Care Of Psychiatric Patients Research Articles

Comorbid Diagnosis of Psychotic Disorders in Borderline Personality Disorder: Prevalence and Influence on Outcome.

A diagnosis of psychotic disorder is traditionally considered incompatible with borderline personality disorder (BPD), even though patients sometimes fulfill the diagnostic criteria for both disorders. How often this happens is barely known, as is the influence of comorbid psychotic disorders on the outcome of BPD. Since studies on isolated auditory verbal hallucinations in patients with BPD indicate that these perceptual symptoms have severe consequences and are associated with suicidal behavior and hospitalization, patients with comorbid psychotic disorders are unlikely to fare better. To examine the point prevalence of psychotic disorders in patients with BPD, their association with the outcome of BPD, and their predictive value for outcome. In a cross-sectional design, 84 female outpatients diagnosed with BPD were interviewed with the aid of the MINI-International Neuropsychiatric Interview to establish the point prevalence of comorbid psychotic and other comorbid disorders. After termination of their treatment at a specialized outpatient clinic, the type of referral was considered to be a "good" outcome when they were referred to their general practitioner or to basic psychiatric care for noncomplex patients, and a "poor" outcome when referred to a specialized psychiatric department or to a psychiatric district team for patients with severe psychiatric disorders. Psychotic disorders were present in 38% of the patients with BPD. With a prevalence of 20%, psychotic disorder not otherwise specified (NOS) was the most common subtype; the least common types were schizophrenia (2%), substance-induced psychotic disorder (2%), and brief psychotic disorder (1%). Among six types of comorbid disorders, only psychotic disorders were associated with a poor outcome; they were also predictors for a poor outcome, along with comorbid mood disorders, eating disorders, and somatoform disorders, as well as the severity of BPD, and, counterintuitively, more years of education. Psychotic disorders, notably of the psychotic disorder NOS subtype, are common among patients with BPD, and their presence is associated with a poor outcome. This implies that adequate diagnosis and treatment of both disorders is warranted in this subgroup with a dual diagnosis.

Challenges of Family Caregivers of Patients with Mental Disorders in Iran: A Narrative Review.

Background:Family caregivers of patients with mental disorders play the most important role in the care of psychiatric patients (PPs) and preventing their readmission. These caregivers face different challenges in different cultures. We conducted this study to determine the challenges of caregivers of patients with mental disorders in Iran.Materials and Methods:This study is a narrative review with a matrix approach conducted by searching electronic databases, SID, IRANMEDEX, MAGIRAN, PUBMED, SCOPUS, Web of Sciences, from February 2000 to 2017. Searched keywords include challenges, family caregivers of psychiatric patient, family caregivers and psychiatric patient, mental illness, families of psychiatric patient, and Iran. One thousand two hundred articles were found in English and Farsi, and considering inclusion and exclusion criteria, 39 articles were examined.Results:The results of the studies show that not meeting the needs of caregivers, burnout and high burden of care, high social stigma, low social support for caregivers, and low quality of life of caregivers were among the most important challenges faced by caregivers.Conclusions:Despite the efforts of authorities in Iran, family caregivers of patients with mental disorders still face challenges. Therefore, the need for all-inclusive support for family caregivers of patients with mental health problems is necessary.

Help-seeking behavior and pathways to care among patients seeking treatment at a private psychiatric hospital in North India

Background: There are no studies on pathways to psychiatric care in patients seeking help at private psychiatric hospitals in India. Aim: This study aims to study help-seeking behavior and pathways to care among patients-seeking treatment at a private psychiatric hospital in North India. Subjects and Methods: Fifty newly registered patients were assessed for their help-seeking behavior and pathways to care before seeking the current consultation. Descriptive analysis was performed. Results: Most of the patients sought help either as self-referral or on advice of their relatives, friends, and other patients. Eighty percent of patients had seen a care provider within 1 month of onset of their symptoms. Forty-eight percent patients approached a psychiatrist while 34% approached a faith healer or unqualified local practitioner as their first care provider. Conclusion: Patients with mental illnesses vary in their help-seeking behavior with regard to their choice of first care provider, time to reach a psychiatrist, and number of care providers sought for their mental health problems.

