Psychiatric Clinical Settings Research Articles

Compliance of healthcare workers in a psychiatric inpatient ward to infection control practices during the COVID-19 pandemic: a participant observation study supplemented with a self-reported survey

BackgroundAs an emerging infectious disease with a heterogenous and uncertain transmission pattern, coronavirus disease 2019 (COVID-19) has created a catastrophe in healthcare-associated infections (HAIs) and posed a significant challenge to infection control practices (ICPs) in healthcare settings. While the unique characteristics of psychiatric patients and clinical settings may make the implementation of ICPs difficult, evidence is lacking for compliance with ICPs among healthcare workers (HCWs) in a psychiatric setting during the COVID-19 pandemic.MethodsA cross-sectional multi-method study based on participant unobtrusive observation coupled with the completion of a self-administered ICP survey was conducted to assess compliance with ICPs among HCWs in a psychiatric inpatient ward in a regional hospital. An online checklist, called eRub, was used to record the performance of HCWs in hand hygiene (HH) and other essential ICPs. Furthermore, a well-validated questionnaire (i.e., Compliance with Standard Precautions Scale, CSPS) was used to collect the participants’ self-reported ICP compliance for later comparison.ResultsA total of 2,670 ICP opportunities were observed from January to April 2020. The overall compliance rate was 42.6%. HCWs exhibited satisfactory compliance to the wearing of mask (91.2%) and the handling of clinical waste (87.5%); suboptimal compliance to the handling of sharp objects (67.7%) and linen (72.7%); and poor compliance to HH (3.3%), use of gloves (40.9%), use of personal protective equipment (20%), and disinfection of used surface/area (0.4%). The compliance rates of the nurses and support staff to HH were significantly different (χ2 = 123.25, p < 0.001). In the self-reported survey, the overall compliance rate for ICPs was 64.6%.ConclusionThe compliance of HCWs in a psychiatric inpatient ward to ICPs during the COVID-19 pandemic ranged from poor to suboptimal. This result was alarming. Revisions of current ICP guidelines and policies that specifically target barriers in psychiatric settings will be necessary.

Perceptions of Mental Health Professionals on Nutritional Psychiatry as an Adjunct Treatment in Mainstream Psychiatric Settings in New South Wales, Australia.

Background Nutritional psychiatry refers to the practice of using food, or nutrition, as alternative or complementary treatment for mental health disorders. It is a growing area of research that has shown links between the biological processes in the gut and how the food we consume can impact cognitive function, which then can impact our mood and behaviour. However, there is a lack of understanding on the knowledge and education of nutritional psychiatry in mental health clinicians, and further, how nutritional psychiatry, if at all, is practised in psychiatric clinical settings. Therefore, this study aims to investigate the perceptions, knowledge, and education of mental health professionals within the state of New South Wales, Australia regarding their clinical practice and knowledge of nutritional psychiatry. Methods In this cross-sectional study, a self-administered structured questionnaire created by the authors was successfully completed by 40 mental health professionals (mental health nurses, occupational therapists, psychologists, medical officers, and other allied health workers) who were working in New South Wales, Australia. 49 questionnaires were attempted with nine excluded due to these being predominantly incomplete, including demographic data only or empty,ensuring integrity of the remaining data and analysis. The questionnaire aimed to uncover their perceptions, knowledge, and education in nutritional psychiatry and its role in mental health settings. The questionnaire included 16 questions that covered various themes such as the frequency and importance of discussing nutrition with patients, nutrition referrals for issues regarding nutrition, the value of including nutritional psychiatry in their clinical practice, and clinician training and willingness to train or gain further education in nutritional psychiatry. Data was analysed through a series of frequency tables to categorise patterns and identify patternsthrough the use of descriptive statistics in our analysis of the distribution of attitudes and practicesamong mental health professionals regarding nutritional psychiatry. Results A total of 40 mental health clinicians successfully completed the survey and their results were analysed. The results suggest that most clinicians (85% to 93%) recognised the importance of nutrition in mental health, however, revealed variousbarriers which hinderedtheir clinical practice such as a lack of time, knowledge, and access to nutritional services. Further, 54% of clinicians rated their knowledge of nutritional psychiatry as low, however, 92% revealed that they would attend nutritional psychiatry training if given the opportunity. Additionally, the clinicians reported varied levels of education in nutrition, with 43% reporting no education at all on nutrition in their preclinical studies. Conclusions Clinicians recognise the importance of nutrition in mental health settings, but revealed lack of time, knowledge, and nutritional services as barriers in clinical practice. Further, clinicians reported a lack of pre-clinical education on nutrition together with an overwhelming interest in engaging with nutritional psychiatry education if it were made available. These conclusions provide important insights for higher education and health policy.

