Acute Psychiatric Inpatients Research Articles

COVID-19 infection rates in patients referred for psychiatric admission during a regional surge: The case for universal testing

Some psychiatric hospitals have instituted mandatory COVID-19 testing for all patients referred for admission. Others have permitted patients to decline testing. Little is known about the rate of COVID-19 infection in acute psychiatric inpatients. Characterizing the proportion of infected patients who have an asymptomatic presentation will help inform policy regarding universal mandatory versus symptom-based or opt-out testing protocols. We determined the COVID-19 infection rate and frequency of asymptomatic presentation in 683 consecutively admitted patients during the surge in the New York City region between April 3rd, 2020 and June 8th, 2020. Among these psychiatric inpatients, there was a 9.8 % overall rate of COVID-19 infection. Of the COVID-19 infected patients, approximately 76.1 % (51/67) either had no COVID-19 symptoms or could not offer reliable history of symptoms at the time of admission. Had they not been identified by testing and triaged to a COVID-19 positive unit, they could have infected others, leading to institutional outbreak. These findings provide justification for psychiatric facilities to maintain universal mandatory testing policies, at least until community infection rates fall and remain at very low levels.

Non-disclosure of suicidal ideation in psychiatric inpatients: Rates and correlates

The study explored how common non-disclosure of suicidal ideation is in a sample of adult psychiatric inpatients (N = 171) plus associated patient characteristics. A large percentage (51.5%) withheld some information on suicidal ideation during admission. In multivariable analyses, correlates of non-disclosure included a diagnosis of emotionally unstable personality disorder, low satisfaction with stay, and symptoms of the suicide crisis syndrome. In univariate analyses, therapists’ emotional response to the patient was also a correlate. Findings indicate that among acute psychiatric inpatients, non-disclosure of suicidal ideation is quite common, requiring awareness from clinicians relying on this parameter in suicide risk assessments.

Diet Quality and Mental Health Amongst Acute Inpatient Psychiatric Patients.

This is the first study that explored the self-reported dietary habits of acute psychiatric inpatients. We found that 75% of the psychiatric inpatients have an unhealthy diet, which correlates with higher body mass index (BMI) and lower education level. We also found an increased sugar consumption in inpatients with schizophrenia.The link between nutrition and mental health has been explored to a limited extent owing to the cumbersome nature of conducting research that involves specific dietary intervention and follow up. Yet, there is existing literature linking poor diet with impaired mental health and poor recovery from depression, amongst other disorders. Good nutrition can be exemplified with diets like the Mediterranean diet with a focus on certain food groups that provide the nutrients linked to neurotransmitters and a fairly new concept of the gut-brain axis.A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression. A randomised controlled trial published in the nutritional neuroscience journal yielded a positive outcome and improvement in the overall well-being of the patients enrolled.We explored the dietary habits of acute inpatients. After gathering a detailed diet history, their food habits were compared to a Mediterranean dietary index to assess their dietary patterns. Additionally, variables such as socio-economic characteristics, physical activity, income, BMI, and educational achievement were taken into consideration, with the intention to understand the effect of these factors on a diet consumed by acute patients and the relationship of the diet with their mental wellbeing.Ultimately, this study aims at an important aspect of preventive mental health, i.e., improved dietary habits (e.g., Mediterranean diet) may contribute to more rapid symptoms resolution and acute stabilization on a short-stay inpatient unit.

Suicidal and violent ideation in acute psychiatric inpatients: prevalence, co-occurrence, and associated characteristics.

We studied the point prevalence of suicidal and violent ideation, as well as their co-occurrence and associated characteristics in inpatients with mental health disorders. Data on suicidal and violent ideation, and sociodemographic and clinical information, were gathered from 1,737 patients when admitted to the acute psychiatric ward. The point prevalence was 51.9% for suicidal ideation and 19.8% for violent ideation. The point prevalence of co-occurring suicidal and violent ideation was 12.3%, which was significantly greater than expected by chance. Logistic regression analyses indicated that both suicidal and violent ideation were associated with young age and the absence of diagnoses of psychotic disorders; in addition, suicidal ideation was associated with female gender, violent ideation, and diagnoses of mood- neurotic and personality disorders, whereas violent ideation was associated with male gender, suicidal ideation, and diagnoses of mood and neurotic disorders. Overall, the findings highlight the need for further research on suicidal and violent ideation in people with mental health problems including, but not limited to, their association with adverse behavioral outcomes, as well as the need to routinely assess both suicidal and violent ideation in clinical practice.

