Care Of Psychiatric Patients Research Articles

EPA-1325 - Relevance of a mobile psychiatric team for elderly patients within institutions for old people

As they grow older, patients with severe psychiatric illness often have less access to psychiatric care due to loss of autonomy and difficulties in getting about. The recently created Psychiatric Liaison Experimental Unit - ULP - (made up of psychiatrists, nurses and a coordinator), a mobile team in the retirement homes and residences of Paris's Social Services Center (2,600 beds) must enable residents suffering from psychiatric problems to get better treatment. In old people's homes, residents rarely have the opportunity to consult a psychiatrist. Geriatric staff are often at a loss when faced with the expression of psychiatric symptoms, with the specificity of caring for younger patients whose behaviour is different from older people with neurodegenerative disorders. The involvement of community mental health services lacks homogeneity. Professionals in the field of psychiatry and geriatrics are not very familiar with each other's work. The team's purpose is to create a link between the two, to promote partnerships so as to find housing for ageing dependent psychiatric patients. They also provide their expertise in complex cases. Appointed and financed over three years by the health authorities, this team will be assessed on how they set up partnerships, on the quality of the links they create and on the improvement in the living conditions and the care these older patients get. We will present the various missions of this team and a model of a locally based network approach of psychiatric care for elderly patients.

The Nursing Care for Psychiatric Patients to Prevent Hospital Readmission

The Nursing Care for Psychiatric Patients to Prevent Hospital Readmission

Mortality among long-stay patients with schizophrenia during the setting-up of community facilities under the Yuli model

Objective: Over the past 15 years, Yuli Veterans Hospital (YVH) in Taiwan has developed the Yuli model to reform long-stay care for psychiatric patients. The development of the Yuli model could be divided into pre-early (1998–1999), early (2000–2006) and late (2007–2008) periods according to the setting-up of the community facilities. In the pre-early period, a vocational rehabilitation program was established for psychiatric patients in YVH. In the later periods, the independent living skills training and the program for social reintegration were instituted in the community facilities. This study aimed to evaluate mortality among the long-stay patients with schizophrenia during the three periods. Methods: In all, 2457 patients with schizophrenia who had been hospitalized for at least one year initially were retrospectively followed from 1 January 1998 to 31 December 2008. Compared with the general population in Taiwan, we calculated the age- and sex-specific standardized mortality ratios (SMRs) of those patients by cause of death during the three periods. Results: Most of the patients were male (81.3%). The mean ± SD age of the patients was 57.83 ± 16.95 years. The all-, natural- and unnatural-cause mortalities of the patients were nearly two times greater than those of the general population during the whole study period. Compared with those in the pre-early and early periods, all patients in the late period had the lowest mortality gaps. In the pre-early, early and late periods, the all-cause SMR were 5.40 (95% confidence interval (CI) = 4.27–6.81), 2.90 (95% CI = 2.20–3.79) and 1.17 (95% CI = 0.54–2.22), respectively, for the 50–69-year-old male patients. Nearly half of all the patients who participated the whole comprehensive rehabilitation program belonged to this sex and age group (N = 156, 46.6%). Conclusions: With the setting-up of community facilities for the comprehensive rehabilitation program, the mortality gaps among the 50–69-year-old male patients apparently decreased using the Yuli model.

EPA-0575 – Audit to identify the number of patients with multiple diagnoses in a community mental health team in bedford, England

