect (Saphora-Psy: 17.1%, Perceptions of Care: 41.9%, Picker: 36.3%; P < 0.001). There were no differences in the patients' evaluation of the questionnaires. Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients
Full Text Available Farid R Talih,1 Jean J Ajaltouni,1 Hani M Tamim,2 Firas H Kobeissy3 1Department of Psychiatry, 2Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; 3Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon Objectives: This study evaluated the risk of developing obstructive sleep apnea (OSA and excessive daytime sleepiness (EDS in hospitalized psychiatric patients at the American University of Beirut Medical Center (AUB-MC. Factors associated with OSA and EDS occurrence in this sample were also examined. Methods: The Berlin questionnaire and the Epworth sleepiness scale; which respectively evaluate OSA and EDS symptoms, were administered to individuals hospitalized at an acute psychiatric treatment unit at the AUB-MC between the dates of January 2014 and October 2016. Additional data collected included general demographics, psychiatric diagnoses, and questionnaires evaluating depression and anxiety symptoms. Statistical analyses utilizing SPSS were performed to determine the prevalence of OSA and EDS, as well as their respective associations with patient profiles. Results: Our results showed that 39.5% of participants were found to have a high risk of sleep apnea and 9.9% of the participants were found to have abnormal daytime sleepiness. The risk of developing OSA was associated with a higher body mass index (BMI (P=0.02, and depression severity (patient health questionnaire 9 score (P=0.01. Increasing severity of depressive symptoms was associated with a higher risk of sleep apnea (P=0.01. BMI (odds ratio [OR] =5.97, 95% confidence interval [CI] 1.89–18.82 and depression severity (OR =4.04, 95% CI 1.80–9.07 were also found to be predictors of OSA. The psychiatric diagnoses of the participants were not found to have a significant association with the risk of sleep apnea. Conclusion: The risk of OSA is increased among hospitalized
Shalev, Anat; Weil, Gabriel; Rubinstein, Ludmila
Psychiatric hospitalization might be a necessity for certain groups of patients with mental illness, involving acute symptoms and substantial disability which do not allow independent living in the community. In such situations, it is crucial to enable inpatients to enjoy the best possible quality of life, including the right for sexual autonomy as a basic human right. Satisfying sexual life is part of meaningful life and plays an important role in personal and social recovery. On the other hand, sexual relations in psychiatric wards raise many dilemmas, including the need to protect inpatients from sexual abuse and victimization, particularly when mental illness involves judgment deficits and decreased ability to express autonomous will. In spite of its' importance, this subject receives little attention in policy guidelines and clinical practice and is largely ignored. The article reviews literature examining various aspects of sexual behavior in psychiatric facilities, revealing ethical dilemmas, risks and the role of policy guidelines to address this subject. We present viewpoints of practitioners, consumers and family members concerning sexual behavior in psychiatric hospitalization. We conclude with implications that emerge from accumulated knowledge with regard to policy making and proposed frameworks for change.
Objective: To determine the mortality among admitted patients in the study centre, a pioneer psychiatric facility in the West African sub-region. Design: A detailed retrospective study of the records of all deaths among the inpatients during the ten-year period of January, 1991 to December, 2000. Setting: Psychiatric Hospital ...
Programa de informação para alívio da ansiedade de familiares de doentes internados em psiquiatria Programa de información para el alivio de la ansiedad de enfermos internados en psiquiatria Information program for the relief of anxiety in the families of psychiatric in-patients
Pedro Filipe Nabais Neves Renca
Spielberger (STAI-Y1 adaptado para la población portuguesa por Daniel (1996. Constatamos que la ansiedad en el grupo experimental disminuyó significativamente de 87,00 a 60,29 mientras que en el grupo control permaneció prácticamente inalterada, 83,88 en el primer momento a 82,50 en el 2º. Concluimos que, tras el enfoque efectuado en la aplicación del guión estructurado, los niveles de ansiedad de las familias, en relación a la patología psiquiátrica de su familiar y de todo lo que esa patología involucra en relación al (des equilibrio familiar, disminuyeron, siendo que se aceptó de forma más positiva la patología psiquiátrica, ya que ésta fue desmitificada.The aim of this project was to evaluate the effect of an information program on anxiety in the family of patients admitted to a psychiatric unit for the first time. The present article is a report of a quantitative investigation: a quasi-experimental study with a control group and before and after evaluation. A non-probabilistic convenience sample was used, made up of the families of people having their first in-patient psychiatric treatment at DPSM Guarda. The data were collected using an instrument based on the Spielberger State Anxiety Inventory (Inventário de Ansiedade Estado de Spielberger, validated for the Portuguese population by Daniel (1996. It was found that anxiety in the experimental group decreased statistically significantly from 87,00 to 60,29 while in the control group it remained practically unaltered, from 83,88 at the first measurement to 82,50. In conclusion, after application of the structured guidance, anxiety levels in the families in relation to the psychiatric pathology of their relative and of what that pathology involved in relation to family equilibrium and imbalance decreased; in this way, the psychiatric pathology was accepted once it was demystified.
ZHU, Xiaomin; LI, Wen; WANG, Xiaoping
Background The incidence of the aggressive behavior is higher among the patients with severe mental disorder such as schizophrenia than the general population. The study of factors related to aggressive behavior has great meaning in designing prevention and intervention methods with this population of patients. Aims To understand the characteristics of assaultive behavior of male patients with schizophrenia who have been hospitalized. Methods Using a continuous sampling method, data from 75 male inpatients with a diagnosis of schizophrenia was collected at the psychiatric unit of Central South University Second Xiangya Hospital (Changsha, China) from August 2015 to February 2016.On the third day after hospitalization participants were given a general questionnaire as well as being assessed using the modified overt aggression scale (MOAS), historical clinical risk management-20 (HCR-20) questionnaire, hare psychopathic checklist-revised (PCL-R), and positive and negative syndrome scale (PANSS).Based on results of the MOAS participants were group into an ‘aggressive behavior’ group (39 cases) and ‘non-aggressive behavior’ group (36 cases). The differences in socio-demographic characteristics and scores on the other evaluation tools were then compared between these two groups. Results Participants in the ‘aggressive behavior’ group had significantly different scores in the HCR-20 in the H1 (past violence events), H2 (violent events when young), H10 (disobedience in the past), and C4 (impulsiveness) sections; as well in the anti-social section of PCL-R; and significantly higher PANSS scores in the positive symptom, depressive symptoms and paranoid symptom sections than those in the ‘non-aggressive behavior’ group. Conclusions A combination of adverse and traumatic life events such as a history of violence, vulnerabilities in ones personality (e.g. impulsive or antisocial tendencies) and psychopathology of current illness (e.g. significant anxiety and
Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina
Purpose: The authors compared the levels of job burden and stress in psychiatry residents with those of other healthcare professionals at inpatient and outpatient psychiatric hospitals in a medium-sized Brazilian city. Method: In this study, the levels of job burden and stress of 136 healthcare workers and 36 psychiatry residents from six various…
Afr J Psychiatry 2011;14:130-133. African Journal of Psychiatry • May 2011. 130. Introduction. Aggression within in-patient psychiatric settings is well researched, and the attitude of health professionals towards aggression is often the focus of many research reports.1-4. Attitudes are defined as 'a predisposition toward any.
Chen, Shing-Chia; Hwu, Hai-Gwo; Hu, Fu-Chang
A standard measure to assess and predict violence is important for psychiatric services. No prospective study has examined the history of violence and heterogeneity of violence in predicting specific types of violence among inpatient with schizophrenia. This study aimed to prospectively examine the accuracy of prediction of types of violence using the Chinese modified version of Violence Scale (VS-CM) among inpatients with schizophrenia based on their past history of violence and the real occurrence of violence during hospitalization. A prospective cohort study design. A total of 107 adult patients with schizophrenia spectrum disorders, consecutively admitted to an acute psychiatric ward of a university hospital in Taiwan, were recruited. In addition to data about demographics and clinical illness, count records of the history of violence within one month prior to admission by interview and the actual occurrence of violence during the whole course of hospitalization by participant observation were collected using the VS-CM. Multivariate logistic analysis and area under the Receiver Operating Characteristic curve (AUC) analysis were applied to examine the predictive ability of the VS-CM. A patient's history of violence assessed by the VS-CM predicted the actual occurrence of violence during hospitalization with the Odds Ratio of 17.5 (p=0.001). The predictive accuracy of the VS-CM had high sensitivity (97.0%), moderate positive predictive value (71.4%), and high negative predictive value (87.5%); however, the specificity was relatively low (35.0%). The AUC was 79.5% using the total scale of the VS-CM and 70.7-74.5% using the subscales in predicting corresponding types of violence. The VS-CM is a valid and reliable measure of potential violence. It can be applied to assess and predict specific types of violence among inpatient with schizophrenia. Copyright © 2013 Elsevier Ltd. All rights reserved.