Association of Psychiatric Diagnostic Conditions with Hospital Care Outcomes of Patients with Orthopedic Injuries.

Psychiatric comorbidity is common in orthopedic injury, but the effects on hospital care outcomes have been identified only generally. To quantify psychiatric comorbidity and its outcome effects in a large, multicenter population of inpatients with orthopedic injuries. Retrospective analysis of patient discharge data from 507 California hospitals from 2001 to 2010. Study sample included orthopedic diagnoses using International Classification of Diseases codes for major pelvic and lower extremity injuries in patients older than age 17 years. From the injury data, we extracted psychiatric diagnoses, alcoholism, substance abuse, and sociodemographic characteristics. Length of stay, surgical complications, and inpatient deaths. The entire injury admissions represented about 1.9% of all hospital admissions and were predominantly older than age 64 years, white, and women with conventional health care insurance. The most common comorbidity in the patients with injury was psychiatric illness (24.7%). The most common psychiatric diagnoses in orthopedic injury admissions were dementia (14.3%) and depression (6.9%) without association. Compared with the injury admissions with no psychiatric diagnosis, admissions with psychiatric diagnosis had higher odds of a hospital stay of 7 or more days, surgical treatment complications, and inhospital death. Psychiatric comorbidity adversely affects several hospital outcomes in patients with orthopedic injuries: Length of stay, surgical complications, and inpatient mortality. In low-income populations, the adverse psychiatric effects are incrementally worse. The adverse effects of psychiatric comorbidity, particularly dementia and depression, on hospital outcomes should stimulate improved psychiatric care of many patients at risk of poor clinical outcomes.

From alienation to the nursing clinic: care of patients with psychiatric comorbidity.

to understand how nurses of mental health care for psychiatric patients with clinical comorbidities. qualitative study based on the referential of historical and dialectical materialism. Interviews with nurses were conducted using semi-structured script. Sample determined in snowball. The interviews were recorded and transcribed in full. The data were analyzed through content analysis, including: organization and exhaustive reading of the material, exploration, grouping data into thematic units, processing of results, and interpretation. the role of nurses is marked by the dialectic between knowing and not knowing, a movement that revealed two categories: clinic of psychiatric nursing, and alienation and subordination of nurse in the care process. the development of the nursing clinic, based on the therapeutic relationship, favors integral care towards the patient, whereas alienation/subordination distances the nurse from care and impairs care.

Bo Hejlskov Elvén & Sophie Abild McFarlane. (2017). Frightened, Disturbed, Dangerous? Why working with patients in psychiatric care can be really difficult and what to do about it. London: Jessica Kingsley Publishers. ISBN 9781785922145

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In the Name of … Consultation-Liaison Psychiatry

In the Name of … Consultation-Liaison Psychiatry

Knowledge and Attitudes of Nurses toward Concept of Milieu Therapy

Background: Therapeutic milieu refers to an environment that is structured to provide patients with the opportunity to interact with staff and other clients. Producing a therapeutic milieu is a basic intervention in mental health nursing practice. Consequently sufficient knowledge and positive attitudes are important aspects of providing nursing care for psychiatric patients within the current social climate. This study aimed to assess knowledge and attitudes of nurses toward the concept of milieu therapy. This study was exploratory descriptive, performed on 100 nurses working with psychiatric patients at El-Abbassia Mental Health hospital. Data were collected using three parties, socio-demographic data, and knowledgeof nurses about the milieu therapy and the attitudes of nurses toward milieu therapy. The results of this study showed that nurses working with psychiatric patients possess a satisfied level of knowledge about the definition and aim of milieu therapy (75%) meanwhile; they have unsatisfying knowledge about activity therapy (52%). However, the studied nurses showed a high level of sympathetic attitudes toward psychiatric patients (74%), the negative attitudes toward milieu therapy was observed in (90%).Based on the results of this study, it can be concluded that the nurses with satisfactory knowledge were more probable to have a positive attitude towards the milieu therapy. The study recommended that in-service education programs should be provided to nurses working with psychiatric patients regarding knowledge about activity therapy and how to promote patient participation.