Phenotypic Characterization of Youth Admitted To Acute Psychiatric Inpatient Unit Following Self-Harm Behavior

Objective Deliberate self-harm (DSH) is a major health concern among adolescents, and is often associated with the need for inpatient psychiatric hospitalization. The aim of this study was to identify clinical and demographic characteristics associated with DSH behavior among adolescents admitted to an acute psychiatric inpatient unit. Method We retrospectively analyzed data from the electronic medical records of consecutive admittances to a single acute adolescent inpatient unit (n = 703, mean age 15.2). We compared inpatients with DSH to inpatients without DSH and further compared within the DSH group based on the presence of suicidal intent. Results Compared to Non-DSH inpatients (n = 497), youths admitted following DSH (n = 206) were more likely to be female (OR = 2.6, 95%CI 1.7–4), currently in depressive exacerbation (OR = 2.4, 95%CI 1.6–3.6), with concurrent suicidal ideation (OR = 3.9, 95%CI 2.5–5.9), and history of alcohol use (OR = 5.6, 95%CI 3.2–9.5). Within DSH youths, no significant clinical differences were identified between those admitted following a suicide attempt (n = 102) compared to non-suicidal-self-injury (n = 104), who were generally younger. Conclusions Findings suggest that early detection and intervention of DSH and depressive crisis is warranted, regardless of the self-harm subtype. HIGHLIGHTS Deliberate self-harm is common among adolescent psychiatric inpatients. Adolescent inpatients with deliberate self-harm are predominantly females with concurrent depression and suicidal ideation. We did not detect significant clinical and demographic differences between self-harmers with or without suicidal intent.

Prevalence and clinical correlates of substance use amongst acute psychiatric inpatients in Gauteng, South Africa.

BackgroundMental disorders and substance use disorders (SUD) commonly occur together, impacting healthcare outcomes. The diagnosis of substance use is often inadequate when comorbidity is present. It is vital to understand the prevalence of substance use amongst psychiatric patients to inform both clinical practice and service development in South Africa.AimTo ascertain the prevalence and clinical correlates of SUD amongst acute psychiatric inpatients.SettingThe setting for this study was Helen Joseph Hospital acute psychiatric ward.MethodsA cross-sectional study was conducted whereby consecutively admitted patients were invited to participate in a structured clinical interview utilising the alcohol use disorders identification test (AUDIT) and drug use disorders identification test (DUDIT) questionnaires. Statistical comparisons were made between those with and without SUD.ResultsOf 150 participants, 100 (67%) were identified with a SUD. Those with SUD were younger (p = 0.0010), more often male (p = 0.012), less likely to have a disability grant (p = 0.015) and more likely to be brought to hospital by police, ambulance or self than by a family member (p = 0.025). Almost half of people with bipolar disorder (47.3%) and schizophrenia (41.4%) had comorbid SUD. Twenty-three (15%) participants identified with SUD on questionnaire had been missed clinically. Only two participants were referred for inpatient substance rehabilitation on discharge.ConclusionSubstance use disorders are highly prevalent amongst psychiatric inpatients. The AUDIT and DUDIT are potentially useful screening tools in routine clinical practice. Greater collaboration between psychiatric and substance rehabilitation services is recommended.

Deconstructing violence in acutely exacerbating psychotic patients.

This study examined the proximate causes of psychotic patients' aggression upon the admission to the psychiatric wards of a university and two state hospitals. The authors used a semistructured interview to elicit proximate causes of assaults from the assailants and victims. The treating psychiatrists and nurses provided additional information. Based on this interview, aggressive episodes were categorized as psychotic, impulsive and planned. A total of 820 assaults committed by 289 newly admitted violent psychotic inpatients were evaluated. The interview ratings indicated that 76.71% of the assaults were directly driven by psychotic symptoms and 22.32% of all attacks were labeled as impulsive. Only 0.98% of assaults were categorized as planned. These findings indicate that assaultive behavior among recently admitted acute psychiatric inpatients with untreated or undertreated psychosis is primarily driven by psychotic symptoms and disordered impulse control. Because each type of assault requires a different management, identifying the type of assault is crucial in determining treatment interventions.

Nicotine Replacement Therapy and Healthy Lifestyle Psychoeducation for Smoking Reduction in Acute Psychiatric Inpatients: A Cluster-Randomized Parallel Study.