Cabanel, N; Kundermann, B; Franz, M; Müller, M J
Depression is common in old age but is often underdiagnosed and inadequately treated. Although psychotherapy is considered effective for treating elderly patients with depression, it is rarely applied in inpatient settings. Furthermore, treatment on inpatient units specialized for elderly patients and implementation of a psychotherapeutic treatment approach are currently more the exception. From this background, a multiprofessional inpatient behavioral treatment program (MVT) for elderly depressed patients was developed at a specialized unit of a university-affiliated regional psychiatric hospital. The MVT is based on specific and modularized group therapies accompanied by individual therapeutic interventions. While the provision of group therapies (such as psychotherapy, social skills training, relaxation training, euthymic and mindfulness-based methods, exercise and occupational therapy as well as psychoeducational sessions for relatives) is assigned to specific professional groups, a joint multiprofessional treatment planning is of central relevance. First evaluations of different treatment components support the high acceptability of the MVT and highlight that psychotherapeutic inpatient treatment programs for the elderly are feasible. Further research is required to investigate the clinical efficacy of psychotherapy in elderly depressive inpatients.
Nicole C. R. McLaughlin
Full Text Available Background. Neuropsychiatric symptoms are common in idiopathic Parkinson’s disease (PD, and hospitalization for delirium, depression, psychosis, and anxiety is sometimes required. A minimal amount of data exists on these patients. Methods. Charts of all patients admitted to a psychiatric hospital between 2006 and 2009 with a diagnosis of PD were reviewed. Forty-three met entry criteria and were reviewed. Initial and discharge diagnoses, comorbid psychiatric diagnoses, length of stay, and living arrangements before and after hospitalization are described. Results. Consistent with previous research, this study showed evidence of comorbid psychiatric disorders within PD. Conclusions. The long-term goal of this area of study would be to reduce neuropsychiatric symptoms and improve quality of life in order to reduce inpatient hospital stays.
Leader, Hadassa; Singh, Jasmine; Ghaffar, Ayesha; de Silva, Cheryl
Objectives: Bullying is a serious public health issue. We sought to demonstrate an association between bullying victimization and hospital admissions for acute psychiatric problems. We described the demographics and types of bullying in a sample of hospitalized patients in Staten Island, NY, and compared bullying victimization scores with psychiatric versus medical admissions. Methods: Patients in grades 3–12 were recruited from the Staten Island University Hospital Inpatient Pediatrics unit and emergency department. Patients completed the validated Olweus Bully/Victim Questionnaire (OBQ) was analyzed to formulate a report of bullying in our sample as well as a sub-score measurement of bullying victimization. Pediatric residents simultaneously documented whether the subject was a medical versus an in-patient psychiatry admission. Statistical analysis was performed to look for an association between the victimization sub-score and a psychiatric indication for admission. Results: A total of 185 surveys were analyzed. Peak bullying occurred in 7th and 8th grades. Demographics and types of bullying in our sample were described. A strong association between bullying victimization and hospitalization for in-patient psychiatry was demonstrated. Association between bullying victimization and suicidal ideation, psychiatry, and social work consults was also shown. Concern for an association between hospitalization for psychogenic illness and bullying victimization was also raised. Conclusions: There is a significant association between bullying victimization and psychiatric hospital admissions. This raises the specter of the serious consequences of bullying as it is the first study to prospectively link hospital admissions to bullying. Studies using a valid measure of psychogenic illness to look for an association with bullying victimization are needed. PMID:29326819
Metse, Alexandra P; Wiggers, John; Wye, Paula; Wolfenden, Luke; Freund, Megan; Clancy, Richard; Stockings, Emily; Terry, Margarett; Allan, John; Colyvas, Kim; Prochaska, Judith J; Bowman, Jenny A
Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours. A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence. Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls. Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation
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
Sowislo, Julia F; Lange, Claudia; Euler, Sebastian; Hachtel, Henning; Walter, Marc; Borgwardt, Stefan; Lang, Undine E; Huber, Christian G
Background There is evidence for two different types and/or sources of mental illness stigma, namely the display of psychiatric symptoms and the use of psychiatric service institutions. However, no current study has compared the two. Furthermore, gaps exist in our knowledge of both types of stigma. Little is known about the perceived stigma of specific psychiatric service treatment environments, for instance forensic settings. In addition, systematic research on stigma attached to symptoms of personality disorders in the general population is scarce, and for borderline personality disorder, nonexistent. Methods We conducted a representative survey of the general population (N = 2207) in the canton of Basel-Stadt, Switzerland. Participants were asked to read a vignette depicting either the psychiatric symptoms of a fictitious character or a psychiatric service institution to which the character had been admitted, and indicate desired social distance (an indicator for stigma). Type of symptoms, type of psychiatric service, dangerousness, and gender were systematically varied between vignettes. Findings Desired social distance was significantly lower in relation to psychiatric service use than to psychiatric symptoms. Overall, symptoms of alcohol dependency, behavior endangering others, and the fictitious character's being male tend to increase stigmatization. Interestingly, the character's being hospitalized in a psychiatric unit at a general hospital and also respondent familiarity with psychiatric services tend to decrease stigmatization. Interpretation Familiarity of the general population with psychiatric patients should be increased. Furthermore, treatment in psychiatric units located within general hospitals should be promoted, as such treatment is associated with decreased stigma.
Nussbaum, Abraham M; Thurstone, Christian; McGarry, Laurel; Walker, Brendan; Sabel, Allison L
Marijuana use is associated with anxiety, depressive, psychotic, neurocognitive, and substance use disorders. Many US states are legalizing marijuana for medical uses. To determine the prevalence of medical marijuana use and diversion among psychiatric inpatients in Colorado. Some 623 participants (54.6% male) responded to an anonymous 15-item discharge survey that assessed age, gender, marijuana use, possession of a medical marijuana card, diversion of medical marijuana, perceived substance use problems, and effects of marijuana use. Univariate statistics were used to characterize participants and their responses. Chi-square tests assessed factors associated with medical marijuana registration. Of the total number of respondents, 282 (47.6%) reported using marijuana in the last 12 months and 60 (15.1%) reported having a marijuana card. In comparison to survey respondents who denied having a medical marijuana card, those respondents with a medical marijuana card were more likely to have initiated use before the age of 25, to be male, to have used marijuana in the last 12 months, and to have used at least 20 days in the past month. 133 (24.1%) respondents reported that someone with a medical marijuana card had shared or sold medical marijuana to them; 24 (41.4%) of respondents with a medical marijuana card reported ever having shared or sold their medical marijuana. Medical marijuana use is much more prevalent among adults hospitalized with a psychiatric emergency than in the general population; diversion is common. Further studies which correlate amount, dose, duration, and strain of use with particular psychiatric disorders are needed.
Biesbroeck, Lauren K; Shinohara, Michi M
Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Serge Brand,1,2 Flora Colledge,2 Nadja Beeler,2 Uwe Pühse,2 Nadeem Kalak,1 Dena Sadeghi Bahmani,1 Thorsten Mikoteit,1 Edith Holsboer-Trachsler,1 Markus Gerber2 1Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, 2Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland Background: Physical activity and exercise programs (PAEPs are an important factor in increasing and maintaining physical and mental health. This holds particularly true for patients with psychiatric disorders undergoing treatment in a psychiatric hospital. To understand whether the benefits reported in the literature are mirrored in current treatment modalities, the aim of the present study was to assess the current state of PAEPs in psychiatric hospitals in the German-speaking part of Switzerland. Methods: All psychiatric hospitals (N=55 in the German-speaking part of Switzerland were contacted in spring 2014. Staff responsible for PAEPs were asked to complete an online questionnaire covering questions related to PAEPs such as type, frequency, staff training, treatment rationale, importance of PAEPs within the treatment strategy, and possible avenues to increase PAEPs. Results: Staff members of 48 different psychiatric hospitals completed the survey. Hospitals provided the following therapeutic treatments: relaxation techniques (100%, sports therapy (97%, activity-related psychotherapeutic interventions (95%, physiotherapy (85%, body therapies (59%, far-east techniques (57%, and hippotherapy (22%. Frequencies ranged from once/week to five times/week. Approximately 25% of patients participated in the PAEPs. Interventions were offered irrespective of psychiatric disorders. PAEP providers wanted and needed more vocational training. Conclusion: All participating psychiatric hospitals offer a broad variety of PAEPs in their treatment curricula. However, the majority of inpatients do not
Sitvast, J.E.; Widdershoven, G.G.A.M.; Abma, T.A.