Background Patients with ‘simple’ mental health problems should be able to be managed exclusively in primary care. It is therefore anticipated that only the more complex cases would be referred to secondary care. In order to test this hypothesis, the number of patients registered with a community mental health team (CMHT) in Bedford, United Kingdom, who had received multiple psychiatric diagnoses in 2010, 2011 and 2013, was analysed. Method Using an anonymised database that contains all patient data, the proportions of patients with more than one diagnosis were audited for the months of August 2010, June 2011 and February 2013. The total number of patients registered was also determined. Results Many patients were found to have received multiple diagnoses. An increase in the proportion of patients with multiple diagnoses was observed; from 23.2% in 2010 to 25.2% in 2011 to 34.3% in 2013. Discussion Several psychiatric conditions are associated with particular psychiatric co-morbidities, which may be one reason why many of patients receive multiple diagnoses. The trend observed may reflect improving mental healthcare in primary care and therefore fewer referrals of patients with ‘simple’ mental health conditions to secondary care, thus causing the CMHT's caseload to become increasingly complex. It may also reflect improving communication between primary and secondary care, which may also lead to fewer referrals. Finally, the trend may merely reflect better use of the available database. Conclusion We have found that numerous patients received multiple diagnoses. We have also observed an increase in the proportion of such patients over three years, which may reflect improved management of mental health problems in primary care. Our results may therefore provide an incentive to establish formal shared care of psychiatric patients between primary and secondary care to improve patient management even further.

EPA-1698 – Physical health care for psychiatric patients “a white elephant in the room” Dr. Paul Mccrea, Dr. Bhavana Karna

To develop a physical health care policy within the Rotherham Doncaster And South Humber NHS Foundation Trust (RDASH NHS FT) and shared care policy with Primary care, for adult psychiatric patients. To carry out a physical health care pilot in community mental health team of adult psychiatric patients. To achieve a baseline of physical health status of the patients. To present the findings to the trust governance committee. Plan further pilot in Primary care to ensure action plan. Arrange systems in place within IT to store and share information. Pilot was carried out in Ferham clinic in Rotherham. Number of patients: 247 A physical health pro-forma was devised which was completed by patients. Time period: May2013-September2013 Patients identified: 247, Respondents: 225 Type of pre-existing physical illness Side effect profile The results were presented at Trust Governance Committee and the pro-forma has been agreed as a trust wide minimum standard. Pilot in primary care has been agreed with Kivetonpark Medical practice. A system has been agreed with IT to store and share information in electronic case notes. Pending the results of primary care pilot, a policy for physical health care will be agreed.

Educação permanente/continuada como estratégias de gestão no Serviço de Atendimento Móvel de Urgência

The objective of this study was to analyze the perception that healthcare professionals make of permanent and/or continuing education at the Mobile Emergency Care Services in a municipality in São Paulo state. This qualitative study was performed using thematic content analysis. Interviews were conducted with 30 healthcare professionals, which revealed two categories: Unawareness of the theme by the institutional actor; Realized and reported needs. Results showed that permanent education remains incipient at this service. A lack of compliance to protocols, ineffective communication, poor supervision, lack of preparation to care for psychiatric patients, need for humanization and a lack of psychological support to healthcare professionals were highlighted as problems to be solved. It was identified that permanent education should receive close attention as a strategy for improving practice in emergency care services. Understanding the concept and its implementation in everyday practice are a great challenge in this setting. Descriptors: Nursing; Education; Education, Continuing; Emergency Relief; Emergency Relief.

Depressive disorders in older patients with chronic obstructive pulmonary disease (COPD) in Hong Kong: a controlled study

Objective: There have been few studies examining the relationship between chronic obstructive pulmonary disease (COPD) and psychiatric morbidity in Hong Kong. This study aimed to examine the prevalence of depressive disorders (major depression, dysthymia and adjustment disorder with depressed mood) in Chinese patients with COPD and explore their demographic and clinical correlates.Method: A total of 146 patients aged 50 years and above with COPD and 220 age and gender matched control subjects without COPD formed the study sample. Data of demographic and clinical characteristics were collected by a form designed for this study. Activity of daily living was assessed by the Instrumental Activities of Daily Living Scale and life events were evaluated by the Life Event Scale. Depressive disorders were determined using the Chinese version of the Structured Clinical Interview for DSM-IV.Results: The point prevalence of DSM-IV depressive disorders in patients with COPD and controls were 15.1% and 3.6%, respectively. Multivariate analyses revealed that female sex and severe impairment in daily activity functioning were independently associated with depressive disorders. Only 22.7% of the depressed COPD patients had consulted psychiatrists in the past three months.Conclusion: Depressive disorders are significantly higher in COPD patients than controls. The low percentage of depressed patients with COPD seeking psychiatric treatment suggests that there is an unmet need in the psychiatric care of COPD patients.

