Care Of Psychiatric Patients Research Articles

Medical experience as an influencing parameter in emergency medical care for psychiatric emergencies: retrospective analysis of a multicenter survey

BackgroundPrehospital care of psychiatric patients often relies on the medical experience of prehospital emergency physicians (PHEPs). The psychiatrists (PSs) involved in the further treatment of psychiatric patients also often rely on their experience. Furthermore, the interaction between PHEPs and PSs is characterized by interaction problems and different approaches in the prehospital care of the psychiatric emergency.ObjectivesTo analyze the phenomenon of “medical experience” as a cause of possible interaction-related problems and assess its impact on the prehospital decision-making process between prehospital emergency physicians and psychiatrists.MethodsThe retrospective data analysis was conducted between November 2022 and March 2023. Medical experience was defined as follows, based on the demographic information collected in the questionnaires: For PHEPs, the period since obtaining the additional qualification in emergency medicine was defined as a surrogate marker of medical experience: (i) inexperienced: < 1 year, (ii) experienced: 1–5 years, (iii) very experienced: > 5 years. For PSs, age in years was used as a surrogate parameter of medical experience: (i) inexperienced: 25–35 years, (ii) experienced: 35–45 years, (iii) very experienced: > 45 years.ResultsInexperienced PSs most frequently expressed anxiety about the psychiatric emergency referred by a PHEP (27.9%). Experienced PHEPs most frequently reported a lack of qualifications in handling the care of psychiatric emergencies (p = 0.002). Very experienced PHEPs were significantly more likely to have a referral refused by the acute psychiatric hospital if an inexperienced PS was on duty (p = 0.01). Experienced PHEPs apply an intravenous hypnotic significantly more often (almost 15%) than PSs of all experience levels (p = 0.001). In addition, very experienced PHEPs sought prehospital phone contact with acute psychiatry significantly more often (p = 0.01).ConclusionPHEPs should be aware that the PS on duty may be inexperienced and that treating emergency patients may cause him/her anxiety. On the other hand, PHEPs should be receptive to feedback from PS who have identified a qualification deficiency in them. Jointly developed, individualized emergency plans could lead to better prehospital care for psychiatric emergency patients. Further training in the prehospital management of psychiatric disorders is needed to minimize the existing skills gap among PHEPs in the management of psychiatric disorders.

To Measure or Not to Measure: Perspectives of Measurement-Based Care From the Trenches

Measurement-based care has improved patient health outcomes by adding precision to clinical decision making at the patient level, when implemented correctly, across health care systems. Payors and system administrators also use measurements to assess program performance and inform resource allocation. This article describes frustrations and unintended consequences experienced by patients, psychiatric providers, administrators, and health systems when exuberant measurement, often without clearly stated goals, is promulgated with insufficient consideration as to the purpose, selection, and timing of these measurements by administrators and health systems. We propose some principles to inform when, how, by whom, and what to measure in managing the care of psychiatric patients. [ Psychiatr Ann . 2023;53(9):410–414.]

Trends in Telepsychiatry and In-Person Psychiatric Care for Depression in an Academic Health System, 2017-2022.

The authors aimed to assess differences in appointment completion rates between telepsychiatry and in-person outpatient psychiatric care for patients with depression in an academic health system. Electronic health records of encounters for patients (ages ≥10) with a depression diagnosis and at least one scheduled outpatient psychiatric appointment (N=586,266 appointments; November 2017-October 2022) were assessed for appointment volume and completion of telepsychiatry versus in-person sessions. Telepsychiatry became the dominant care modality after the onset of the COVID-19 pandemic, although the number of telepsychiatry and in-person appointments nearly converged by October 2022. Logistic regression showed that telepsychiatry appointments (July 2020-October 2022) were more likely (OR=1.30, 95% CI=1.27-1.34) to be completed than in-person appointments. Telepsychiatry appointments were less likely to be canceled or missed than in-person appointments, suggesting that telepsychiatry improved efficiency and continuity of care. As in-person operations resume following the pandemic, maintaining telepsychiatry services may optimize hospital-level and patient outcomes.