Psychoactive substance use in specialized psychiatric care patients.

Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.

Potential drug-drug interactions and polypharmacy in institutionalized elderly patients in a public hospital in Brazil.

Introduction Despite the impact on patient safety and the fact that prevalence is higher in older patients, previous research did not analyse drug-drug interactions (DDIs) in view of nursing care of elderly psychiatric patients. Aim To identify potential drug-drug interactions and polypharmacy in prescriptions of aged inpatients with psychiatric disorders and analyse associated factors. Methods In this retrospective cross-sectional study, we analysed the medical records of institutionalized patients diagnosed with psychiatric disorders (n=94), aged >60years, and prescribed multiple medications. Drug prescriptions were checked at admission, midway through and the last prescription. Factors associated with DDI occurrence were assessed using multivariable logistic regression analysis. Results A DDI prevalence potential of 67.0%, 74.5% and 80.8% occurred in patients at admission, midway through hospitalization and the last prescription, respectively. Most of the prescribed drugs were nervous system agents. A high percentage of serious and contraindicated potential DDIs occurred. Age between 60 and 69years, use of cardiovascular and respiratory system drugs, and the number of medications contributed significantly to DDI. Implications for mental health nursing Knowledge on the factors associated with DDIs in patients with mental disorders can contribute to the improvement of effectiveness and safety of nursing care.

Rural-urban differences in accessing mental health treatment in patients with psychosis.

Delay in accessing psychiatric treatment has considerable influence on the outcome of psychoses. Systematic studies examining the source of the delay are lacking in India. In this article, we examine rural-urban differences regarding delay in accessing psychiatric care in patients with psychosis, an issue which was hitherto not studied. To evaluate the rural-urban differences in treatment seeking among patients with psychosis. Patients with psychotic disorders who presented to the outpatient department of an academic psychiatric institute for the first time ( n = 551) were interviewed using a semi-structured interview tool to assess the date of onset of illness. Families in urban areas had significantly higher level of education and greater income than their rural counterparts. However, there was no difference in urban and rural patients in the duration of untreated illness (DUI). There was no correlation between average years of education of the family members and DUI (spearman's rho = -0.01; p = .77). Despite the proximity to psychiatric centers, better education and greater income, patients in urban areas do not access psychiatric care earlier than patients in rural areas. So, mere presence of services would not make patients access them early.

General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis

SummaryBackgroundSelf-harm is an extremely common reason for hospital presentation. However, few estimates have been made of the hospital costs of assessing and treating self-harm. Such information is essential for planning services and to help strengthen the case for investment in actions to reduce the frequency and effects of self-harm. In this study, we aimed to calculate the costs of hospital medical care associated with a self-harm episode and the costs of psychosocial assessment, together with identification of the key drivers of these costs.MethodsIn a retrospective analysis, we estimated hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital (Oxford, UK), between April 1, 2013, and March 31, 2014. Episode-related data were provided by the Oxford Monitoring System for Self-harm and we linked these with financial hospital records to quantify costs. We assessed time and resources allocated to psychosocial assessments through discussion with clinical and managerial staff. We then used generalised linear models to investigate the associations between hospital costs and methods of self-harm.FindingsBetween April 1, 2013, and March 31, 2014, 1647 self-harm presentations by 1153 patients were recorded. Of these, 1623 (99%) presentations by 1140 patients could be linked with hospital finance records. 179 (16%) patients were younger than 18 years. 1150 (70%) presentations were for self-poisoning alone, 367 (22%) for self-injury alone, and 130 (8%) for a combination of methods. Psychosocial assessments were made in 75% (1234) of all episodes. The overall mean hospital cost per episode of self-harm was £809. Costs differed significantly between different types of self-harm: self-injury alone £753 (SD 2061), self-poisoning alone £806 (SD 1568), self-poisoning and self-injury £987 (SD 1823; p<0·0001). Costs were mainly associated with the type of health-care service contact such as inpatient stay, intensive care, and psychosocial assessment. Mean costs of psychosocial assessments were £228 for adults and £392 for individuals younger than 18 years.InterpretationIf our findings are extrapolated to England, the estimated overall annual cost of general hospital management of self-harm is £162 million per year. More use of psychosocial assessment and other preventive measures, especially for young people and against self-poisoning, could potentially lower future costs at a time of major cost pressures in the NHS.FundingNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research, Care Oxford at Oxford Health NHS Foundation Trust, and Department of Health.