Medical Status and Care of Psychiatric Patients in a Day Treatment Program

Given the limited literature reporting on the medical comorbidity of patients attending psychiatric day treatment, we studied the medical status and care of a cohort of 100 patients for 1 year following enrollment in a day treatment program at a public sector hospital. Data were abstracted from electronic medical records retrospectively for the year following day treatment enrollment. Study variables included lifetime medical and psychiatric diagnoses documented in the medical record, patient measures performed during the study year (including laboratory, diagnostic, and physical measures), current medication, and encounters within the hospital system. Despite an average age of only 41 years for the cohort, 80% had 1 or more major medical diagnoses. For the 57 subjects with laboratory studies performed during the 1-year study interval, more than half had abnormal results. Forty-three subjects had no laboratory studies during the study interval. Forty-four were seen in the emergency room and an equal number in the medicine clinic. The occurrence of medical co-morbidity in this population was alarmingly high. The vigor of medical care provided was greater than one would expect for a psychiatric population averaging 41 years of age, although there were inadequacies reflecting a lack of standardized medical assessment at entry to day treatment. We propose a reconceptualization for day treatment, incorporating full medical screening as a standard component of entrance into day treatment.

Designing and accrediting the evidence-based care guidelines on insomnia and constipation in psychiatric patients

Background:Evidence-based care guidelines are one of the new ways to improve the quality of care and increase patient satisfaction. In addition to the mental and emotional problems, mentally ill patient suffers from multiple health problems. The most common patient's bio-psycho problems are insomnia and constipation. Aim: The aim of this study was to designing and Accredit the evidence-based care guidelines on insomnia, and constipation in psychiatric patients. Methods: This study is a developmental research and was performed in mental wards of the Baqiyatallah hospital in Tehran in 1392. Evidence-based care guidelines were designed based on the stetler model in evidence-based approach. To check the validity of the content instruction with Delphi method, comments of ten elected faculty members were considered in three different stages. Application of the guidelines was examined using ten experts in focused group discussions. Â In addition to nursing books, 100 articles from proquest, Pubmed, Google scholar, Elsevier, SID, and Magiran with evidence based nursing care, insomnia, constipation, psychiatric patients, protocol keywords were studied. Results: In this study, 4 evidence-based care guidelines, including nursing diagnosis, etiology, evaluation criteria, and nursing interventions were designed. These guidelines can be used as a clinical guide for the care of psychiatric patients based on the credible scientific literature and evidence-based approach. Conclusion: With designing evidence-based nursing care instructions for psychiatric patients, the need of clinical nurses in confronting these patients was removed. It also leads to improve the quality of care and reduce complications in duration of the hospital stay.

Effects of Educational Music Therapy on Knowledge of Social Supports in Acute Care Psychiatric Patients: A Randomized Three-Group Effectiveness Study

Psychoeducation is one of the six established evidence-based treatments for psychiatric consumers while quantitative knowledge of social supports constitutes a consequential area of psychoeducation for people diagnosed with mental disorders. The purpose of this study was to determine the effects of educational music therapy on quantitative knowledge of social supports in acute care psychiatric patients utilizing a cluster randomized three-group design. Acute psychiatric inpatients (N=65) were cluster randomized by group to one of three conditions: educational music therapy, education, or recreational music therapy. Participants completed brief pre- and posttests within each single treatment condition. Although there were no between-group differences, there were consistent increases and improvements from pre-to posttest concerning all dependent measures. Participants in the educational music therapy condition tended to have the highest scores, regardless of dependent measure.Within the time constraints of a single session, it seems that music therapy can be utilized in an educational context to teach acute care psychiatric patients about social supports. Due to the engaging and creative medium, educational music therapy may be a motivating psychoeducational treatment modality for acute care psychiatric patients. Limitations of the study, implications for clinical practice, and suggestions for future controlled inquiry are provided.