Effectiveness of nicotine replacement therapies in acute psychiatric inpatient settings remains under-researched. The aim of this study was to compare effectiveness and acceptability of 3 different forms of nicotine replacement therapy in achieving smoking reduction among acute psychiatric inpatients. This cluster-randomized, parallel study compared effectiveness and acceptability of nicotine inhalers, nicotine gum, and nicotine patches for smoking reduction in the acute psychiatric inpatient setting. The primary outcome was the exhaled breath carbon monoxide (CO) level change from baseline at weeks 4 and 8. Secondary outcomes included changes in nicotine withdrawal symptoms and psychiatric symptom severity. Three hundred ten inpatients on the acute care wards were randomly assigned to nicotine inhalers (n = 184), gum (n = 71), and patches (n = 55). Only the nicotine inhaler group showed statistically significant reduction in CO level from baseline at both weeks 4 and 8 (P < 0.001 and P = 0.032, respectively). The nicotine inhaler and the patch group showed significant decrease in nicotine withdrawal symptoms from baseline at both weeks 4 and 8. Meanwhile, the nicotine inhaler and the gum group showed significant decrease in psychiatric symptom severity from baseline at both weeks 4 and 8. Post hoc comparisons revealed that the inhaler group had a greater decrease in psychiatric symptom severity compared with the patch group. Nicotine inhalers may be an effective choice for smoking reduction in acute psychiatric inpatient settings given its significant effects on CO level, withdrawal symptoms, and psychiatric symptom severity, particularly during the first 4 weeks of treatment.

Urinalysis-Assessed and Self-Reported Substance Use as Correlates of Multiple Indicators of Suicide Risk Among Acute Care Psychiatric Inpatients

Nonalcohol substance use is a robust correlate of suicide risk. However, few data exist regarding the degree to which nonalcohol substance use, as measured by objective indicators (e.g., urinalysis toxicology screen), is related to suicide risk. This study examined the associations of a multimodal assessment of nonalcohol substance use and multiple indicators of suicide risk. Overall, 168 acute care psychiatric inpatients participated and provided data spanning urinalysis toxicology screen and self-report instruments. Substance use per urinalysis toxicology screen and self-report was not related to current suicidal ideation severity. However, substance use per urinalysis toxicology screen was significantly associated with a suicide attempt history and suicidality as a primary reason for admission. Substance use is an important variable to consider in suicide risk conceptualization. Findings underscore the importance of leveraging, when possible, objective indicators of substance use (e.g., urinalysis toxicology screen) in suicide risk formulations.

Self-Esteem Prevalence Amongst Acute Psychiatric Inpatients; Socio-Demographic Correlates and Association with Internalized Stigma and User Satisfaction

Objective: A field research on the prevalence of self-esteem among discharged patients from acute mental health wards was performed, including its socio-demographic correlates and the association with internalized stigma and user satisfaction.

Associations between readmission and patient-reported measures in acute psychiatric inpatients: a study protocol for a multicenter prospective longitudinal study (the ePOP-J study)

BackgroundSeveral previous observational studies have reported the risk factors associated with readmission in people with mental illness. While patient-reported experiences and outcomes have become increasingly important in healthcare, only a few studies have examined these parameters in terms of their direct association with readmission in an acute psychiatric setting. This project will investigate multiple factors associated with readmission and community living in acute psychiatric patients in Japan. This study will primarily investigate whether patient-reported experiences at discharge, particularly quality of life (QoL), are associated with future readmission and whether readmission after the index hospitalization is associated with changes in patient-reported outcomes during the study period. Here, we describe the rationale and methods of this study.MethodsThis multicenter prospective cohort study is being conducted in 21 participating Japanese hospitals, with a target sample of approximately 600 participants admitted to the acute psychiatric ward. The study has four planned assessment points: time of index admission (T1), time of discharge (from the index admission) (T2), 6 months after discharge from the index admission (T3), and 12 months after discharge from the index admission (T4). Participants will complete self-reported measures including a QoL scale, a subjective disability scale, and an empowerment- and self-agency-related scale at each assessment point; additionally, service satisfaction, subjective view of need for services, and subjective relationships with family members will be assessed at T2 and T3. We will assess the participants’ hospitalization during the study period and evaluate several potential individual- and service-level factors associated with readmission and patient-reported experiences and outcomes. Multivariate analyses will be conducted to identify potential associations between readmission and patient-reported experiences and outcomes.DiscussionThe present study may produce evidence on how patient-reported experiences at discharge influence readmission and on the influence of readmission on the course of patient-reported outcomes from admission to community living after discharge. The study may contribute to improving care for both patients’ subjective views of their own health conditions and their community lives in an acute psychiatric setting.Trial registration University Hospital Medical Information Network—Clinical Trials Registry (UMIN-CTR) UMIN000034220. Registered on September 20, 2018.