A Critical Reflection on Integrating Gardening Activities into Psychiatric Patient Care from The Nurses' Perspectives

A Critical Reflection on Integrating Gardening Activities into Psychiatric Patient Care from The Nurses' Perspectives

Knowledge, Attitude and Practices of Nurses towards Oral Care of Psychiatric Patients at a Teaching Hospital, Kigali, Rwanda

BackgroundPsychiatric patients are prone to different oral health problems. This study aimed to assess nurses’ knowledge, attitudes, and practices towards oral care of psychiatric patients due to their limited mental abilities of self-control at a Teaching Hospital.Methods and materialsThis was a cross-sectional study conducted at a Teaching Hospital using self-administered questionnaire. Sixty-five nurses were enrolled through census sampling method in December 2021. Data were analyzed using SPSS version 25 by applying descriptive statistics to assess nurse’s knowledge attitude and practices towards oral care.ResultsThe results showed that 53 (93%) nurses had poor knowledge. Also 44(75%) of nurses had inappropriate practice and among them 33(57.9%) had positive attitude.ConclusionThis study found that high number of nurses had poor knowledge and inappropriate practices and half of them had positive attitude. Therefore, there is a need training for nurses to increase their level of knowledge and improve their practice regarding oral care of psychiatric patients.Rwanda J Med Health Sci 2023;6(2):135-142

The implications of the Convention on the Rights of Persons with Disabilities for the care of psychiatric patients

Dignity is considered the basis of human existence, and legislation seeks to ensure this for all people. This principle of equality requires that neither the state, nor society should discriminate between fellow human beings. The prohibition of discrimination therefore reassures the principle of equality legal equality and lists disability among the characteristics to be protected. Consequently, special attention must be paid to the protection of the dignity and rights of persons with disabilities in all areas of life.Following the promulgation of the Convention on the Rights of Persons with Disabilities and the related Optional Protocol the harmonization of Hungarian regulations began based on the new definition of disability. The new definition includes persons living with mental impairment. We will discuss the purpose and effect of the legal instruments created and still being developed as a result of the Convention, as well as the additional necessary measures to create equal opportunities for persons with mental disabilities within health care, focusing specially on psychiatric care.

Borderline personality disorder and depression severity predict suicidal outcomes: A six-month prospective cohort study of depression, bipolar depression, and borderline personality disorder.

Suicide risk is high in patients with major depressive disorder (MDD), bipolar disorder (BD) and borderline personality disorder (BPD). Whether risk levels of and risk factors for suicidal ideation (SI) and suicide attempts (SA) are similar or different in these disorders remains unclear, as few directly comparative studies exist. The relationship of short-term changes in depression severity and SI is underinvestigated, and might differ across groups, for example, between BPD and non-BPD patients. We followed, for 6 months, a cohort of treatment-seeking, major depressive episode (MDE) patients in psychiatric care (original n = 124), stratified into MDE/MDD, MDE/BD and MDE/BPD subcohorts. We examined risks of suicide-related outcomes and their risk factors prospectively. We examined the covariation of SI and depression over time with biweekly online modified Patient Health Questionnaire 9 surveys and analysed this relationship through multi-level modelling. Risk of SA in BPD (22.2%) was higher than non-BPD (4.23%) patients. In regression models, BPD severity was correlated with risk of SA and clinically significant SI. During follow-up, mean depression severity and changes in depression symptoms were associated with SI risk regardless of diagnosis. Concurrent BPD in depression seems predictive for high risk of SA. Severity of BPD features is relevant for assessing risk of SA and SI in MDE. Changes in depressive symptoms indicate concurrent changes in risk of SI. BPD status at intake can index risk for future SA, whereas depressive symptoms appear a useful continuously monitored risk index.