The purpose of this article is to illustrate moral learning in persons with a psychiatric disability who participated in a nursing intervention, called the photo-instrument. This intervention is a form of hermeneutic photography. The findings are based on a multiple case study of 42 patients and
Sellin, Linda; Asp, Margareta; Kumlin, Tomas; Wallsten, Tuula; Wiklund Gustin, Lena
ABSTRACT In today’s health care, participation is acknowledged as important. However, there is limited research on how relatives of patients at risk of suicide experience their opportunities to participate in care during periods when their close ones are subject to inpatient care. The aim of this study was to describe the phenomenon of participation, as experienced by relatives of persons who are subject to inpatient psychiatric care due to a risk of suicide. The study was conducted through a reflective lifeworld research (RLR) approach, based on phenomenological philosophy. Eight relatives of patients receiving care from professionals in a psychiatric specialist health care context in Sweden participated in phenomenon-oriented interviews. Data were analysed to elucidate a meaning structure of the phenomenon. The findings show that the phenomenon of participation was more associated with patients’ recovery processes than with the caring process, and means “being actively involved in a process in which the person regains the desire to live”. The meaning of participation is further described by its meaning constituents: struggling for being able to be present for the person at risk of suicide, being able to share everyday life, and nurturing sources for vitality. These insights into the meaning of participation highlight the importance of allowing supportive relatives to be a part of the patient’s life, while the person is cared for in an inpatient hospital setting. Thus, participation enables relatives to be acknowledged as resourceful human beings in the patient’s recovery process, and thereby facilitates a sense of being able to manage and share life itself together with the person. This means that mental health nurses need to recognize individual variations of relatives’ participation processes, and take on the responsibility of acknowledging relatives’ lifeworlds. PMID:28245364
Sellin, Linda; Asp, Margareta; Kumlin, Tomas; Wallsten, Tuula; Wiklund Gustin, Lena
In today's health care, participation is acknowledged as important. However, there is limited research on how relatives of patients at risk of suicide experience their opportunities to participate in care during periods when their close ones are subject to inpatient care. The aim of this study was to describe the phenomenon of participation, as experienced by relatives of persons who are subject to inpatient psychiatric care due to a risk of suicide. The study was conducted through a reflective lifeworld research (RLR) approach, based on phenomenological philosophy. Eight relatives of patients receiving care from professionals in a psychiatric specialist health care context in Sweden participated in phenomenon-oriented interviews. Data were analysed to elucidate a meaning structure of the phenomenon. The findings show that the phenomenon of participation was more associated with patients' recovery processes than with the caring process, and means "being actively involved in a process in which the person regains the desire to live". The meaning of participation is further described by its meaning constituents: struggling for being able to be present for the person at risk of suicide, being able to share everyday life, and nurturing sources for vitality. These insights into the meaning of participation highlight the importance of allowing supportive relatives to be a part of the patient's life, while the person is cared for in an inpatient hospital setting. Thus, participation enables relatives to be acknowledged as resourceful human beings in the patient's recovery process, and thereby facilitates a sense of being able to manage and share life itself together with the person. This means that mental health nurses need to recognize individual variations of relatives' participation processes, and take on the responsibility of acknowledging relatives' lifeworlds.
Camargo, Ana Luiza Lourenço Simões; Maluf Neto, Alfredo; Colman, Fátima Tahira; Citero, Vanessa de Albuquerque
There is high prevalence of mental and behavioral disorders in general hospitals, thus triggering psychiatric risk situations. This study aimed to develop a psychiatric risk assessment checklist and routine for nurses, the Psychiatric Risk Evaluation Check-List (PRE-CL), as an alternative model for early identification and management of these situations in general hospitals. Ethnographic qualitative study in a tertiary-level private hospital. Three hundred general-unit nurses participated in the study. Reports were gathered through open groups conducted by a trained nurse, at shift changes for two months. The questions used were: "Would you consider it helpful to discuss daily practice situations with a psychiatrist? Which situations?" The data were qualitatively analyzed through an ethnographic approach. The nurses considered it useful to discuss daily practice situations relating to mental and behavioral disorders with a psychiatrist. Their reports were used to develop PRE-CL, within the patient overall risk assessment routine for all inpatients within 24 hours after admission and every 48 hours thereafter. Whenever one item was present, the psychosomatic medicine team was notified. They went to the unit, gathered data from the nurses, patient files and, if necessary, attending doctors, and decided on the risk management: guidance, safety measures or mental health consultation. It is possible to develop a model for detecting and intervening in psychiatric and behavioral disorders at general hospitals based on nursing team observations, through a checklist that takes these observations into account and a routine inserted into daily practice.
de Burgh, H Thomas
Over the last 10 years, the UK armed forces (UKAF) have been involved in operations worldwide. Mental health in the armed forces (AF) has been the subject of considerable interest in part because of a perceived added risk of psychological distress in this population. Inpatient psychiatric services are provided through partnerships with NHS hospitals. The Cavell Centre, Peterborough's acute inpatient psychiatric unit has up to four beds for service personnel, under the care of a civilian consultant psychiatrist and his AF Foundation Year 2 doctor (F2). This was the only Ministry of Defence (MoD) inpatient unit which had a training post for an AF doctor, but the post ended in August 2014 with the closure of MoD Hospital Unit Peterborough (MDHU(P)). This article outlines the differences in civilian and AF inpatient care and discusses the training value of AF doctors managing service personnel who are psychiatric inpatients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Neuner, Tanja; Hubner-Liebermann, Bettina; Hausner, Helmut; Hajak, Goran; Wolfersdorf, Manfred; Spiessl, Hermann
Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n =…
van de Laar, N; Henter, L; Bartko, JJ; Wyatt, RJ
Background: This report builds on a previous analysis examining the long-term effects of a placebo period on a group of inpatients with chronic schizophrenia. In the present analysis, outcome was evaluated through the use of the Psychiatric Adverse Events Rating Scale. Methods: This retrospective
Kratochvil, Christopher J.; Varley, Christopher; Cummins, Thomas K.; Martin, Andres
This paper presents a case of an 11-year-old boy who was admitted to an acute inpatient psychiatric setting because of a recent exacerbation of physical aggression, accompanied by long-standing problems with verbal aggression, irritability, dysphoria, and sleep disturbance. His family history was notable for domestic violence, substance abuse by…
Riddle, C R
The development and implementation of an adolescent sexual abuse group on an inpatient psychiatric unit is described. Steps of Kurt Lewin's model of change are used as a framework for this planned change. Specific issues concerning group procedure and process are detailed. Recommendations for this group and broader use of the Lewin model are included.
Management of Inpatient Aggression in Forensic Mental Health Nursing. The application of the Early Recognition Method. Forensic mental health nurses take care of forensic patients convicted for an offense for which they were assessed not to be fully accountable due to their psychiatric disorder. For
Siegel, Matthew; Milligan, Briana; Chemelski, Bruce; Payne, David; Ellsworth, Beth; Harmon, Jamie; Teer, Olivia; Smith, Kahsi A.
Psychiatric hospitalization of children with autism spectrum disorder and/or intellectual disability is common, however, the effectiveness of this intervention is largely unknown. Thirty-eight clinically-referred children 8-19 years old admitted to a specialized inpatient psychiatry unit were assessed by a consistent caregiver on the Aberrant…
Jeandarme, Inge; Wittouck, Ciska; Vander Laenen, Freya; Pouls, Claudia; Oei, T I; Bogaerts, Stefan
Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment.
Sitvast, J E; Widdershoven, G A M; Abma, T A
The purpose of this article is to illustrate moral learning in persons with a psychiatric disability who participated in a nursing intervention, called the photo-instrument. This intervention is a form of hermeneutic photography. The findings are based on a multiple case study of 42 patients and additional interviews with eight of them. Photo groups were organized within three settings of psychiatric services: ambulatory as well as clinical, all situated in the Netherlands. Data were analysed according to hermeneutic and semiotic principles. Two cases are presented. Findings show that voice and face are concepts that help to identify elements of moral learning in the rehabilitation process of persons with a psychiatric disability. During the process patients become more aware of their responsibilities towards themselves and others.