Development and validation of a questionnaire (SOMA-Q) to assess ojus in manasroga

Abstract Background: Ojus in Ayurveda refers to the unique functioning state of bodily tissues favoring survival and homeostasis. Functional decline in ojus (ojakṣaya) is recognized in Ayurveda as a candidate causative factor for the incidence and progression of major psychiatric conditions (manasroga). Assessing the functional status of ojus shall predict the prognosis and its monitoring while intervention shall favor clinical decision-making across timelines. The characteristics of ojokshaya are reasonably detectable in current psychiatric clinical settings. However, the data collection strategies on ojus vary remarkably among physicians owing to its weightage for patient-reported subjective expressions. Subjective health status assessment-related data handling requires clinical expertise and validated tools. Aims: Thus, this study is committed to developing and validating a tool assessing the functional status of ojus in manasroga. The tool constructs are fairly developed based on patient-reported outcomes and need to be evaluated for their reliability and validity. Settings and Design: The work was conducted within the institute. The mixed methods study design was used. Subjects, Methods and Statistical Analysis: In phase one, the questionnaire was developed through literature review, expert evaluation, data from previous research works, focus group discussion for final consensus, and pretesting. The construct validity was established through principal component analysis/regression analysis. In phase two, the validity of the questionnaire after distinguished phases of the face (100 participants), content (six experts evaluation), and criterion (Pearson’s correlation coefficient) sets; was obtained by conducting a cross-sectional survey on 82 participants. Cronbach’s alpha value was used to assess the reliability of the questionnaire. Results: The 28-item questionnaire to assess ojus in manasaroga, named SOMA-Q, was developed. The results satisfied the tests for validity and reliability. Factor analysis was performed. The Cronbach’s alpha value of the questionnaire was 0.897, suggesting a reasonable internal consistency. In split-half reliability testing, a significant decrease in reliability was noted for every item, and hence, no items were deleted from the questionnaire. Conclusions: The developed tool is valid for assessing the functional status of ojus (SOMA-Q) in psychiatric disorders.

Scaffolded Simulation in Psychiatric Mental Health Nursing Education

Objectives: The purpose of this study was to investigate the impacts of using scaffolded clinical simulations on nursing students’ confidence in clinical reasoning, clinical judgment, and critical thinking skills. Next, we also attempted to gain insights into students’ perceptions of the benefits of scaffolded clinical simulations. Method: We used a mixed-methods research design to investigate the impacts of using scaffolded clinical simulations on 133 second-semester baccalaureate nursing students’ confidence in clinical reasoning, clinical judgment, and critical thinking skills. Results: Findings from this study indicate that students who perceived the benefits of scaffolded simulation activities (i.e., peer observations, debriefings, and self-reflections) were more likely to engage in this deep learning process, which in turn led to their higher confidence in clinical reasoning, clinical judgment, and critical thinking skills. Conclusions: This study demonstrates that scaffolded simulations in psychiatric clinical settings, coupled with the novice to expert model in nursing education, are a valuable tool for preparing nursing students for the rigors of clinical practice, despite decreased in-person client experiences in nursing programs. Implications: This study has implications for designing and implementing scaffolded clinical simulations that foster clinical judgment and help students perform tasks with which they are already familiar, while new responsibilities are introduced throughout the semester.