Factors affecting spiritual care competency of mental health nurses: a questionnaire-based cross-sectional study

BackgroundAlthough providing spiritual care is an important part of holistic nursing care for psychiatric patients, factors associated with spiritual care competency in mental health nurses remain unclear. The aim of our study was to explore a possible association of personal and external factors with spiritual care competency in mental health nurses.MethodsThis prospective questionnaire-based cross-sectional study was conducted by inviting mental health nurses from mental health hospitals and tertiary referral centers. Personality traits and spiritual care competency were assessed by using [1] “big-five Mini-Markers” questionnaire, and [2] spiritual care competency scale, respectively. From the 250 mental health nurses being invited, 239 valid questionnaires were valid for final analysis. Statistical analyses including descriptive statistics, ANOVAs, t-tests, and hierarchical multiple regression models were used to investigate the associations between personal/external factors and their spiritual care competency in mental health nurses.ResultsThe mean age of the 239 participants was 35.96 ± 8.11 and the mean years of working experience was 9.41 ± 7.06. Over 90% of them had no experience of providing spiritual care. There were significant positive correlations of spiritual care competency with the experience of delivering spiritual care (p < 0.001), previous participation in spiritual care education programs (p = 0.045), a longer working experience (p = 0.014), and a higher education level (postgraduate vs. college, p = 0.006), as well as the personality components of “Conscientiousness” (p < 0.001), “Agreeableness” (p < 0.001), “Extraversion” (p = 0.03), and “Openness/Intellect” (p < 0.001).ConclusionsBoth personal and external factors may be related to the self-perception of spiritual care competency among mental health nurses. These findings may help mental health nurses understand the possible positive and negative associations of their personality components with their spiritual care abilities. Moreover, our identification of the positive impacts of educational programs and previous experience of spiritual care on spiritual care competency may underscore the importance of tailoring appropriate training programs to cater for the individual needs of mental health nurses.

Factors Influencing the Intention to Sign Up for Advanced Care Planning in Day Care for Psychiatric Patients.

(1) Background: Currently, Taiwan has adopted a "person-centered" approach to Advance Care, including Hospice Palliative Care and Advance Decisions, both of which are intended to enhance the right of individuals to choose their own end-of-life care; however, it is extremely challenging and difficult to implement the principle of autonomy for psychiatric patients. (2) Methodology: The aim in this study is to investigate the factors affecting the intention of day ward patients to sign up for hospice and palliative care by using the questionnaire content of the "Survey on Knowledge, Attitude Toward, Experience, and Behavior Intention to Sign Up for Hospice and Palliative Care". A cross-sectional design compliant with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) was employed. An independent sample t-test, Pearson's correlation analysis, and stepwise regression analysis were used to determine the factors influencing the intention of psychiatric patients to sign up for advanced care planning. (3) Results: The relationships between knowledge of and attitude toward advanced care planning, knowledge of and behavior intention to sign up for advanced care planning, and attitude toward and behavior intention to sign up for advanced care planning were all positive (p-value < 0.001). The final three most relevant indicators were attitude toward hospice and palliative care, hospitalization of family members during the previous five years, and death of a close friend within the previous five years. (4) Conclusions: The results of the study show that the hospice and palliative care attitude and past experience of psychiatric patients affect the intention to sign up, reminding us that psychiatric patients are at an increased risk of decision-making disability as their illness progresses and that, in addition to initiating the discussion of Advance Care Planning as soon as possible, it may be an opportune time for medical professionals to actively promote Advance Care Planning among their patients.

Nutritional counseling needs of patients with mental disorders in psychiatric care: A cross-sectional survey.