Protocol for the management of psychiatric patients with psychomotor agitation

BackgroundPsychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode.MethodsSpanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement.ResultsThe protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in the least invasive and coercive manner, ensuring their own safety and that of others around them.ConclusionEstablishing specialized teams in agitation and providing them with continued training on the identification of agitation, patient management and therapeutic alternatives might reduce the burden of PMA for both the patient and the healthcare system.

Suicide risk assessment among psychiatric inpatients: a systematic review and meta-analysis of high-risk categories.

The clinical care of psychiatric patients is often guided by perceptions of suicide risk. The aim of this study was to examine the methods and results of studies reporting high-risk models for inpatient suicide. We conducted a registered meta-analysis according to PRISMA guidelines. We searched for relevant peer-reviewed cohort and controlled studies indexed in Medline, EMBASE and PsychINFO. The pooled odds ratio (OR) among 18 studies reporting high-risk models for inpatient suicide was 7.1 [95% confidence interval (CI) 4.2-12.2]. Between-study heterogeneity in ORs was very high (range 0-94.8, first quartile 3.4, median 8.8, third quartile 26.1, prediction interval 0.80-63.1, I2 = 88.1%). The meta-analytically derived sensitivity was 53.1% (95% CI 38.2-67.5%, I2 = 95.9%) and specificity was 84.2% (95% CI 71.6-91.9%, I2 = 99.9%) with an associated meta-analytic area under the curve of 0.83. The positive predictive value of risk categorization among six cohort studies was 0.43% (95% CI 0.014-1.3%, I2 = 95.9%). A history of suicidal behavior and depressive symptoms or affective disorder was included in the majority of high-risk models. Despite the strength of the pooled association between high-risk categorization and suicide, the very high degree of observed heterogeneity indicates uncertainty about our ability to meaningfully distinguish inpatients according to suicide risk. The limited sensitivity and low positive predictive value of risk categorization suggest that suicide risk models are not a suitable basis for clinical decisions in inpatient settings.

長期入院患者,再入院を繰り返す患者の退院支援と地域生活継続支援(シンポジウム:精神看護における患者・家族の体験,先駆的看護実践と研究の統合,第22回日本精神保健看護学会学術集会)

長期入院患者,再入院を繰り返す患者の退院支援と地域生活継続支援(シンポジウム:精神看護における患者・家族の体験,先駆的看護実践と研究の統合,第22回日本精神保健看護学会学術集会)

A meta-analysis of adjuvant group-interventions in psychiatric care for patients with bipolar disorders