The PRESIDE (PhaRmacogEnomicS In DEpression) Trial: a double-blind randomised controlled trial of pharmacogenomic-informed prescribing of antidepressants on depression outcomes in patients with major depressive disorder in primary care

BackgroundThe evidence for the clinical utility of pharmacogenomic (PGx) testing is growing, and guidelines exist for the use of PGx testing to inform prescribing of 13 antidepressants. Although previous randomised controlled trials of PGx testing for antidepressant prescribing have shown an association with remission of depression in clinical psychiatric settings, few trials have focused on the primary care setting, where most antidepressant prescribing occurs.MethodsThe PRESIDE Trial is a stratified double-blinded randomised controlled superiority trial that aims to evaluate the impact of a PGx-informed antidepressant prescribing report (compared with standard prescribing using the Australian Therapeutic Guidelines) on depressive symptoms after 12 weeks, when delivered in primary care. Six hundred seventy-two patients aged 18–65 years of general practitioners (GPs) in Victoria with moderate to severe depressive symptoms, measured using the Patient Health Questionnaire-9 (PHQ-9), will be randomly allocated 1:1 to each arm using a computer-generated sequence. Participants and GPs will be blinded to the study arm. The primary outcome is a difference between arms in the change of depressive symptoms, measured using the PHQ-9 after 12 weeks. Secondary outcomes include a difference between the arms in change in PHQ-9 score at 4, 8 and 26 weeks, proportion in remission at 12 weeks, a change in side effect profile of antidepressant medications, adherence to antidepressant medications, change in quality of life and cost-effectiveness of the intervention.DiscussionThis trial will provide evidence as to whether PGx-informed antidepressant prescribing is clinically efficacious and cost-effective. It will inform national and international policy and guidelines about the use of PGx to select antidepressants for people with moderate to severe depressive symptoms presenting in primary care.Trial registrationAustralian and New Zealand Clinical Trial Registry ACTRN12621000181808. Registered on 22 February 2021.

Risk assessment of agressive behavior in schizophrenia and schizoaffective disorder : a cross-sectional study

IntroductionPsychotic disorders have been consistently associated with aggressive behaviors. Psychiatrists are frequently asked to perform assessment regarding potentially aggressive patients. Thus, many psychometric instruments can be useful for identifying the risk of violence and thereby offering appropriate treatment for these individuals.ObjectivesThe aims of this study were to assess the risk of agressive behavior in inpatients with schizophrenia or schizoaffective disorder and to determine its correlates.MethodsUsing face-to-face interviews, inpatients diagnosed with schizophrenia or schizoaffective disorder, in psychiatric department of the University Hospital in Sfax (Tunisia) were included in this cross-sectional, descriptive and analytical study, carried out between novembre 2020 and octobre 2022.The modified overt aggression scale (MOAS) and historical clinical risk management-20 (HCR-20) questionnaire were used for data acquisition. The HCR-20 score of 20 was used as threshold to divide the sample to violent patients (scoring&gt;20) and non-violent patients (scoring ≤ 20).ResultsThe sample consisted of 60 male inpatients. The mean age was 38.23± 10.37 years.In our sample, 68.3% were single, 35% didn’t reach the secondary educational level, 16.7% used psychoactive substance(s), 35% had prior criminal record, 30% had a history of suicidal attempt and 81.7% had previous hospitalization.The mean score of MOAS was 13.08±8.19. The mean total HCR-20 score was 19.25±5.26. The Historical, Clinical and Risk Management subscales showed mean scores of 8.33±2.96, 5.62±1.89, and 5.28±2.42, respectively.The violent patients represented 45% of the sample.The mean scores of the items H3, H10, C1, C2, C4 and R5 of HCR-20 were respectively : 1.33±0.79, 1.20±0.77, 1.22±0.88, 0.38±0.71, 1.30±0.64 and 1.28±0.73.There was no statistical difference between the two groups in socio-demographic factors.A history of suicidal attempts was significantly more common in the group of violent patients (p=0.029).Regarding the HCR subscales, H3 score (relationship instability) and H10 score (Prior supervision failure) were significantly higher among violent patients (p=0.018 and 0.003 respectively). The C1 score (lack of insight), the C2 score (negative attitudes) and the C4 score (impulsivity) were also significantly higher among violent patients (p=0.016, 0.009 and 0.005 rescpectively).The item R5 (stress) of the risk management subscale was significantly higher in the group of violent patients (p=0.003).The total MOAS score detected severe agression in the nonviolent group (p=0.031).ConclusionsOur study suggests the efficacy of HCR-20 in identifying and distinguishing between violent and nonviolent patients with schizophrenia or schizoaffective disorder. The use of such reliable instrument in clinical psychiatric settings should be encouraged.Disclosure of InterestNone Declared