The exploration of diet and nutrition as they relate to mental health and psychiatric disorders is a developing field. Anxiety, depression, and pharmacological treatments used to treat these disorders are likely to have side effects that induce decreases in activity and irregular eating habits, resulting in persistent nutritional imbalance. Unhealthy dietary patterns are associated with an increased risk of developing physical and mental health conditions. Despite this, nutritional support to patients in psychiatric care is not adequate. This study aimed to determine the factors underlying the need for nutritional counseling among patients with a mental disorder in psychiatry. The factors explored are eating-related symptoms, eating behavior, interest in food, seeking nutritional counseling, and impact on quality of life (QOL). We utilized a cross-sectional study design. Eligible patients were asked to complete a questionnaire regarding physical measurements and nutritional counseling. In addition, patients' diagnoses and blood test data were referenced from their medical records. The analysis focused on two groups: those who desired to consult a nutritionist and those who did not. Ninety-three patients completed the study. The nutritional status and need for nutritional counseling in psychiatry patients indicates that patients with dietary problems requested nutritional counseling (p < .001). Patients who were more likely to need nutritional counseling had lower QOL in daily life (p = .011), pain/discomfort (p = .024), and anxiety/depression (p = .010) on the EuroQol 5-Dimension 5-level (EQ-5D-5L). Patients with mental disorders who need nutritional counseling tend to have food-related problems and low QOL. It is necessary to establish an interdisciplinary system for nutritional counseling.

Actual problems of practical psychiatry: will the new Order of medical care for mental disorders and behavioral disorders solve them?

The article contains examples of the impact of changes in the legislative provision of psychiatric care on the performance indicators of the psychiatric service and the mental health of the population. We analyze optimization of psychiatric care for patients with severe mental disorders, enabled by the legislation of hospital substitution, as well as existing barriers of providing care to patients with non-psychotic mental disorders. Such barriers include the stigmatization of psychiatry, on the one hand, and the lack of legislative support for the provision of medical care to patients with nonsevere mental disorders by non-psychiatrists, on the other hand. Such legislative peculiarities lead to a constant decrease in the detection of mental disorders, while the level of disability due to mental disorders remains stable in the population. In addition, the article provides a brief overview of the key changes in the Order of medical care for mental disorders and behavioral disorders implemented in 2022.