BackgroundBipolar disorders are ranked amongst the top ten causes of global disability and cause high health care costs. Previous studies have showed that mood stabilizing drug therapy combined with psychological treatments lead to significantly fewer relapses and a reduction in hospitalization rates. However, there is a wide spectrum of psychosocial intervention methods for individuals and groups which have been insufficiently examined on a scientific basis. MethodsStudies published between 2003 and 2015 on different types of adjuvant psychosocial group interventions in the MESH database were reviewed and evaluated for their efficacy on patients with bipolar disorder related to the relapse ratio by a meta-analysis. ResultsThe meta-analysis included 24 intervention groups and showed that 75% of treated groups under medication and psychosocial therapy had a lower risk of a relapse than the control groups which only received medication therapy. LimitationsThe meta-analysis includes a number of trials with participants in different phases of disease course and study designs, the number of studies in each analyzed intervention group was not balanced and many studies focused on recovery and recurrence of episodes, precluding identification of the impact on subsyndromal symptoms ConclusionsAdjuvant psychosocial interventions seem to be indispensable for patients, their relations as well as for saving costs in the health care system. Nevertheless, an evaluation of effectiveness and impact factors of different psychosocial intervention methods needs further research.

A Model of Collaborative Spiritual and Psychiatric Care of Oncology Patients

Many oncology patients see both chaplains and consultation-liaison (C-L) psychiatrists during medical hospitalizations. Studies show that spirituality and mental health influence one another, and that patients often prefer that physicians understand their spirituality. Though models of inpatient chaplaincy-psychiatry collaboration likely exist, none are apparent in the literature. In this study, we present one model of chaplaincy-psychiatry collaboration, hypothesizing that both specialties would find the intervention helpful. From April through December 2015, the C-L psychiatry service at Brigham & Women's Hospital piloted 13 sessions of interdisciplinary rounds, where chaplains and C-L psychiatrists discussed common oncology patients. Participants completed questionnaires including quantitative and qualitative prompts before the intervention, after each session, and at the study's conclusion. Eighteen individuals completed baseline questionnaires. Between baseline and final surveys, the proportion of participants describing themselves as "very satisfied" with the 2 services' integration rose from 0-36%. The proportion of participants feeling "not comfortable" addressing issues in the other discipline declined from 17-0%. The most frequently chosen options on how discussions had been helpful were that they had enhanced understanding of both patient needs (83.3%) and the other discipline (78.6%). Qualitative data yielded similar themes. At conclusion, all respondents expressed preference that interdisciplinary rounds continue. This study describes a model of enhancing collaboration between chaplains and C-L psychiatrists, an intervention not previously studied to our knowledge. A pilot intervention of the model was perceived by both specialties to enhance both patient care and understanding of the other discipline.

Care of psychiatric patient’s at community level

Care of psychiatric patient’s at community level

The Impact of Mental Health Services in a Pediatric Emergency Department: The Implications of Having Trained Psychiatric Professionals.

This study assessed improvement in the emergency department (ED) length of stay and costs after implementation of an ED program which added board-certified psychiatrists and trained psychiatric social workers to the pediatric ED. A retrospective medical record and administrative data review were conducted for all pediatric psychiatric visits of children aged 5 to 18 years who were seen and discharged from the Greenville Memorial Hospital ED between January 1, 2007, and June 31, 2013. These subjects were diagnosed by the ED physician at the time of the visit using codes ranging from 290.0 to 319.0 based on the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. The mean (SD) age of children in the postprogram period (14.3 ± 3.1) was younger than during the preprogram period (14.9 ± 3.1) (P < 0.001) with the greatest increase in the 11- to 15-year age group (42% vs 35%, respectively). Patients in the postprogram period were significantly more likely to be discharged to a psychiatric hospital than during the pre-program period (18% vs 9%, respectively). After the initiation of the program, ED length of stay decreased significantly from 14.7 to 12.1 hours (P < 0.001) and costs per visit decreased slightly from US $602 to US $588 (this difference was not statistically significant). Although this model of care has significant costs associated with it, the efficiency of care for psychiatric pediatric patients in the ED improved after targeted training of ED staff and provision of these specialized services within the ED.

Collaborative Care Leaders Seek to Bring Model to Residency Training

While many residency programs offer electives in integrated care, only a few have rotations in which trainees work in consultation to primary care as a regular part of their training.