Examining cognitive functioning of adult acute psychiatric inpatients through a brief screening assessment.

Psychiatric inpatients present with multiple difficulties, including comorbid diagnoses, social problems, trauma, and high levels of psychiatric medication use. All of these factors have been associated with poorer cognitive functioning, which is rarely assessed. The aim of this study was to examine the acceptability of a brief cognitive screening assessment, and identify the cognitive and psychological profile of current psychiatric inpatients. A cross-sectional design was adopted. Participants (N = 75) were administered brief measures of cognitive functioning, the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), and psychological global distress, Clinical Outcomes of Routine Evaluation-Outcome Measure, (CORE-OM; Evans et al., 2002) within the first 4 weeks of their hospital admissions. The MoCA was identified as acceptable for the inpatient environment. Most of the participants (79%) met the cut-off for mild cognitive impairment. No significant differences were found across diagnoses in regard to cognitive functioning, but participants with diagnoses of personality disorder experienced the most psychological global distress. Acute psychiatric inpatient wards should consider mild cognitive impairments when assessing and treating people with serious mental illness and make appropriate adaptations to their care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Admission Experience Survey Italian Version (I-AES): A factor analytic study on a sample of 156 acute psychiatric in-patients

Coercive treatments are often regarded as an inevitable and yet highly debated feature of psychiatric care. Perceived coercion is often reported by patients involuntarily committed as well as their voluntary counterparts. The Admission Experience Survey (AES) is a reliable tool for measuring perceived coercion in mental hospital admission. We developed the Italian AES (I-AES) through translation back-translation and administered it to 156 acutely hospitalized patients (48% women, 69% voluntarily committed) in two university hospitals in Rome (Policlinico Umberto I, Sant'Andrea Hospital). A principal component analysis (PCA) with equamax rotation was conducted. The I-AES showed good internal consistency (Cronbach's alpha = 0.90); Guttmann split-half reliability coefficient was 0.90. AES total score significantly differed between voluntary and involuntary committed patients (5.08 ± 4.1 vs. 8.1 ± 4.9, p < .05). PCA disclosed a three-factor solution explaining 59.3 of the variance. Some discrepancies were found between the factor structure of the I-AES and the original version. I-AES total score was positively associated with numbers of previous involuntarily hospitalization (r = 0.20, p < .05) and psychiatric symptoms' severity (r = 0.22, p < .02). I-AES and its proposed new factor structure proved to be reliable to assess perceived coercion in mental hospital admission. Consequently, it may represent a helpful instrument for the study and reduction of patients' levels of perceived coercion.

Use of a proforma to aid in reducing coercion into informal admission for acute adult psychiatric inpatients in the U.K.

People with acute psychiatric illness may be at risk of coercion into informal admission. A lack of capacity assessment (CA) and provision of adequate information (PAI) for informal patients may constitute a risk of coercive admitting practice, resulting in increased use of the mental health act (MHA) in the days following admission. We developed and tested a proforma to aid in ensuring CA and PAI for informal admissions. A pilot case-study was conducted in 2015 at a U.K. NHS trust (n = 50), analysing the prevalence of CA & PAI for adult psychiatric inpatient admissions, alongside the prevalence of MHA use in the next 72 h. Case-note audits were completed in 2016 & 2017 (n = 100 each), to assess the impact of the proforma in improving documented CA & PAI, alongside the prevalence of MHA use in the next 72 h. We tested for any demographic associations with CA & PAI using logistic regression. CA improved from 39% (2015) to 60% (2017). PAI improved from 9% (2015) to 45% (2017). Use of the MHA in the 72 h following admission fell from 32% (2015) to 7% (2017). Most informal admissions detained within 72 h had no record of CA & PAI. People under the age of 26 years were significantly less likely to have documented CA & PAI. Use of the proforma was successful in improving CA & PAI in a U.K. Further improvements could be made. Future research should seek to further examine demographic differences in informal coercion.

Religious Activity, Psychotic Features, and Suicidality in 688 Acute Psychiatric Inpatients.