Brooklyn Resident Competition Develops Young Researchers

Back to table of contents Previous article Next article APA & MeetingsFull AccessBrooklyn Resident Competition Develops Young ResearchersMark MoranMark MoranSearch for more papers by this authorPublished Online:4 May 2023https://doi.org/10.1176/appi.pn.2023.06.6.24AbstractThe competition, founded and coordinated for 31 years by APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc., promotes resident involvement with APA and the Brooklyn district branch, while helping resident scholars advance their careers as psychiatric researchers.In March 1992, Ramaswamy Viswanathan, M.D., Dr.Med.Sc., then president of the Brooklyn Psychiatric Society (BPS), organized and moderated the first annual Brooklyn Psychiatric Society (BPS) Resident Scholarly Presentations Competition.APA Deputy Medical Director and Chief of Research Nitin Gogtay, M.D. (left), served as a judge in the resident scholarly presentations competition. With him are Kusum Viswanathan, M.D., chief medical officer at Brookdale University Medical Center, and APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc.Mark MoranThis year’s competition 31 years later, which took place in April at Interfaith Medical Center in central Brooklyn, marked his last year coordinating the event. Viswanathan, who is president-elect of APA and professor and interim chair of psychiatry at SUNY Downstate Health Sciences University, is turning over coordination of the event to Maria Bodic, M.D., a psychiatrist at Maimonides Medical Center.The competition brings together resident scholars from psychiatric training programs at four Brooklyn hospitals—Brookdale University Hospital Medical Center, Maimonides Medical Center, SUNY Downstate Health Sciences University, and Interfaith Medical Center. The residents present poster and oral presentations on a variety of research projects, with winners selected by a panel of research experts (Brooklyn District Branch Honors Residents for Outstanding Research).Kelvin Oke, M.D., a resident at Interfaith Medical Center, received first prize in the poster competition for his research project titled “Adolescent Crimes: Association of Multiple Substance Use With Arrests Among Adolescents.”Mark MoranWhen he originated the competition, Viswanathan and his wife, Kusum Viswanathan, M.D., a pediatric hematologist-oncologist who is now the chief medical officer at Brookdale, donated what he called “a modest amount of money” to pay for some of the expenses related to the competition over the years.“At the time we originated it, it was an innovative program and the first such program to be organized by a district branch of APA,” he told Psychiatric News. “It has helped strengthen our residents’ involvement with APA and promoted their professional development.”Kunal Gandhi, M.D. (left), received first prize for his oral presentation titled “Is Cannabis a Gateway Drug? A Retrospective Analysis of American Adolescents.” With him are Tolu Olupona, M.D., president of the Brooklyn Psychiatric Society, and APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc.Mark MoranThe judges were Nitin Gogtay, M.D., APA deputy medical director and chief of research; Aparna Dole, M.D., a clinical instructor in psychiatry at New York University Grossman School of Medicine; and Jose Vito, M.D., a clinical professor of psychiatry at NYU Langone Health. Vito is also past president of the New York County Psychiatric Society.“The BPS Resident Scholarly Presentations Competition is an outstanding way for young psychiatrist researchers to hone their skills at gathering and analyzing data on topics relevant to psychiatric practice and patient care and presenting their findings in a professional setting,” Gogtay said. “I urge these young researchers and all residents interested in research to join APA and avail themselves of the mentorship and resources offered by APA’s Division of Research.”Following opening remarks by LaRay Brown, CEO of One Brooklyn Health, Gogtay spoke about APA and the work of the Division of Research, especially around DSM, PsychPRO (APA’s mental health registry), and the APA Research Consortium.Brooklyn Psychiatric Society President Tolu Olupona, M.D., director of residency training at Interfaith Medical Center, credited Viswanathan and Linda Majowka, BPS executive director, for shepherding the program over many years.The competition “is a great opportunity for psychiatry residents in Brooklyn to showcase their scholarly activity to their peers and other faculty from psychiatry residency programs in Brooklyn,” she told Psychiatric News. “Residents and faculty also network with colleagues from other programs during the event, and the activity helps residents in training to build their CV as they grow in their academic careers.” ■ ISSUES NewArchived

The impact of the COVID-19 pandemic on the psychosocial rehabilitation of forensic psychiatric patients in Austria

The coronavirus disease 2019 (COVID-19) pandemic led to increased psychological distress and far-reaching restrictions of freedom. In March 2020, Austrian penal authorities enacted various safety and protection measures to mitigate the propagation of COVID-19. While infection rates in penal institutions were low, restrictive conditions of detention limited the forensic care of offenders. This retrospective longitudinal observational study aimed to evaluate the impact of the pandemic on the psychosocial rehabilitation in forensic psychiatry.Administrative and clinical data obtained from 97 males treated at an inpatient forensic mental health institution were compared before (January 2019 – mid-March 2020) and after (mid-March 2020 – May 2021) the enactment of pandemic-related restrictive measures. The study outcomes related to rehabilitative activities, social contacts, psychopathological stability, and compliance with institutional regulations.During the pandemic, a decrease in individual one-day temporary releases (64 vs. 3, p < .001) and one-day group excursions (103 vs. 10, p < .001) was observed. Likewise, visits by relatives (1440 vs. 429, p < .001) and legal guardians (286 vs. 130, p = .009) decreased. Regarding compliance with institutional regulations, illegal activities decreased from 27 to 8 after enactment of restrictive measures (p = .024). In contrast, long-term temporary releases (122 vs. 188 weeks, p = .131) and admissions to the acute ward (141 vs. 143, p = .712) remained unchanged. Overall, this study demonstrates the substantial impact of COVID-19 on the psychosocial care of forensic psychiatric patients and implies the necessity for guidelines to uphold an appropriate standard of forensic rehabilitation during future pandemics.