Donaghay-Spire, Eloise G; McGowan, John; Griffiths, Kim; Barazzone, Natalie
This research explored what happens when psychological input is offered in the inpatient setting and examined service users' and staff members' understanding and portrayal of these experiences. Narrative analysis, an interview design, was used to examine experiences of inpatient psychological interventions in National Health Service inpatient mental health settings. Ten participants (four service users and six staff members; five males and five females; seven White British, one White Irish, one Black African, and one Black Caribbean) were recruited via clinical psychologists from an inpatient psychology department and participated in 18- to 90-min interviews. Evidence suggested that direct, indirect, and strategic psychological interventions were used in the inpatient setting, with formulation and the therapeutic relationship conceptualized as common features. Connections between inpatient psychology and change, evidenced in the stories, suggested that interventions can help people make sense of a crisis, improve relationships, and contribute to meaningful recovery. Evidence of barriers suggests that psychological input in this setting might not always be compatible with everyone's needs. This paper explored service users' and staff members' experiences of psychological input in the inpatient setting. The analysis revealed that psychological provision in the inpatient mental health setting is varied and encompasses direct and indirect input, valued by service users and clinicians. It also identified that psychological input in the acute inpatient mental health setting is perceived as meaningful and can lead to changes at an interpersonal and intrapersonal level. There is a sense that providing psychological thinking in the inpatient setting can be challenging due to environmental constraints and individual factors. This highlights the need for further research focused on the costs and clinical effectiveness of providing psychological thinking within the acute
Hill, Ryan M; Hatkevich, Claire E; Kazimi, Iram; Sharp, Carla
The Columbia-Suicide Severity Rating Scale divides suicide attempt behaviors into actual, interrupted, and aborted attempts, but limited data have been reported regarding associations between interrupted, aborted, and actual attempts. This study provided initial data on the ability of interrupted and aborted attempts to estimate the frequency of actual suicide attempts. Participants were adolescent psychiatric inpatients (59.9% female), 12-17 years (mean = 14.73, SD = 1.62). Results suggest that interrupted and aborted suicide attempts are associated with the frequency of actual suicide attempts, controlling for suicidal ideation and depressive symptoms. Future research should evaluate whether interrupted and aborted attempts prospectively predicting actual suicide attempts. Copyright © 2017. Published by Elsevier B.V.
Bartak, Anna; Andrea, Helene; Spreeuwenberg, Marieke D; Ziegler, Uli M; Dekker, Jack; Rossum, Bert V; Hamers, Elisabeth F M; Scholte, Wubbo; Aerts, Janneke; Busschbach, Jan J V; Verheul, Roel; Stijnen, Theo; Emmelkamp, Paul M G
For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital, and inpatient treatment. The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis. Patients were assigned to 3 different settings of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Patients in all 3 settings improved significantly in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life 18 months after baseline. The inpatient group showed the largest improvements. The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result (p = 0.057) in favour of inpatient treatment. Patients with cluster B personality disorders improved in all investigated treatment settings, with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting. Specialised inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders, both in research and in clinical practice. Copyright © 2010 S. Karger AG, Basel.
Fischer-Kern, Melitta; Fonagy, Peter; Kapusta, Nestor D; Luyten, Patrick; Boss, Sarah; Naderer, Andrea; Blüml, Victor; Leithner, Katharina
Depression is associated with profound impairments in social and interpersonal functioning. However, little research has addressed deficits in mentalizing capacity that may underlie these impairments. The aim of this study was, therefore, to investigate the capacity for mentalization in female inpatients with depression in comparison with healthy controls. We assessed 46 inpatients with major depressive disorder with regard to psychiatric diagnoses, severity of depression, cognitive impairment, and verbal intelligence. In addition, 20 healthy controls matched for sex, age, and education were included. Mentalization was scored on the Adult Attachment Interview using the Reflective Functioning Scale. The female inpatients with depression showed a significantly lower capacity for mentalization compared with the healthy controls. Mentalization deficits were not restricted to depression-specific topics. Moreover, deficits in mentalizing capacity were related to illness duration, number of admissions, and cognitive impairment. The results indicate severe impairment in the ability of the female inpatients with depression to identify and interpret mental states of the self and others. Correlations with illness duration and number of admissions suggest that a chronic course of depression results in further mentalizing impairments. The investigation of mentalization may be of particular importance for the development of targeted psychotherapeutic interventions for depression.
Full Text Available Background: Research in consultation-liaison psychiatry is important clinically because of high incidence of coexistence of psychiatric and medical disorders in patients attending psychiatry and general healthcare systems. In contrast to west, research about liaison psychiatry in India has been minimal. Thus a study about understanding clinical and sociodemographic profile patterns of inpatient psychiatry referrals was undertaken to enhance our knowledge of this field. Objective: To describe the clinical and socio-demographic profile of inpatient psychiatry referrals in a multispecialty teaching hospital. Materials and methods: The study population comprised all consecutive inpatients who were referred for psychiatric consultation from other departments of a multispecialty teaching hospital over a period of six months. In a semi-structured proforma, socio-demographic profile of patients, referring departments, reason of referral, psychiatric diagnosis, and physical illness diagnosis were recorded and analysed using descriptive statistics. Results: A total of 356 patients were referred for psychiatric consultation, 55.9% were males and 44.1% were females. Majority of patients belonged to 20-40 years age group (37.9%. Department of medicine made majority of the psychiatric referrals (50.6%; commonest reason for referral was abnormal behaviour (30.9%, followed by suicidal/self-harm acts (17.9%, and past psychiatric history (10.9%. The most commonly diagnosed psychiatric disorders were delirium (17.9%, followed by organic psychosis/mood disorder (14.8%, substance related disorder (12.9%, and depression (12.9%. Conclusion: There is an urgent need for raising awareness among all physicians and medical staff regarding early recognition and prompt referral for psychiatric problems. Also further research is warranted, especially longitudinal studies with outcome variables and various clinical processes related to consultation-liaison psychiatry.
Yalch, Matthew M; Hopwood, Christopher J; Fehon, Dwain C; Grilo, Carlos M
Suicide is a leading cause of death among adolescents and suicidal behavior is one of the primary risk factors for youth psychiatric hospitalizations. A number of studies indicate that depression and substance abuse are associated with suicide risk in this population, but less is known about the role of borderline personality features or their incremental influence over other known risk factors in indicating suicidal behavior among adolescents. This study examined whether borderline features were associated with suicide risk when controlling for symptoms of depression and substance abuse in a sample of adolescents hospitalized in an inpatient psychiatric facility. Self-report data from 477 adolescent psychiatric inpatients were used to test hypotheses about the association of borderline features with suicide risk after controlling for other common risk factors. Borderline features were significantly related to suicide risk even after accounting for symptoms of depression and substance abuse. These findings underscore the clinical value of routinely assessing borderline features among adolescents.
Veltri, Carlo O C; Graham, John R; Sellbom, Martin; Ben-Porath, Yossef S; Forbey, Johnathan D; O'Connell, Carol; Rogers, Robert; White, Robert S
The purpose of this study was to expand the empirical basis for interpretation of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992). Participants were 157 boys from a forensic setting and 197 girls from an acute psychiatric inpatient setting. Criterion variables were identified from sources such as psychiatrist report, parent report, and psychosocial history. Results generally support the construct validity of MMPI-A scales. Scales measuring internalizing problems were more highly correlated with criterion measures of internalizing behaviors than measures of externalizing behaviors, whereas scales measuring externalizing problems were more highly correlated with externalizing variables than with internalizing criteria. Implications of this study include an expanded empirical foundation for interpretation of the MMPI-A, greater understanding of the constructs it measures, and evidence supporting the generalizability of these constructs across settings.
Full Text Available Background Mental illness may strongly affect relatives’ lives. Therefore, it is important to empower relatives by providing health information according to their preferences. Methods An online cross-sectional survey was conducted using a purpose-designed questionnaire on online health information and decision-support needs. Results Prevalent reasons for online health information search of the 185 participating relatives were the need for general information and the insufficiency of the information given by the health care provider. The most difficult treatment decisions concerned the treatment setting (inpatient or outpatient as well as the psychopharmacological treatment. Discussion Since psychiatric patients’ relatives report extensive information and decision-support needs, it is essential to address their needs in health information material. Assessment of relatives’ needs when developing health information materials is recommended.
