Acute Inpatient Psychiatry Unit Research Articles

The Use and Safety of Leave From an Acute Inpatient Psychiatry Unit: A Retrospective Review of Pass Outcomes for 4 Years.

Leave passes provide authorized leave for hospitalized patients from a psychiatric inpatient unit. Although providing day passes was once a relatively common practice, there are relatively few data describing their safety and efficacy. This descriptive study examines the use of leave passes in an adult inpatient unit at a university hospital between 2017 and 2021, with attention to reasons for granting the day pass, duration, and outcome of the pass. During the study period, 10 patients with primary psychotic or mood disorders received 12 passes for housing coordination, COVID-19 vaccination, or major family events. There were no fatalities or abscondments. One patient experienced severe agitation and engaged in nonsuicidal self-injurious behavior. A second patient showed mild, redirectable psychomotor agitation upon return to the unit. The remaining 10 passes were uneventful. Our findings support the view that patients with diverse diagnoses can safely be provided leave from an inpatient setting with adequate planning and support, yielding a low incidence of adverse events.

P.0874 30-day psychiatric readmission in an acute inpatient psychiatry unit in Spain: a descriptive study

P.0874 30-day psychiatric readmission in an acute inpatient psychiatry unit in Spain: a descriptive study

Medication charts and consent to treatment documentation audit in an acute mixed in-patient psychiatry unit in south Manchester

AimsThe main aim of this audit was to look at documentation in medication charts in an acute mixed inpatient unit in South Manchester. In addition, we also looked at completion of capacity assessment and consent to treatment forms as appropriate.BackgroundSafe prescription, administration and monitoring of medication is key to effective patient care. Due to the busy nature of inpatient hospital wards, errors do unfortunately occur both with the medications, and with the recording of their administration.We will use a data collection tool to collect data as per standards described in our local GMMH policy. The medication chart will be used as the standard, as this is the current chart that is in use in the Trust.MethodData were collected from 31 medication charts for inpatients admitted in the ward between the 5/12/19 to 18/12/19. We captured data from each page of the medication chart that required a record to be made by any staff, including details of prescribing, administration and pharmacist checks. Data were recorded as either Yes/No or NA (Not Applicable). Data were then summarised and analysed using MS excel.ResultOf the 31 patients, 22 (71%) had a capacity assessment form completed and 16 (52%) had a consent to treatment form completed. From the data analysis, it was clear that there are high rates of completion for the ‘essential’ parts of all prescriptions, including medicine name, dose, route and data. ‘Route’ was only recorded for 40% of prescriptions for depot medicines. Details of the administration of a medicine by a nurse was generally well-completed. For as required medications, all information relating to administration (date, time, dose and given by) were fully completed for 100% of prescriptions. For regular prescriptions however, the administration details were not as well-completed, where date of administration was recorded in 84% of prescriptions and signature in 29% of prescriptions. Unique patient identifiers are well-recorded on Page 1 of the prescription chart, though not maintained throughout the prescription chart. Nature of reaction to an allergy or sensitivity was only recorded in 6 of the 21 patients (29%).ConclusionOverall, there were good completion rates for the mandatory parts of the prescriptions. However improvements could be made for prescriptions as well as administration and pharmacy checks. The capacity assessment and consent to treatment forms could be improved upon too. We plan to put the recommendations and re-audit in 3-6 months’ time.