Health care providers’ perspectives on providing end-of-life psychiatric care in cardiology and oncology hospitals: a cross-sectional questionnaire survey

BackgroundPsychological distress is a major concern for patients with end-stage heart failure (HF). However, psychiatric care for patients with HF is not as organized as that for patients with cancer. Therefore, the aim of this study was to elucidate and compare the barriers faced by health care providers of cardiology and oncology hospitals in providing end-of-life psychiatric care to patients with HF and cancer, respectively.MethodsWe conducted a cross-sectional questionnaire survey among the health care providers of Japan. Questionnaires were mailed to physicians and nurses of 427 cardiology and 347 oncology hospitals in March 2018 to assess health care providers’ perspectives. First, we compared the scores of the Palliative Care Difficulties Scale and the original scale of end-of-life psychiatric care difficulties between health care providers of cardiology and oncology hospitals. Second, we asked the health care providers to describe the barriers to providing end-of-life psychiatric care with an open-ended question and then compared the freely-provided descriptions using content analysis.ResultsA total of 213 cardiology and 224 oncology health care providers responded to the questionnaire. No significant differences were found between health care providers of cardiology and oncology hospitals in the frequency of experiencing barriers to providing end-of-life psychiatric care (59.8% and 62.2%, respectively). A content analysis identified the following eight barriers: “patients’ personal problems,” “family members’ problems,” “professionals’ personal problems,” “communication problems between professionals and patients,” “problems specific to end-of-life care,” “problems specific to psychiatric care,” “problems of institution or system,” and “problems specific to non-cancer patients.” The “problems specific to noncancer patients” was described more frequently by health care providers in cardiology hospitals than that in oncology hospitals. However, there were no significant differences in other items between the two.ConclusionAlthough health care providers of both cardiology and oncology hospitals faced barriers to providing end-of-life psychiatric care, those of cardiology hospitals particularly faced challenges pertaining to non-cancer patients, such as unpredictability of prognosis or insufficiency of guideline development. A system of psychiatric care, specifically for patients with HF, should be established.

Emergency Nurses' Care of Psychiatric Patients.

The volume of patients with mental illness presenting to the emergency department (ED) has been increasing in recent years, yet many ED nurses hold stigmatized attitudes and behaviors about patients with mental illness, creating barriers to therapeutic care. At the same time, there has been an increase in workplace violence (WPV) against nurses. Fortunately, resilience helps nurses manage their response to WPV and continue to provide therapeutic care. Although research has considered many barriers to the therapeutic care of patients with mental illness in the ED, the variables of stigma, resilience, and the experience of WPV have not been considered in relation to behavioral care competence and work performance, which is the purpose of this study. A survey consisting of the Brief Resilience Scale, the Individual Work Performance Questionnaire, the Behavioral Healthcare Competency (BHCC) survey, the Opening Minds Scale for Healthcare Providers, and open-ended questions about WPV were used to collect data. Independent t-tests were run between scale scores and categorical descriptive data. Correlations were run between scale scores and continuous descriptive data. Over half (60%) had experienced a personal injury from WPV. Higher behavioral competence scores were associated with lower stigma and higher contextual work performance. Nurses who experienced a WPV injury had higher mean BHCC and higher contextual work performance scores. WPV may be an impetus for nurses to improve their practice in behavioral health and working as part of a team.