Hamlett, Nakia M; Carr, Erika R; Hillbrand, Marc
Positive behavior support (PBS) plans are increasingly used on inpatient units to assess and treat serious and dangerous behaviors displayed by patients with serious psychiatric impairment. A contemporary extension of traditional applied behavior analytic procedures, PBS plans integrate theories from several domains with perspectives on community psychology, positive psychology, and recovery-oriented care. Because there is little evidence to suggest that more invasive, punitive disciplinary strategies lead to long-term positive behavioral change (Parkes, 1996), PBS plans have emerged as an alternative to the use of seclusion and restraint or other forms of restrictive measures typically used on inpatient psychiatric units (Hammer et al., 2011). Moreover, PBS plans are a preferred method of intervention because more invasive interventions often cause more harm than good to all involved (Elliott et al., 2005). This article seeks to provide an integrated framework for the development of positive behavior support plans in inpatient psychiatric settings. In addition to explicating the philosophy and core elements of PBS plans, this work includes discussion of the didactic and pragmatic aspects of training clinical staff in inpatient mental health settings. A case vignette is included for illustration and to highlight the use of PBS plans as a mechanism for helping patients transition to less restrictive settings. This work will add to the scant literature examining the use of positive behavioral support plans in inpatient psychiatric settings. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Full Text Available Tella Lantta,1 Raija Kontio,1–3 Michael Daffern,4 Clive E Adams,5 Maritta Välimäki1,6,7 1Department of Nursing Science, University of Turku, Turku, Finland; 2Helsinki University, Helsinki, Finland; 3Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland; 4Centre for Forensic Behavioural Science (CFBS, Swinburne University of Technology, Melbourne, VIC, Australia; 5Institute of Mental Health, University of Nottingham, Nottingham, UK; 6Turku University Hospital, Turku, Finland; 7School of Nursing, The Hong Kong Polytechnic University, Hong Kong Purpose: This paper aims to explore the acceptability of Dynamic Appraisal of Situational Aggression (DASA from the perspective of patients, its actual use by mental health nurses, and the predictive validity of the DASA instrument. Methods: A feasibility study design incorporating quantitative and qualitative components was used. The study was conducted in three mental health inpatient units at three hospitals in southern Finland. Quantitative data were used to explore demand (nurses’ actual use of the DASA, limited efficacy (predictive validity, and acceptability (measured through patients’ participation in the project. Qualitative data were collected to enhance the understanding of acceptability by describing patients’ perceptions of the strengths and weaknesses of the DASA. Results: Nurses used the DASA for most patient assessments. The predictive validity of the DASA was outstanding or excellent, depending on the type of aggression predicted, although the patient recruitment ratio was low. Patients reported both strengths and weaknesses of the DASA, providing complementary information regarding the instrument’s acceptability and clinical application. Conclusion: The DASA accurately predicts inpatient aggression. The patients’ preferences and concerns regarding risk assessment have been noted. More patient involvement in risk assessment research and
Chu, Chi Meng; Thomas, Stuart D M; Daffern, Michael; Ogloff, James R P
Recent advancements in risk assessment have led to the development of dynamic risk-assessment measures that are predictive of inpatient aggression in the short term. However, there are several areas within this field that warrant further empirical investigation, including whether the average, maximum, or most recent risk state assessment is the most valid for predicting subsequent aggression in the medium term. This prospective study compared the predictive validity of three indices (i.e. mean score, peak score, and most recent single time-point rating) of the Dynamic Appraisal of Situational Aggression (DASA) for inpatient aggression. Daily risk ratings were completed for 60 psychiatric inpatients (from the acute wards of a forensic psychiatric hospital) for up to 6 months; a total of 1054 DASA ratings were obtained. Results showed that mean and peak scores on the DASA were better predictors of interpersonal violence, verbal threat, and any inpatient aggression than the DASA single time-point most recent ratings. Overall, the results support the use of the prior week's mean and peak scores to aid the prediction of inpatient aggression within inpatient forensic psychiatric settings in the short to medium term. These results also have practical implications for clinicians considering risk-management strategies and the scoring of clinically-relevant items on risk-assessment measures. © 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.
Barghadouch, Amina; Kristiansen, Maria; Jervelund, Signe Smith
Purpose: Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. Methods: This study compared 24,427 refugee children from...... and psychiatrists in private practice. Results: Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40–0.45) among refugee boys...... and 0.35 (95 % CI 0.33–0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Conclusions: Refugee children used fewer psychiatric healthcare services than Danish...
Jenkins, Sian; Arribas-Ayllon, Michael
Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.
Krystal, Andrew D.
SYNOPSIS Psychiatric disorders and sleep are related in important ways. In contrast to the longstanding view of this relationship which viewed sleep problems as symptoms of psychiatric disorders, there is growing experimental evidence that the relationship between psychiatric disorders and sleep is complex and includes bi-directional causation. In this article we provide the evidence that supports this point of view, reviewing the data on the sleep disturbances seen in patients with psychiatric disorders but also reviewing the data on the impact of sleep disturbances on psychiatric conditions. Although much has been learned about the psychiatric disorders-sleep relationship, additional research is needed to better understand these relationships. This work promises to improve our ability to understand both of these phenomena and to allow us to better treat the many patients with sleep disorders and with psychiatric disorders. PMID:23099143
Romanowicz, Magdalena; O’Connor, Stephen S.; Schak, Kathryn M.; Swintak, Cosima C.; Lineberry, Timothy W.
Background Suicide is the third leading cause of death in the United States for youth 12–17 years or age. Acute psychiatric hospitalization represents a clear worst point clinically and acute suicide risk is the most common reason for psychiatric admission. We sought to determine factors associated with differences in individual suicide risk assessment for children and adolescents during acute psychiatric admission. Methods Study participants were 1,153 youth consecutively admitted to an inpatient psychiatry unit who completed a self-administered Suicide Status Form (SSF) within 24 hours of admission. Additional information on suicide risk factors was obtained through medical chart abstraction. Results Females reported significantly greater psychological pain, stress, hopelessness, and self-hate on the SSF and were significantly more likely to have made a suicide attempt just prior to the index hospital admission (OR = 1.59, SE = .29; CI = 1.12–2.26), report a family history of suicide (OR = 2.02, SE = .33; CI = 1.47–2.78), and had experienced a greater number of inpatient psychiatry admissions related to suicidal ideation (RR = 1.33, SE = .13; CI = 1.10–1.61). High school aged youth and those with a primary diagnosis of depression displayed consistently elevated SSF scores and risk factors for suicide compared to comparison groups. Limitations Diagnosis was determined through chart abstraction. Responses to access to firearm question had missing data for 46% of the total sample. Conclusions Systematic administration of a suicide-specific measure at admission may help clinicians improve identification of suicide risk factors in youth in inpatient psychiatry settings. PMID:23856283
Lay, B; Nordt, C; Rössler, W
The use of coercive measures in psychiatry is still poorly understood. Most empirical research has been limited to compulsory admission and to risk factors on an individual patient level. This study addresses three coercive measures and the role of predictive factors at both patient and institutional levels. Using the central psychiatric register that covers all psychiatric hospitals in Canton Zurich (1.3 million people), Switzerland, we traced all inpatients in 2007 aged 18-70 (n = 9698). We used GEE models to analyse variation in rates between psychiatric hospitals. Overall, we found quotas of 24.8% involuntary admissions, 6.4% seclusion/restraint and 4.2% coerced medication. Results suggest that the kind and severity of mental illness are the most important risk factors for being subjected to any form of coercion. Variation across the six psychiatric hospitals was high, even after accounting for risk factors on the patient level suggesting that centre effects are an important source of variability. However, effects of the hospital characteristics 'size of the hospital', 'length of inpatient stay', and 'work load of the nursing staff' were only weak ('bed occupancy rate' was not statistically significant). The significant variation in use of coercive measures across psychiatric hospitals needs further study. Copyright © 2010 Elsevier Masson SAS. All rights reserved.
Sørensen, Tina; Jespersen, Hans Søe Riis; Vinberg, Maj
equivalents. Compared to the general population, the psychiatric patients had higher odds of being current smokers and having used illicit drugs within the past month. Women with psychiatric disorders were twice as likely to binge drink on a monthly basis. No significant difference was found in the patients......, 412 psychiatric patients participated in the study, and 33% had an AUDIT-score ≥8, indicating problematic alcohol use according to the AUDIT guidelines. The mean weekly alcohol intake was 9.7 ± 28.3 standard drinks, and 47% were current smokers with a mean daily use of 19.9 ± 13.8 cigarette...