Psychosis as a symptom of Vitamin B12 deficiency. Report of one case

IntroductionVitamin B12 deficiency may cause neurological and psychiatric symptoms, especially among elderly patients. Two clinical cases are presented of patients admitted to an Acute Inpatient Psychiatry Unit due to psychotic symptoms, being reported a B12 deficiency.ObjectivesReview clinical information about vitamin B12 deficiency as a factor involved in the development of psychiatric disorders, specifically psychotic symptoms, pointing out the peculiarities regarding clinical presentation, diagnosis, prognosis, and treatment management.MethodsSearch in the medical database PUBMED, MEDSCAPE and UPTODATE.ResultsVitamin B12 deficiency is associated with hematological, neuropsychiatric, and digestive disorders, is estimated that around 5-40% of the elderly population may present it. Neuropsychiatric syndromes may be the first, and sometimes sole, manifestation, related to a different etiological mechanism. Vitamine B12 deficiency implies enzymatic defects that cause an accumulation of methylmalonic acid and homocysteine, which is proportionally related to the severity of the neuropsychiatric symptoms. The range of clinical features includes psychotic and affective episodes, behavioral disorders, cognitive impairment, along with other neurological manifestations such as polyneuropathy and encephalopathy. The diagnosis delay is crucially important, as early detection could lead to reverse the neuropsychiatric symptoms and some of the neuroradiological alterations. Parenteral and oral vitamin B12 supplementation should be initiated, monitoring levels in plasma, together with psychiatric drugs until the symptoms are controlled.ConclusionsVitamin B12 deficiency is a factor that may be involved in the etiopathogenesis of psychiatric disorders. Thus, screening must be considered among the vulnerable population when presenting neuropsychiatric disorders as early diagnosis and treatment are key to clinical prognosis.

Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study.

BackgroundMental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders. ObjectiveThe main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model.MethodsFor the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015.ResultsAfter analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69%. This trend is due to the implementation of a new hospital management model in this health complex.ConclusionsWith the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced.

Implementing a Psychiatric Behaviours of Concern emergency team in an acute inpatient psychiatry unit: Staff perspectives.

Behaviours of concern including aggression are widespread in mental health inpatient settings. Restrictive interventions such as restraint and seclusion can cause additional trauma to already traumatized patients. To decrease use of these interventions in an acute psychiatric unit in Melbourne, Australia, a Psychiatric Behaviours of Concern (Psy-BOC) response team was introduced. In a Psy-BOC call, senior medical, nursing, and allied health staff respond to escalating behavioural situations to work with the primary treating team to implement clinical interventions of least restrictive practice. Here, we present qualitative findings reporting staff response to Psy-BOC. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Twenty-four staff participated in five focus groups. Four themes were identified: Identifying behavioural deterioration, responding to behaviours of concern, staff reactions, and barriers. Although staff were skilled in recognizing and de-escalating behaviours of concern, patients were secluded when heightened risk was perceived. The adoption of Psy-BOC was met with some resistance to the cultural change required to adopt this new model. Increased awareness, early identification of behaviours of concern, and pressure from management resulted in reductions in restrictive interventions. Management of patients with drug-induced psychosis without restraint presented specific difficulties. The ward setting was challenging, offering no break-out spaces for patients, and few comfortable areas. Some staff appreciated the advice and expertise of the Psy-Boc team, others felt disempowered and undermined. Improving leadership, staff education, support and collaboration, and including frontline staff in refining the process could enhance the Psy-BOC response and increase safety for all.

Reducing readmission rates in inpatient settings

ABSTRACTThe provision of good quality and cost effective mental healthcare remains a significant public health issue. The objective of this study was to improve the transition from inpatient to outpatient aftercare services, thereby reducing readmission rates. A total of 1,707 patients in acute inpatient psychiatry units participated in the intervention program over a period of 12 months. The readmission was reduced by 27 percent (9.54% to 6.95%, p = 0.004). The data suggest that these modalities significantly lower readmission rates and therefore improve the cost effectiveness and quality of mental health care.

First psychiatric hospitalization in patients older than 65 years

IntroductionMedical assistance for elderly people with mental health problems increases at the same time that life expectancy does.ObjectivesThe aim of this work is to describe several demographic and clinical characteristics of elderly patients admitted for the first time to an acute inpatient psychiatry unit.MethodsObservational, descriptive, and retrospective study from June 2013 to May 2015, where it is analysed patients older than 65 years admitted to the acute psychiatric ward of Hospital de Getafe in that period without psychiatric hospitalization in their personal background.ResultsSeventeen patients were included of a total of 428 patients admitted in that period (3.97%). Mean age: 70.7 ± 4.7. A total of 10 male (58.9%). The average stay in the studied group was 18.5 days, slightly lower than general average stay in that period (19.2 days). No psychiatric background was found in 4 patients. The most common diagnoses was depressive episode (5 patients) followed by manic episode (4 patients) and delusional disorder. Every of them but one, were taking at least one antipsychotic drug at discharge.ConclusionsElderly patients represent a low percentage of the total of patients admitted to an acute inpatient psychiatry unit. Many of them, despite having long-term ambulatory psychiatric follow-up, require a first psychiatric hospitalization after 65 years, as well as other patients begin their treatment in the mental health services in that hospitalization. It is noteworthy that antipsychotic drugs are used very commonly in those patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change.

Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.

Substance use and PTSD among smokers with serious mental illness

Aims: Epidemiological studies indicate Posttraumatic Stress Disorder (PTSD) frequently co-occurs with substance use and abuse, particularly among women. This study examined the PTSDsubstance use relation in a sample of men and women smokers with serious mental illness. Methods: 733 adult smokers (51% male) aged 18–73, were recruited from 5 acute inpatient psychiatry units. The e-MINI measured PTSD. Past 30-day substance use and readiness to change were assessed for heavy alcohol use (ALC), stimulants (STIM), sedatives (SED), hallucinogens (HAL), opiates (OP), and marijuana (MJ). The SF-12 assessed physical and mental health functioning. Logistic regression analyses tested for women and men separately the relation of PTSD with substance use and readiness to change. Results: 44% of women and 36% of men had PTSD. Past 30 day use of ALC, STIM, SED, OP and MJ was high (women range: 21.5–39.6%, men range: 24.9–47.1%). HAL use was lower (women: 3.9%, men: 5.9%). On average, women used 1.6 (sd =1.2) and men used 1.7 (sd =1.2) substances, during the past 30 days. Adjusting for covariates, use of OP (OR=2.1, p= .01), SED (OR=1.8, p= .02), and MJ (OR=1.9, p= .01) predicted PTSD in women. Use of STIM (OR=1.8, p= .04) and MJ (OR=1.7, p= .04) predicted PTSD in men. Number of substances used predicted PTSD in women (OR=1.5, p< .01), but not men. PTSD was unrelated to motivation to quit ALC/drugs. PTSD and # of substances used were associated with poorermental health functioning, anda significant interaction indicated mental health functioning was the worst among those with both PTSD and greater substance use (b=2.1, p= .03). Conclusions: Among smokers with serious mental illness, recent heavy alcohol, illicit drug use, and PTSD were common, found to co-occur, and predictive of worse mental health functioning. Integrative treatments for PTSD and substance abuse, with attention to sex-specific drugs of abuse, appear warranted. Financial support: Funding: K23MH083684, K05DA01869, P50DA09253, TRDRP#23BT-0018, T32HL007034.

A Lifetime of Recovery: Spirituality Groups on an Acute Inpatient Psychiatry Unit

Spirituality groups provide an environment in which persons experiencing acute stages of mental illness can find healing. Focused spiritual care is an important aspect in the recovery model of mental health care, by addressing the needs of the whole person rather than simply treating an illness. Spirituality groups provide a non-judgmental setting in which patients can discover and experience three elements for recovery: acknowledgement, meaning, and coping skills. This article briefly describes a recovery model for psychiatric care and the acute care environment identifying how the three key modular elements are facilitated within the dynamics of a group. Structured experiences and treatments are particularly important during acute stages of mental illness. This model provides a structured intervention detailed for an acute inpatient psychiatric spirituality group.