Second Opinions for Patients With a Persistent Depressive Disorder: Effects on Severity of Depression and Quality of Life

A persistent depressive disorder has a major impact on both patients and health care systems. Despite the advice in guidelines to seek a second opinion if there is insufficient evidence of recovery after treatment, and the great number of second opinions in psychiatric care for patients with persistent depression, only a few studies have been published about their effects. Multilevel analyses were conducted to compare the mean test scores of a group of patients with a persistent depressive disorder who received the intervention of a second opinion with scores from a matched control group, at 3 time points: baseline, intervention, and follow-up. A significant decrease in the severity of depression 3 months after the second opinion was found. No effects on quality of life or treatment satisfaction were found. The study sample was a convenience sample without randomization, and many values were missing in the data. In addition, a 3-month follow-up may have been too short to expect effects of the recommendations from the second opinion. The instructions concerning how to rate treatment satisfaction were also ambiguous. A second opinion can be of value for persistent depression. Further research should address the question of whether the effect that was found is caused by the second opinion itself or is the result of subsequent changes in treatment.

Managing the risk of suicide in a psychiatry clinic: an ethnographic study on the work atmosphere of nurses during the pandemic period

IntroductionIt is known that the restrictions and clinical changes experienced during the pandemic period have negative effects on the care and treatment of psychiatric patients. However, insights on how the pandemic environment and the approaches of healthcare professionals serving during the pandemic affect the care and treatment of patients at risk of suicide are insufficient.ObjectivesThis ethnographic study aimed to identify the approaches of psychiatric nurses in managing suicide risk during the pandemic period in relation with their work environment.MethodsThis ethnographic research design used a sample of 13 psychiatric nurses in a psychiatric clinic in Ankara. Data were collected with in-depth interviews, participant observations and observant participations. Data were obtained from a total of 612 hours of observation and 13 planned nurse interviews. Data were analyzed using qualitative thematic analysis.ResultsThe emergent main theme from data analysis is explained under the title of “The risk of loss of inauthenticity in suicide risk management”. “Risk of loss of inauthenticity” means the fact that the individual suicidal risk factors and differences of the patients cannot be perceived/assessed by the nurses.ConclusionsSupposing all patients having the same suicide risk level by psychiatric nurses caused insensitivity to risky patients in the care process. Nurses’ inadequate approach to patient personality disorder and limited social interactions due to the pandemic atmosphere made it difficult for nurses to have knowledge and understanding of how patients cope with suicidal ideations. These findings show the importance of the use of valid and reliable scales with risk formulations and the significance of triage in crisis periods such as current pandemic. In addition, creating available online consultancy service alternatives may have an important role in the management of suicide risk for patients who are disturbed by long-term hospitalization. Also these findings may contribute to the creation of qualified care and treatment guidelines on suicide risk management for crisis periods.Disclosure of InterestNone Declared

PSYCHOSOCIAL REHABILITATION UNDER LONG-TERM STRESS: A RELEVANT APPROACH FOR EFFECTIVELY ACHIEVING RESULTS

This article aims to declare effective, practical methods of psychosocial rehabilitation for patients under long-term stress conditions. Long nervous tension forces the body to be at the limit all the time. This can lead to the development of cardiovascular and other diseases. It has been established that the subject area under consideration has a significant research and organizational and methodological direction in psychology. It has become a considerable part of the population's psychiatric care content. The study revealed the signs of chronic stress and how to recover from it. The obtained result of the scientific analysis of the subject area can be used in the practical activities of medical specialists in organizing psychiatric care for the population for compiling educational programs to improve the professional qualifications of medical psychologists and psychiatrists. The review substantiates the relevance and novelty of research areas for further development of the problem of improving the organization and content of psychiatric care for patients with mental disorders after long-term stress.

Clinical update and commentary on psychiatric care for patients experiencing workplace bullying.

To provide a brief clinical research update and commentary advice on the practical psychiatric care of patients suffering workplace bullying. While there is empirical research on the prevalence and impacts of workplace bullying, there is a relative dearth of clinical research into psychiatric patient care. Accordingly, we provide commentary on practical considerations that assist in psychiatric care planning and delivery.

Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study

BackgroundContinuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care.MethodsProspective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables.ResultsHigher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care.ConclusionOur results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients’ motives as well as methodological reasons for non-participation remain considerable potential sources for bias.Trial registrationThis prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.