Chen, Qiongni; Zhou, Jiansong
To systematically review and analyze literature on episodes of aggression in psychiatric wards and to determine the coping and preventive strategies employed to deal with aggression of patients with schizophrenia. We used the key words such as "schizophrenia" and "aggression" to collect literature citations, which were published between July 1997 and November 2011, by searching databases such as the Chinese Journal Full-text Database (CJFD). The literature reports of aggression by patients with schizophrenia were surveyed by computer-assisted searches, scanning of reference lists, and manual search of relevant journals. We analyzed the reports of episodes of aggression in psychiatric wards. Prevalence of aggression in psychiatric wards was reported to range from 9.1% (95% CI: 6.3 to 11.9) to 49.6% (95% CI: 41.1 to 58.1), with most reports in the range of 20% to 40% (mean 28.0%). The aggressive behavior often occurred in special groups and typically bore a close relationship with the patient's personal qualities, social environment, or psychiatric symptoms. The aggressive behaviors can be attributed to a lack of standardized assessments and intervention instruments. There is a high risk of aggression in Chinese inpatients with schizophrenia, and it is urgent to establish the scientific, standardized, operational systems for assessing and treating the aggression of these patients.
Steer, R A; Rissmiller, D J; Beck, A T
To provide information about the clinical utility of the Beck Depression Inventory-II (BDI-II) [Beck, A.T., Steer, R.A., & Brown, G.K. (1996b). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation] with geriatric inpatients, the BDI-II was administered to 130 psychiatric inpatients who were 55 years old or above and who were diagnosed with principal DSM-IV major depressive disorders (MDD) (N = 85, 65%) or adjustment disorders with depressed mood (N = 45, 35%). The internal consistency of the BDI-II was high (coefficient alpha = 0.90), and its total score was not significantly related to sex, age, or ethnicity. An iterated maximum-likelihood factor analysis found the Cognitive and Noncognitive dimensions which have been reported for the BDI-II by Steer and co-workers (Steer R.A., Ball R., Ranieri W.F., & Beck A.T. (1999). Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. Journal of Psychopathology and Behavioral Assessment, 55, 117-128) in a younger sample of clinically depressed psychiatric outpatients. The mean BDI-II total score of the 85 geriatric inpatients with MDD was also comparable to that of 42 younger (< or = 54 years old) inpatients with MDD. The results were discussed as supporting the use of the BDI-II with clinically depressed geriatric inpatients.
Research on recovery from mental illness and the influence of compulsory psychiatric institutional care has revealed the complexity of this concept. There is also limited knowledge regarding the impact of gender-role expectations in these contexts, and how such expectations may influence both the care and individuals' recovery processes. To explore women's and men's perceptions of the impact of compulsory inpatient care on recovery from severe mental illness. Grounded theory was used to analyse 30 first-person accounts of recovery from mental illness, elicited via interviews with individuals who had been compulsorily treated in hospital and diagnosed with a severe mental illness. Inpatient care at an early stage was crucial for the informants' recovery. However, there was ambivalence in their perceptions of the impact of compulsory inpatient care. The narratives confirmed gender differences as well as gender stereotypes. The results have implications for recovery research, in that they emphasise the importance of understanding recovery as a gender-influenced process.
Bobo, William V; Nevin, Remington; Greene, Elizabeth; Lacy, Timothy J
Few studies have directly compared the effects of third-year clerkship rotation type on measures of academic performance, student attitudes about psychiatry and psychiatric patients, and level of interest in psychiatry as a career. The goal of this study was to assess the extent to which rotation type influenced these outcome variables among third-year medical students. The authors conducted a prospective study of 647 third-year medical students administratively assigned to one of three clinical settings: an acute inpatient ward, a hospital-based consultation-liaison service, and an outpatient mental health care clinic. Academic performance was estimated using scores from a nationally standardized examination provided by the National Board of Medical Examiners (NBME), while responses to an anonymous survey developed by the investigators were used as indicators of student attitudes about and interest in psychiatry as a potential career field. Administrative residency match data were collected on all participants. Rotation type had no effect on NBME exam scores after controlling for grade point average, age, gender, rotation order, and rotation year. Although individuals who rotated on the inpatient service scored an average of 1.8 points higher on the examination relative to individuals who rotated on the consultation service, this small difference was not considered academically meaningful. Similarly, there were no statistically meaningful patterns that emerged between survey responses and rotation type. Approximately 4% of our sample matched into psychiatric residencies after graduating from medical school. Rotation type and survey responses were not statistically correlated with specialty choice. Rotation type does not appear to affect acquisition of psychiatric knowledge as estimated by standardized examination scores, nor does it appear to influence students' perceptions of psychiatry or specialty choice.
Martin, Lynn; Hirdes, John P
Recognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade. However, actually bringing fully integrated services to life has eluded most health care organizations. Mental health has followed the rule, rather than the exception, when it comes integrating services. The lack of effective mechanisms to evaluate the needs of persons across mental health care services has been an important barrier to communication between professionals involved in care. This study sought to understand communication among inpatient and community-based mental health staff during transfers of care, before and after implementation of compatible assessment instrumentation. Two focus groups were held with staff from inpatient (n = 10) and community (n = 10) settings in an urban, specialized psychiatric hospital in Ontario (Canada) - prior to and one year after implementation of compatible instrumentation in the community program. Transcripts were coded and aggregated into themes. Very different views of current communication patterns during transfers of care emerged. Inpatient mental health staff described a predictable, well-known process, whereas community-based staff emphasized unpredictability. Staff also discussed issues related to trust and the circle of care. All agreed that compatible assessments in inpatient and community mental health settings would facilitate communication through use of a common assessment language. However, no change in communication patterns was reported one year post implementation of compatible instrumentation. Though all participants agreed on the potential for compatible instrumentation to improve communication during transfers of care, this cannot happen overnight. A number of issues related to trust, evidence-based practice, and organizational factors act as barriers to communication. In particular, staff noted the need for the results
Benjamin L. Cook
Full Text Available Natural language processing (NLP and machine learning were used to predict suicidal ideation and heightened psychiatric symptoms among adults recently discharged from psychiatric inpatient or emergency room settings in Madrid, Spain. Participants responded to structured mental and physical health instruments at multiple follow-up points. Outcome variables of interest were suicidal ideation and psychiatric symptoms (GHQ-12. Predictor variables included structured items (e.g., relating to sleep and well-being and responses to one unstructured question, “how do you feel today?” We compared NLP-based models using the unstructured question with logistic regression prediction models using structured data. The PPV, sensitivity, and specificity for NLP-based models of suicidal ideation were 0.61, 0.56, and 0.57, respectively, compared to 0.73, 0.76, and 0.62 of structured data-based models. The PPV, sensitivity, and specificity for NLP-based models of heightened psychiatric symptoms (GHQ-12 ≥ 4 were 0.56, 0.59, and 0.60, respectively, compared to 0.79, 0.79, and 0.85 in structured models. NLP-based models were able to generate relatively high predictive values based solely on responses to a simple general mood question. These models have promise for rapidly identifying persons at risk of suicide or psychological distress and could provide a low-cost screening alternative in settings where lengthy structured item surveys are not feasible.
Cook, Benjamin L; Progovac, Ana M; Chen, Pei; Mullin, Brian; Hou, Sherry; Baca-Garcia, Enrique
Natural language processing (NLP) and machine learning were used to predict suicidal ideation and heightened psychiatric symptoms among adults recently discharged from psychiatric inpatient or emergency room settings in Madrid, Spain. Participants responded to structured mental and physical health instruments at multiple follow-up points. Outcome variables of interest were suicidal ideation and psychiatric symptoms (GHQ-12). Predictor variables included structured items (e.g., relating to sleep and well-being) and responses to one unstructured question, "how do you feel today?" We compared NLP-based models using the unstructured question with logistic regression prediction models using structured data. The PPV, sensitivity, and specificity for NLP-based models of suicidal ideation were 0.61, 0.56, and 0.57, respectively, compared to 0.73, 0.76, and 0.62 of structured data-based models. The PPV, sensitivity, and specificity for NLP-based models of heightened psychiatric symptoms (GHQ-12 ≥ 4) were 0.56, 0.59, and 0.60, respectively, compared to 0.79, 0.79, and 0.85 in structured models. NLP-based models were able to generate relatively high predictive values based solely on responses to a simple general mood question. These models have promise for rapidly identifying persons at risk of suicide or psychological distress and could provide a low-cost screening alternative in settings where lengthy structured item surveys are not feasible.