PTSD symptomatology and readiness to quit smoking among women with serious mental illness

IntroductionPosttraumatic stress disorder (PTSD) is a risk factor for tobacco addiction. The majority of research on PTSD and smoking has been conducted with men, particularly combat veterans, and little is known about the association among women. In a clinical sample of women civilian smokers with serious mental illness (SMI), we examined the prevalence of PTSD symptomatology and associations with physical and mental health functioning, co-occurring substance use, nicotine dependence, and readiness to quit smoking. Methods376 adult women smokers aged 18–73 were recruited from 7 acute inpatient psychiatry units and screened by diagnostic interview for current PTSD symptomatology (PTSD+). In multiple regressions, we examined the associations of screening PTSD+ with physical and mental health functioning; past-month drug use; past-year substance use disorders; nicotine dependence and readiness to quit smoking. ResultsNearly half the sample (43%) screened PTSD+, which was significantly associated with the use of stimulants (OR=1.26) and opiates (OR=1.98), drug use disorders (OR=2.01), and poorer mental health (B=−2.78) but not physical health functioning. PTSD+ status was unrelated to nicotine dependence, but predicted greater desire to quit smoking (B=2.13) and intention to stop smoking in the next month (OR=2.21). In multivariate models that adjusted for substance use disorders, physical and mental health functioning, and nicotine dependence, screening PTSD+ remained predictive of greater desire and intention to quit smoking. ConclusionPTSD symptomatology was common in our sample of women smokers with SMI and associated with not only worse substance use and mental health, but also greater readiness to quit smoking, suggesting the need for and potential interest in integrative PTSD-addiction treatment among women.

Baseline metabolic monitoring of atypical antipsychotics in an inpatient setting

Background: Atypical antipsychotic agents serve an important role in the treatment of many psychiatric disorders but have the potential to cause adverse effects, notably metabolic disturbances. These agents are known to cause increases in obesity, glucose intolerance, dyslipidemia and hypertension. In 2004, the American Diabetes Association (ADA) and the American Psychiatric Association (APA), in collaboration with other organizations, acknowledged the association between the use of atypical antipsychotics and the development of metabolic abnormalities and provided monitoring recommendations for the use of these agents. Despite these recommendations, rates of monitoring remain low. Objective: The purpose of this study is to assess whether a pharmacist recommendation form is effective in improving baseline metabolic monitoring for patients admitted to an acute inpatient psychiatry unit who are ordered a scheduled atypical antipsychotic. Methods: A pharmacist recommendation form with metabolic monitoring parameters was placed on the charts of patients ordered a scheduled atypical antipsychotic during a two month period. A retrospective chart review was conducted to compare the percentage of baseline monitoring ordered pre-intervention versus the intervention period. Patients ages 18 years or older who were ordered a scheduled atypical antipsychotic were included. Results: During the intervention period, there was a significant increase in documentation for presence or absence of diabetes (p = 0.018) and cardiovascular disease (p &amp;lt; 0.001). A significant difference in the number of orders for hemoglobin A1c (p = 0.007) and lipid panels (p &amp;lt; 0.001) were noted. No other significant differences were found. Conclusion: A pharmacist recommendation form was effective in improving the baseline monitoring of personal history of diabetes and cardiovascular disease and monitoring of hemoglobin A1c and lipid panels, but rates of other baseline monitoring parameters did not improve.

Ethics Commentary: Fundamentals of Life

Caring for patients involves understanding the ways in which they fulfill their physical natures. Balance in the basic drives of life, such as eating, sleeping, and having sex, is important to the quality of one’s life. Imbalance in these fundamental domains, moreover, may reflect an underlying disruption in mental health or, alternatively, threaten mental well-being. Physiological dysfunction accompanying either illness or treatment may further upset this balance, interfering with the regulation of appetite, sleep patterns, or sexual interest and capacities. These dimensions of life are often very private and involve deeply personal concerns for our patients. Impulses, intimacy, image, and insecurities—these are the complex, overdetermined biological and psychological issues that arise. And as with other such sensitive considerations in psychiatric practice, certain values and bioethical principles are held especially dear in caring for these aspects of our patients’ lives.

Interdisciplinary treatment and training issues in the acute inpatient psychiatry unit

While interdisciplinary team treatment processes are well elaborated in geriatric treatment settings and literature, there has been less elaboration of the interdisciplinary model in other clinical areas. This paper describes the independent evolution of an analogous interdisciplinary team model in an acute, tertiary care inpatient psychiatric unit in a Veterans Affairs hospital in the USA. The practices, benefits and drawbacks of the model in a psychiatric setting are similar to those described in the gerontological literature.