Pharmaceutical care of psychiatric patients - Focus on adherence

Background: About 30% of psychiatric patients don't take their drugs as advised, which can lead to treatment failure and relapses [1]. Pharmacists' interventions improved medication adherence in other indications such as diabetes, [2] but it is unclear if psychiatric patients benefit from pharmacist counseling during hospitalization and particularly after discharge from hospital. Methods: To assess the impact of pharmacists' interventions on patient adherence, a controlled clinical trial in the department of psychiatry and psychotherapy at the university hospital of Erlangen was planned. Control patients receive usual care whereas patients in the intervention group benefit from education services offered by pharmacists during their stay and after discharge. Adherence is measured by “Medication Adherence Rating Scale” (MARS). The MARS is conducted at admission, discharge and 3 months after discharge. Results: So far, 114 control patients have been included in the control phase. During hospitalization, patient adherence improved from admission to discharge. First results from follow-up measurement indicate that adherence declines after discharge. Conclusion: Although follow-up data is still incomplete, it becomes apparent that some patients discontinue their drugs after discharge. The intervention phase will show if pharmacists can improve patients' adherence. 1. Burkhart P et al, Journal of Nurs Scholarsh 2003;35:207 2. Shah M et al, Journal of Pharm Practice 2013;26:120 – 124

Mechanisms of Reward Circuit Dysfunction in Psychiatric Illness

The brain’s “reward circuit” has been widely implicated in the pathophysiology of mental illness. Although there has been significant progress in identifying the functional characteristics of individual nodes within the circuit and linking dysfunction of these brain areas to various forms of psychopathology, there remains a substantial gap in understanding how the nodes of the circuit interact with one another, and how the growing neurobiological knowledge may be applied to improve psychiatric patient care. In this article, we summarize what is currently known about the functions and interactions of two key nodes of this circuit—the ventral striatum and the ventromedial prefrontal/orbital frontal cortex—in relation to mental illness.

What makes a difference to patients?

To make a difference to patients who increasingly suffer multiple chronic conditions, in a healthcare system that is capable of providing excellent care but is often ineffective and at cross-purposes in its application, means being prepared to take a different approach not only to the delivery of patient care, but to the education of physicians and other healthcare professionals. The model we must now practice and teach is one that emphasizes collaboration and prevention, quality and efficiency. Changes in practice recommended by the 2001 US Institute of Medicine report are being implemented system-wide, following the enactment of the US Patient Protection and Affordable Care Act. This paper discusses the evolving needs of patients with chronic psychiatric illness, and the psychiatrist's role in a rapidly changing healthcare landscape as a care provider, an interdisciplinary role model, and educator. In an aging population in which multi-morbidity is the norm, episodic, crisis-driven care is prohibitively expensive and does not serve patients well. Yet we still teach that model of care. The medications we prescribe for psychiatric illness, particularly antipsychotics, can cause and/or aggravate some of the commonest chronic medical illnesses; psychiatric educators must address the management of these complications. The management of chronic psychiatric illness in multi-morbid patients demands that we practice and teach a ‘whole patient’ approach to care, preferably delivered as part of a patient-centred team. The Affordable Care Act has mandated and created opportunities for new models designed to facilitate this, and a paradigm shift is needed in medical education. Clinicians must become adept at identifying underlying and contributing factors and collaborating with the patient, other providers, and the patient's family and significant others. Psychiatric formulation and patient care rely on these principles; we must now teach their application to other specialties, disciplines and professions.

Pathways to psychiatric care of patients from rural regions: A general-hospital-based study

Pathway studies highlight the help-seeking behaviours of patients with physical and mental illness. A number of these studies have been completed in other countries, but there have been few reports from China. Therefore, this study was planned to explore the characteristics of the help-seeking pathways of patients with mental illness from rural regions of China through the mental health professionals and treatment at the General Hospital of the People's Liberation Army (PLAGH). The pathway diagrams were documented for 203 subjects with various mental disorders using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns of help-seeking and durations were analysed, and the χ(2) test and Mann-Whitney U test were employed as needed. On average, each patient consulted 3.6 caregivers. The vast majority of patients first visited local secondary general hospitals (SGHs) (35.5%, χ(2) = 41.93, p < .0001) or local tertiary general hospitals (TGHs) (32%, χ(2) = 36.21, p < .0001); however, 75.4% of them had not received professional diagnosis and treatment. The patients who first contacted the psychiatric service, finally reached the PLAGH, because of poor treatment or the high cost of medical care. The subjects first seek the help of various sources before attending PLAGH due to a lack of awareness of the treatment services and the fear of the stigma associated with mental disorders. The primary care, even the local general hospital, did not act as a gatekeeper to psychiatric services.