Religiosity has been linked to mental health outcomes for decades. This study examined the potential relationship between religiosity and demographic and clinical variables in a sample of psychiatric inpatients. In total, 688 adults admitted to an acute psychiatric facility with a primary mood or psychotic disorder completed the Duke University Religion Index (DUREL). The DUREL measures religious activity in 3 domains: organizational religious activity (ORA), nonorganizational religious activity (NORA), and intrinsic (or subjective) religiosity (IR). We categorized scores into high and low religiosity. Bivariate analyses with χ and independent sample t tests were used to examine the association between the DUREL subscales and demographic, clinical, and outcome measures. A generalized linear model was used to identify predictors of suicidality, psychosis, and 30-day rehospitalization. Elevated religious activity was common in the inpatient sample, with 58% categorized as high IR, 43% as high NORA, and 36% as high ORA. For all 3 DUREL subscales, high religiosity scores were associated with significantly more psychosis (P<0.05) and significantly less suicidal ideation (P<0.001). High ORA (P=0.001) and high IR (P=0.01) were associated with significantly fewer suicide attempts. High ORA scores were also associated with an increased length of stay (P<0.05) and more frequent 30-day readmission rates (P=0.01). In the generalized linear model, predictors of lower levels of suicidality were high ORA, high IR, and a diagnosis of schizophrenia, schizoaffective disorder, or other psychotic disorder, whereas a diagnosis of depressive disorder was associated with greater suicidality. Predictors of psychosis were high IR and Hispanic ethnicity, whereas a diagnosis of depressive disorder was associated with lower rates of psychosis. Female inpatients were more likely than male inpatients to score high on the ORA (P<0.05), NORA (P<0.05), and IR (P<0.0001) subscales. In addition, a significant relationship was detected between age and high IR scores (P<0.005), with increasing age associated with higher IR scores. Although preliminary, these results suggest that a brief measure of religiosity may provide important information concerning clinical features and acute outcomes in patients hospitalized with serious mental illness.

Association between Elevated C-Reactive Protein and Manic Polarity in Acute Psychiatric Inpatients with Affective Symptomatology

The interplay between the immune system and behaviour is of increasing interest in psychiatry research. Specifically, accumulating data points to a link between inflammation and psychopathology, including affective symptomatology. We investigated the association between inflammation and affective polarity in psychiatric inpatients who were hospitalized due to an affective exacerbation. Data was collected retrospectively and comparisons were made between manic and depressed patients. C-reactive protein (CRP), a general laboratory marker of immune activation and inflammation, was used as a non-specific inflammatory biomarker. Age, smoking and body mass index were considered covariates. Manic polarity (n = 89) was associated with statistically significant elevated CRP levels compared to depressed polarity (n = 44, 56%; p = 0.036), after controlling for covariates. No differences were observed in CRP levels across Diagnostic and Statistical Manual of Mental Disorders-IV Edition-Text Revised psychiatric diagnoses. These findings suggest a transdiagnostic association between inflammation and manic polarity in affective inpatients.

Psychological therapy for inpatients receiving acute mental health care: A systematic review and meta-analysis of controlled trials.

The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomized controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesize evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes and examine whether the presence of randomization and rater blinding moderated these estimates. A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, EMBASE, CINAHL, Cochrane, MEDLINE, and PsycINFO using a combination of the key terms 'inpatient', 'psychological therapy', and 'acute'. No restriction was placed on diagnosis. The moderating effect of the use of assessor-blind RCT methodology was examined via subgroup and sensitivity analyses. Overall, psychological therapy was associated with small-to-moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression, and anxiety. The use of single-blind randomized controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms and was also associated with reduced benefits on readmission and depression; however, these reductions were not statistically significant. The provision of psychological therapy to acute psychiatric inpatients is associated with improvements; however, the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and external validity are now required to establish what type, format, and intensity of brief psychological therapy is required to achieve sustained benefits. Clinical implications: This review provides the first meta-analytical synthesis of brief psychological therapy delivered in acute psychiatric inpatient settings. This review suggests that brief psychological therapy may be associated with reduced emotional distress and readmissions. The evidence in this review is of limited quality. The type, format, and intensity of brief psychological therapy required to achieve sustained benefits are yet to be established.