Silverman, Michael J
The purpose of this study was to determine the effects of a songwriting intervention on psychiatric patients' knowledge of coping skills and working alliance. Participants were randomly assigned to scripted and manualized experimental (n=48) or control (n=41) conditions. The experimental condition was a group psychoeducational music therapy songwriting session concerning coping skills while the control condition was a group psychoeducational session concerning coping skills. Both conditions were single-session therapy with patients on an acute adult psychiatric unit. Results indicated no significant between group differences in measures of knowledge of coping skills, consumer working alliance, or perception of enjoyment (p>.05), although the experimental condition tended to have slightly higher mean scores than the control group for these measures. There was a significant between group difference in measures of therapist working alliance (pcoping skills can be as effective a psychosocial intervention as traditional talk-based psychoeducation to teach psychiatric inpatients how to proactively manage their illness. Additionally, music therapy can be as effective as talk-based psychoeducation in establishing working alliance. Implications for clinical practice, limitations, and suggestions for future research are provided.
Quality of care in the context of inpatient neurology is the standard of performance by neurologists and the hospital system as measured against ideal models of care. There are growing regulatory pressures to define health care value through concrete quantifiable metrics linked to reimbursement. Theoretical models of quality acknowledge its multimodal character with quantitative and qualitative dimensions. For example, the Donabedian model distils quality as a phenomenon of three interconnected domains, structure-process-outcome, with each domain mutually influential. The actual measurement of quality may be implicit, as in peer review in morbidity and mortality rounds, or explicit, in which criteria are prespecified and systemized before assessment. As a practical contribution, in this article a set of candidate quality indicators for inpatient neurology based on an updated review of treatment guidelines is proposed. These quality indicators may serve as an initial blueprint for explicit quality metrics long overdue for inpatient neurology. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Chung, Woojin; Cho, Woo Hyun; Yoon, Chung Won
The institutionalization of psychiatric patients has put a tremendous burden on many societies, but few studies have examined the effects of institutional characteristics on patient length of stay (LOS). This paper investigated the association between institutional characteristics and LOS for 160,517 psychiatric patients in South Korea by applying a two-level modeling technique to administrative claims databases covering the entire patient population. Patient LOS, expressed in terms of days, was analyzed by taking account of institutional type, ownership, location, inpatient capacity, staffing, and patient demographics. The characteristics of inpatients were used as control variables and consisted of gender, age, sub-diagnosis, and the type of national health security program. The main findings of this study are: (1) patient LOS was 69% longer at psychiatric hospitals than at tertiary-care hospitals; (2) neither location nor inpatient capacity was associated with LOS; (3) larger staffs reduced LOS; and (4), LOS increased with a higher proportion of male inpatients, inpatients > or =65 years old, or inpatients diagnosed with organic or schizophrenic disorders, possibly through contextual effects. The results of this study suggest that researchers and policy makers could improve their assessment of psychiatric patient LOS and its association with health outcome by taking into account institutional characteristics and using multi-level analyses.
James, B O; Isa, E W; Oud, N
Aggression is a common feature in psychiatric in-patient units in Africa. The attitudes of psychiatric nurses and their perceptions of the frequency of in-patient aggression have not been explored in the Nigerian context. Using a crosssectional study design, two self-report questionnaires (the Attitudes toward Aggression Scale (ATAS) and the Perception of the Prevalence of Aggression Scale (POPAS)) were administered to nursing staff (n=73) at two psychiatric facilities in Benin City, Nigeria. Overall, nurses viewed aggression as offensive, destructive and intrusive. They were less likely to view it as a means of communication or serving protective functions. Verbal aggression was the commonest type of aggression experienced while sexual intimidation and suicide attempts were least common. Male nurses were more likely to experience physical violence and aggressive 'splitting' behaviours, while nurses with over a decade of professional experience were more likely to experience verbal and humiliating aggressive behaviours. In contrast to previous studies, fewer nurses required days off work due to aggressive behaviour. Aggression is commonly experienced by nurses in in-patient units in Nigeria. Their views were predominantly negative. Training programmes are required to change staff attitudes as well as research on the cultural factors mediating these attitude dispositions.
Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals--interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies.
English, Mike; Nzinga, Jacinta; Mbindyo, Patrick; Ayieko, Philip; Irimu, Grace; Mbaabu, Lairumbi
We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator) based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped create a soft-contract with senior managers clarifying
Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies
Background We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Methods Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator) based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. Results A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped create a soft-contract with
Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies
Full Text Available Abstract Background We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Methods Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. Results A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped
Keller, R; Rigardetto, R; Vaccarino, P; Maggioni, M; Iannoccari, G; Teriaca, M J
Several studies indicate a relationship among depression, anxiety, pain and hospitalization. Depression has a bidirectional relationship with cardiovascular disease, and it is observed in HIV-positive individuals, in cancer patients and it often complicates chronic pain. In order to assess dimensionally depressive and anxious symptoms and pain in medical inpatients, 327 non-psychiatric inpatients were assessed using the Hospital Anxiety and Depression Scale (HADS) and Visual Analogical Scale (for pain, VAS). Inpatients were hospitalized for neurovascular disease, chronic medical illness, cancer, infectious disease, cardiovascular illness, orthopaedic surgery and general surgery. Very high anxiety levels were discovered in cardiovascular, general surgery, infectious and neurovascular patients, whereas depression levels were higher among cardiovascular and chronic patients. The highest levels of pain were found among patients admitted to the Oncology Unit and those suffering from chronic medical illness. A stronger, direct relationship was obtained between anxiety and depression than between pain and anxiety or depression. No statistical differences were found in men and women. Statistically speaking significant differences were found in wards. Pain is a significant predictive variable for anxiety and depression (PScreening for anxiety and depression should be included in the clinical interview carried out by the nurse at the moment of admission to the ward.
Kumar, Navin L; Perencevich, Molly L; Trier, Jerry S
Inpatient training is a key component of gastroenterology (GI) fellowship programs nationwide, yet little is known about perceptions of the inpatient training experience. To compare the content, objectives and quality of the inpatient training experience as perceived by program directors (PD) and fellows in US ACGME-accredited GI fellowship programs. We conducted a nationwide, online-based survey of GI PDs and fellows at the conclusion of the 2016 academic year. We queried participants about (1) the current models of inpatient training, (2) the content, objectives, and quality of the inpatient training experience, and (3) the frequency and quality of educational activities on the inpatient service. We analyzed five-point Likert items and rank assessments as continuous variables by an independent t test and compared proportions using the Chi-square test. Survey response rate was 48.4% (75/155) for PDs and a total of 194 fellows completed the survey, with both groups reporting the general GI consult team (>90%) as the primary model of inpatient training. PDs and fellows agreed on the ranking of all queried responsibilities of the inpatient fellow to develop during the inpatient service. However, fellows indicated that attendings spent less time teaching and provided less formal feedback than that perceived by PDs (p < 0.0001). PDs rated the overall quality of the inpatient training experience (p < 0.0001) and education on the wards (p = 0.0003) as better than overall ratings by fellows. Although GI fellows and PDs agree on the importance of specific fellow responsibilities on the inpatient service, fellows report experiencing less teaching and feedback from attendings than that perceived by PDs. Committing more time to education and assessment may improve fellows' perceptions of the inpatient training experience.
Boehm, Gabriela; Schroeder, Yvonne; Schoberberger, Rudolf
This study aims to answer the question to which extent even very heavy nicotine-dependent smokers can benefit from a 3-week inpatient smoking cessation program. A particular focus lies on analyzing the positive effects, which go above and beyond normally anticipated health benefits. This is a descriptive study observing 270 patients over a 1-year period consisting of recruitment, therapy, and two post-therapy follow-up visits at 6-month interval. Gender differences, changes in body weight, and factors relating to addiction and the nicotine withdrawal process are analyzed. In comparing successful participants-post-therapy nonsmokers-with less successful ones, our analysis identifies benefits and advantages an inpatient smoking cessation therapy can bring to even the heaviest smokers. At the 12-month post-therapy follow-up visit, 42.6% of participants were identified as nonsmokers. A total of 34.0% of participants took up smoking again. No data is available on the remaining participants. Nonsmokers experienced significant reduction in nicotine craving and withdrawal symptoms. In terms of body weight, increases were found in both, men and women, nonsmokers and smokers. Successful quitters fail to report of an unbearable strong desire to smoke. Such unfounded fear should be communicated. Weight gain remains an undesired side effect. Hence, it is crucial to diagnose individuals more prone to weight gain and offer coping strategies thus reducing the risk of developing obesity. Nevertheless, the outcome of the study should be an encouragement to also heavy smokers and empower them to undertake smoking cessation.
Testa, Nicole; McCarthy, James B.
This article describes a small group of preadolescent, psychiatric inpatients and their collaborative painting of a memorial mural about the September 11, 2001, attack on the World Trade Center in New York City. Through an immersion in the group experience, the group members became increasingly introspective about their feelings of loss and their…
Niet, G.J. De; Tiemens, B.G.; Achterberg, T. van; Hutschemaekers, G.J.M.