Assumption of drugs with self-injurer purpose: a retrospective study about 111 patients hospitalized in Policlinico of Modena

AIM OF THE STUDY The aim of this work was to evaluate the epidemiology of suicidal attempts by ingestion of drugs in our area. MATERIALS AND METHODS This is a retrospective study considering all patients admitted to the hospital between January 2004 and December 2006 for suicidal attempts using drugs. RESULTS A total of 111 patients were seen in our Department in the evaluated period. The large majority of patients were women (75%). Suicidal attempt was more common in individuals aged 31 to 40 years. The more common drugs used were: BDZ (28%), anti-depressive (21%), anti-psychotics (10%) and anti-epileptics (8%). A gastric washout was performed in 65.8% of all patients admitted to the hospital. The most used antidote was flumazenil. Alterations of laboratory exams were seen only in a small percentage of the cases. In the majority of cases, suicide was at the first attempt. 71% of patients were followed by psychiatrist and were taking daily psychiatric pharmacologic therapy; 5% had a history of previous admission to the hospital in a psychiatric ward; only 24% had no a history of a prior mental illness. 43% of patients were admitted to a psychiatric ward after intensive treatment in our department. Self-discharging was not usual (10%), and only few patients were restrained against their will (3%). CONCLUSIONS Our study has identified some risk factors for a suicidal attempt. Family doctors should have a stronger control of their patients with mental illness especially during the first period of treatment. In future it should be very helpful to create an informatic network connecting all departments involved in the care of these patients. Moreover, it is crucial to increase the role of family doctors in the care of psychiatric patients after their hospitalization.

„Dass man also frei bleibt, aber immer das Gefühl hat: Da ist diese Haltestange, die ich brauch“

Models of integrated care (IC) have a high potential to improve psychiatric care in a sectored health care system. The present study aims to delineate differences in the perception of psychiatric care after introduction of a regional IC-model in schizophrenic patients and family caregivers. Six focus group interviews with n = 32 schizophrenic patients and three with n = 17 family caregivers either from the region with IC-model or a nearby control region were conducted. Categories of the contents of transcribed interviews were developed and subsequently compared between persons with and without experience of IC. Most participants of the IC-group were not aware to participate in an IC-model. Differences between IC- vs. non-IC groups were primarily related to feelings of security and experiences of flexibility of care which was ensured by the outpatient nursing service in the IC-model. This was noticeable both in daily living and in coping with crisis. No substantial differences were found with regard to the experience of cooperation of professionals, information and psychoeducation of patients as well as support for family caregivers, amongst others. IC will play an important part in the psychiatric care of schizophrenic patients. It has the potential to integrate sustainable relations, general availability and needs-related care provision.

Effects of family-based educational music therapy on acute care psychiatric patients and their family members: An exploratory mixed-methods study

The purpose of this exploratory mixed-methods study was to determine the effects of family-based educational music therapy on acute care psychiatric patients and their families. Participants (n = 11 patients and n = 21 family members) were randomly assigned to one of three treatment groups: educational music therapy, education or music activity. The therapist’s treatment notes from each session were thematically analysed. Although the sample size was small and quantitative results were not significant, patient and family member participants in the educational music therapy condition tended to have more positive post-test means. Emerging themes from treatment notes included: (a) complexity of treatment required attentive approach; (b) song lyrics provided action-oriented future dialogue; (c) songwriting provided needed structure; (d) participants were eager for interventions; (e) problem-solving techniques were effective; (f) flexibility required of the therapist; and (g) enjoyment and appreciation expressed by participants. Family-based educational music therapy may be an engaging illness management technique for psychiatric consumers and their families. Limitations, implications for clinical practice and suggestions for future research are provided.