The delay to the first psychiatry consult in two acute inpatients clinics in Romania

Around 25% of adults experience a mental illness in each year and approximately 60% received no mental health care. There are still long delays between the onset of symptoms and the first psychiatric consult and treatment. Objective: To understand the pathway to care and to determine the delay in seeking help for mental health problems, considering sociodemographic variables in patients admitted in two Romanian acute psychiatric inpatients settings. Methods: Between May-August 2015, WHO's Pathway Encounter Form was applied to 200 individuals, at their first admission, consecutively hospitalized in acute psychiatry clinics from Targu Mures and Craiova, Romania. Results: The profile of the participants in this study was: woman in the sixth decade of life, having an average economic status and without psychiatric history, searching help for depressive symptoms (by themselves or at the advice of the family), mainly to a psychiatrist or a General Practitioner. The average delay from the onset of symptoms to the first psychiatry consult was 16 weeks. Only previous positive personal history for MH problems and current diagnosis had a high statistically significant influence on the moment when subjects of our study decided to access the MH services. Conclusions: A better knowledge and understanding on the factors that influence people to seek help in mental health problems would be useful for improving the future organization of healthcare services and programs.

ADHD in acute care psychiatric inpatients.

Attention-deficit hyperactivity disorder (ADHD) is a neurocognitive disorder characterized by symptoms of inattention, impulsivity and motor hyperactivity. The worldwide prevalence of ADHD, in the general adult population, has been estimated to be 2.8%. Patients with ADHD have a high incidence of comorbidity with other psychiatric disorders. Those with a psychiatric disorder as well as ADHD have more psychosocial difficulties than those without ADHD. Despite knowing that ADHD is often comorbid with other psychiatric diagnoses, there are currently no studies elucidating the prevalence of ADHD in the inpatient psychiatric population, nor is there significant information about its impact. The lack of research into this topic suggests more needs to be done in the field of adult ADHD, especially in the inpatient psychiatric population and with respect to impairment in patient function. Knowing the prevalence of ADHD and its impact on quality of life in adult inpatients will help lay the groundwork for effective screening and management. The purpose of this study was to understand the prevalence rates of ADHD among psychiatric acute care inpatients. Other objectives included comparing the quality of life and functioning between patients with a primary psychiatric diagnosis and ADHD (treated or untreated) versus those with a primary psychiatric diagnosis and no ADHD. Thirty-three (N=31) psychiatric inpatients were screened using the Adult ADHD Self-Report Scale. Those that screened positive for ADHD received a full diagnostic assessment for ADHD. All patients completed the Weiss Functional Impairment Rating Scale (WFIRS) to assess level of functioning and a Clinical Global Impression of Severity/Improvement Scale (on admission and discharge). Demographic information was also obtained. Of the 31 patients analyzed, 12 had a diagnosis of ADHD (36.4%). The participants diagnosed with ADHD scored significantly higher on the WFIRS, suggesting decreased functioning compared to patients without comorbid ADHD. Patients with ADHD also scored significantly higher in the individual domains of this rating scale, suggesting impairment in family, work and social functioning as well as decreased life-skills, poor self-concept and increased risk-taking behavior. In this sample, the prevalence of ADHD is significantly higher among acute care psychiatric inpatients than in the general population. Patients with concomitant ADHD suffer more functional impairment than those without. These findings merit further investigation into the value of routine screening and patient-specific treatment of ADHD in this patient population.

Influence of medications and psychotic symptoms on fall risk in acute psychiatric inpatients

Objective: In this study, we investigated the incidence rate and risk factors related to falls among acute psychiatric inpatients in a regional hospital. Methods: We included 521 patients who were admitted to the acute psychiatric ward in Taoyuan Armed Forces General Hospital from January 2015 to January 2016 and analyzed their medical records within a 1-year period. We compared differences between the fall and nonfall groups in demographic characteristics, psychiatric diagnoses, medication use, psychotic symptoms, and Timed Up and Go scores. Chi-square tests were used for comparison of categorical variables and t-test was used for continuous variables. Results: A total of 521 patients with an average age of 38.9 years were included in our study; 167 (32.1%) patients were female. Among the inpatients in our study, 3.07% were fallers. Patients with female gender, older age, psychotic symptoms, and use of more types of medication, especially mood stabilizers, laxatives, and other classes of medications, were significantly more likely to experience falls (P < 0.05). Conclusion: Determining the risk factors for falls in an acute psychiatric ward is useful for clinical care. As we identified patients in a high-risk group, fall prevention can be performed to help them to avoid possible injury. However, further studies are needed to determine more quantitative measures to evaluate or predict the risk of falls in acute psychiatric units.