The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at
Laux, G; Sander, K; Artmann, S; Dreher, J; Lenz, J; Hauth, I
Since the introduction of the qualification as specialist for psychiatry and psychotherapy, in addition to psychopharmacotherapy psychotherapy is an integral component of the treatment of mentally ill people. A survey was carried out to evaluate the reality of clinical routine use of psychotherapy in German psychiatric hospitals. Between October 2011 and March 2012 German hospitals of psychiatry and psychotherapy were contacted by the head organization, the conference of national directors (Bundesdirektorenkonferenz), to participate in a survey regarding the application of psychotherapy in the real clinical world of daily treatment. With an anonymous questionnaire, data were requested as either a printed form or online version. Data from 25 psychiatric hospitals in the year 2010 could be analysed (average number of beds 300 of which 53 were for psychosomatic/psychotherapeutic patients) and a total of 87,000 inpatients were treated whereby 34 % were diagnosed as F1 addictive disorders and 24 % as F3 affective disorders. More than 80 % of the hospitals applied group therapies of relaxation, cognitive behavior therapy, social competence training and specific techniques, such as dialectic-behavior therapy. As individual treatment methods, patients with depressive disorders were treated with cognitive behavior therapy, interpersonal psychotherapy or psychodynamic therapy in more than 50 % of the cases. Relaxation techniques were offered in most cases by the nursing staff, behavior therapy by psychologists and physicians and psychodynamic therapy mainly by psychiatrists.
Parrott, Fiona R
Research into the character of social relationships in psychiatric inpatient facilities has focused on face-to-face interaction between individuals and within groups in the communal areas of wards. Using theories developed in material culture and media studies, this article argues that patients' relationships to goods, namely, photographs, cards and gifts from family or friends, televisions and radios, are important mediators and constituents of sociability. In an ethnographic study of a medium-secure psychiatric unit, I show how these goods are put to use in private space in ways that reflect and mitigate the constraints of incarceration and stigmatization. The data were derived from 3 months of participant observation on a male and a female ward at a unit in the south of England, including a series of anthropological interviews with 19 patients. This article highlights two important findings. First, potentially isolating activities are perceived by patients as sociable, in that watching television and looking at photographs in their room helps to counter feelings of loneliness and isolation. Second, potentially sociable activities, exchanging goods or watching the communal television, are often practiced in such a way as to maintain distance between patients in acknowledgment of the constrained and volatile nature of these relationships. This suggests that patients aspire to retain a sense of the artificiality of their situation, preferring to confine their notion of 'real' relationships to those that exist outside the institution.
Mabuza, Langalibalele H; Omole, Olufemi B; Govender, Indiran; Ndimande, John V
Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However, not all patients seek this clarity. To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood. This was a qualitative arm of a larger study, titled 'Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa', conducted in 2010. Of the 264 inpatients who participated in the larger study, we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners, but that they had nonetheless not sought clarity.Data were analysed thematically. Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be 'too busy', aloof, non-communicators and sometimes uncertain about patients' conditions. Some inpatients had unquestioning trust in healthcare practitioners,whilst others had experiences of bad treatment. Inpatients had poor self-esteem, incapacitating clinical conditions, fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity. The reasons for not seeking clarity were based on patients' experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners.
Full Text Available Psychiatric disorders are common in women during their childbearing years. Special considerations are needed when psychotic disorders present during pregnancy. Early identification and treatment of psychiatric disorders in pregnancy can prevent morbidity in pregnancy and in postpartum with the concomitant risks to mother and baby. Nevertheless, diagnosis of psychiatric illnesses during pregnancy is made more difficult by the overlap between symptoms of the disorders and symptoms of pregnancy. In majority of cases both psychotherapy and pharmacotherapy should be considered. However, psychiatric disorders in pregnancy are often under treated because of concerns about potential harmful effects of medication. This paper reviews findings about the presentation and course of major psychiatric disorders during pregnancy.
Full Text Available The etiology of these dermatological diseases is entirely psychiatric origin. These patients show overconcern to their skin or self inflicted dermatoses unconsciously instead of facing with their real problems. In this group, delusions, dermatitis artefacta, trichotillomania, body dysmorphic disorder can be seen. They use denial as defence mechanism to their real psychiatric problems and prefer to apply dermatology instead of psychiatry. Dermatologist should be very careful before asking psychiatric consultation. Denial mechanism help patients to overcome agressive impulses like suicide or prevent further psychiatric damage like psychosis. Dermatologist should see these patients with short and frequent intervals with a good empathic approach. This will help to progress a powerful patient doctor relationship which will lead to a psychiatric evaluation.
Munk-Olsen, Trine; Maegbaek, M L; Johannsen, B M
and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods......Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed...... psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy...
Williams, W; Weiss, T W; Edens, A; Johnson, M; Thornby, J I
The relationship between hospital utilization and psychometric, demographic, and diagnostic data was examined among veterans with psychiatric problems. Data were obtained from the records of 500 psychiatric inpatients admitted to a Veterans Affairs medical center between 1984 and 1987 and followed for four years. All patients completed the Minnesota Multiphasic Personality Inventory, the California Personality Inventory, the Millon Clinical Multiaxial Inventory, and the Psychological Inventory of Personality and Symptoms. Stepwise linear regression analysis was used to predict the number and length of inpatient stays, and Cox and logistic regression analyses predicted rehospitalization. Higher rates of psychiatric hospital utilization were found among patients who were unmarried, who had disabilities connected with their military service, who had lower levels of adaptive functioning, and who were diagnosed as having posttraumatic stress disorder, drug or alcohol use disorder, or passive-aggressive or antisocial personality disorder. Higher utilization was also found among those whom psychometric data characterized as less responsible and more compulsive. The data also predicted the length of subsequent medical hospitalization and identified patients who stayed out of the hospital longer and who were not rehospitalized. Hospital utilization was found to be a function of psychiatric diagnosis, marital status, and various personality factors. Factors relating to social disadvantage also played a role. Axis I diagnoses, particularly substance use disorders, were as important as, if not more important than, axis II diagnoses in predicting utilization.
Czyz, E.K.; King, C.A.
Objective A period of particularly high risk for suicide attempts among adolescent inpatients is within 12 months after discharge. However, little is known about longitudinal trajectories of suicidal ideation in this high-risk group and how these relate to post-hospitalization suicide attempts and rehospitalizations. Our objectives were to identify these trajectories and examine their relationships with post-hospitalization psychiatric crises. We also examined predictors of trajectory group membership. Method Participants (N=376; ages 13-17; 72% females) were assessed at hospitalization and 3, 6, and 12 months later. Trajectory groups, and their predictors, were identified with latent class growth modeling. We used logistic regression to examine associations between trajectory groups and likelihood of suicide attempts and rehospitalization, controlling for attempt history. Results Three trajectory groups were identified: (1) subclinical ideators (31.6%); (2) elevated ideators with rapidly declining ideation (57.4%); and (3) chronically elevated ideators (10.9%). Adolescents in the chronically elevated ideation group had 2.29[(CI=1.08,4.85), p=0.03] and 4.15[(CI=1.65,10.44), psuicide and 3.23[(CI=1.37,7.69), p=0.01] and 11.20[(CI=4.33,29.01), psuicidal ideation. Conclusions Results suggest that suicidal ideation severity at hospitalization may not be an adequate marker for subsequent suicidal crises. It is important to identify adolescents vulnerable to persisting suicidal ideation, as they are at highest risk of psychiatric crises. Addressing hopelessness may facilitate faster declines in ideation after hospitalization. Results also highlight a need for consistent monitoring of these adolescents' suicidal ideation after discharge. PMID:24079705
... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor Regulations... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...
Sams, Deanna P; Garrison, David; Bartlett, Joanne
Child and adolescent psychiatric units serve the highest risk, most vulnerable populations in the mental health delivery system. This article describes the integration of a strength-based approach with a traditional, medical model of psychiatric care on an acute inpatient unit. A strength-based framework allows for increased focus on exploring patients' goals, strengths, relationships, skills, and family communication within the hospital setting. The process of integration of strength-based care is described, followed by discussion of the implementation and evaluation of interventions, including mindfulness, family movie, narrative, and animal-assisted therapies. Innovative interventions led to improvement in patient symptoms, unit culture, and patient, family, and staff satisfaction. A strong emphasis on strength-based, multidisciplinary treatment has enhanced patient care, as the goals of acute inpatient admission are broadened to include more than diagnosis and medication management. © 2016 Wiley Periodicals, Inc.