The societal cost of depression: Evidence from 10,000 Swedish patients in psychiatric care

ObjectiveDepression cost studies have mainly taken a primary care perspective and should be completed with cost estimates from psychiatric care. The objectives of this study were to estimate the societal per-patient cost of depression in specialized psychiatric care in Sweden, and to relate costs to disease severity, depressive episodes, hospitalization, and patient functioning. MethodsRetrospective resource use data in inpatient and outpatient care for 2006–2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF), were obtained from the Northern Stockholm psychiatric clinic (covering half of Stockholm's population aged 18 years and above). As a complement, data from national registers on pharmaceuticals and sick leave were used in order to estimate the societal cost of depression. ResultsBased on 10,430 patients (63% women), the mean annual per-patient cost was €17, 279 in 2008. The largest cost item was indirect costs due to productivity losses (88%), followed by outpatient care (6%). Patients with mild and severe depression had average costs of €14,200 and €21,500, respectively. Total costs were substantially higher during depressive episodes, among patients with co-morbid psychosis or anxiety, for hospitalized patients, and for patients with poor functioning. LimitationsPrimary care costs and costs for reduced productivity at work were not included. ConclusionsThe main cost item among depression patients in psychiatric care was indirect costs. Costs were higher than previously reported for primary care, and strongly related to hospitalization, depressive episodes, and low functioning. This suggests that effective treatment that avoids depressive episodes and hospitalization may reduce society's costs for depression.

Psychiatric Disorders after Epilepsy Diagnosis: A Population-Based Retrospective Cohort Study

BackgroundPsychiatric manifestations after occurrence of epilepsy have often been noted. However, the association between newly diagnosed epilepsy and psychiatric disorders afterward is not completely understood. We conducted two longitudinal cohorts for patients with and without epilepsy to investigate the risk factors and hazard ratios of developing psychiatric disorders after patients were newly diagnosed with epilepsy.MethodsWe identified 938 patients with a new diagnosis of epilepsy and 518,748 participants without epilepsy from the National Health Insurance Research Database in 2000–2002 and tracked them until 2008. We compared the incidence of developing psychiatric disorders between the two cohorts, evaluated risk factors and measured the associated hazard ratios (HRs) and 95% confidence intervals (CIs) of developing psychiatric disorders.FindingsThe incidences of psychiatric disorders for people with and without epilepsy were 94.1 and 22.6 per 1000 person-years, respectively. After adjusting the covariates, the epilepsy cohort showed the highest risks in mental retardation (HR 31.5, 95% CI 18.9 to 52.4), bipolar disorder (HR 23.5, 95% CI 11.4 to 48.3) and alcohol or drug psychosis (HR 18.8, 95% CI 11.1 to 31.8) among psychiatric complications developed after newly diagnosed epilepsy. The risk increased with epileptic general seizure and frequency of outpatient visits for epilepsy, as well as with emergency room visits and hospitalizations for epilepsy, and with older age. Chronologically, the highest risk occurred in the first year after epilepsy diagnosis (HR 11.4, 95% CI 9.88 to 13.2).ConclusionVarious psychiatric disorders were demonstrated after newly diagnosed epilepsy and closely related to general seizure and use of medical services for epilepsy. This shows a need for integrated psychiatric care for patients newly diagnosed with epilepsy, especially in the first year.

Emergency Room Psychiatric Services: A Qualitative Study of Nurses’ Experiences

Emergency nurses working in general emergency divisions (EDs) are primarily trained to assess and treat acute physical problems. However, ED nurses often care for psychiatric patients and the perceptions of nurses in EDs regarding their experiences with psychiatric patients have not been well-studied. Using focus groups, the purpose of this study was to explore and describe ED nurses’ experiences, and feelings caring for patients with mental illness. Krueger and Casey's qualitative analysis for focus groups was utilized to code and categorize phrases and identify themes from transcribed interviews. Four themes emerged; powerlessness best captured the overarching and substantive experience of the participants. Based on the findings, implications for emergency room care of psychiatric patients are described.