Current opinions on the present and future use of functional near-infrared spectroscopy in psychiatry.

Functional near-infrared spectroscopy (fNIRS) is an optical imaging technique for assessing human brain activity by noninvasively measuring the fluctuation of cerebral oxygenated- and deoxygenated-hemoglobin concentrations associated with neuronal activity. Owing to its superior mobility, low cost, and good tolerance for motion, the past few decades have witnessed a rapid increase in the research and clinical use of fNIRS in a variety of psychiatric disorders. In this perspective article, we first briefly summarize the state-of-the-art concerning fNIRS research in psychiatry. In particular, we highlight the diverse applications of fNIRS in psychiatric research, the advanced development of fNIRS instruments, and novel fNIRS study designs for exploring brain activity associated with psychiatric disorders. We then discuss some of the open challenges and share our perspectives on the future of fNIRS in psychiatric research and clinical practice. We conclude that fNIRS holds promise for becoming a useful tool in clinical psychiatric settings with respect to developing closed-loop systems and improving individualized treatments and diagnostics.

Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population.

Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

Current Status of Therapeutic Drug Monitoring in Mental Health Treatment: A Review.

Therapeutic drug monitoring (TDM) receives growing interest in different psychiatric clinical settings (emergency, inpatient, and outpatient services). Despite its usefulness, TDM remains underemployed in mental health. This is partly due to the need for evidence about the relationship between drug serum concentration and efficacy and tolerability, both in the general population and even more in subpopulations with atypical pharmacokinetics. This work aims at reviewing the scientific literature published after 2017, when the most recent guidelines about the use of TDM in mental health were written. We found 164 pertinent records that we included in the review. Some promising studies highlighted the possibility of correlating early drug serum concentration and clinical efficacy and safety, especially for antipsychotics, potentially enabling clinicians to make decisions on early laboratory findings and not proceeding by trial and error. About populations with pharmacokinetic peculiarities, the latest studies confirmed very common alterations in drug blood levels in pregnant women, generally with a progressive decrease over pregnancy and a very relevant dose-adjusted concentration increase in the elderly. For adolescents also, several drugs result in having different dose-related concentration values compared to adults. These findings stress the recommendation to use TDM in these populations to ensure a safe and effective treatment. Moreover, the integration of TDM with pharmacogenetic analyses may allow clinicians to adopt precise treatments, addressing therapy on an individual pharmacometabolic basis. Mini-invasive TDM procedures that may be easily performed at home or in a point-of-care are very promising and may represent a turning point toward an extensive real-world TDM application. Although the highlighted recent evidence, research efforts have to be carried on: further studies, especially prospective and fixed-dose, are needed to replicate present findings and provide clearer knowledge on relationships between dose, serum concentration, and efficacy/safety.

Staff attitudes and perceptions towards the use of coercive measures in psychiatric patients.

The failure of efforts to significantly reduce the use of physical coercive measures (PCMs) in psychiatric hospitals remains a global concern. There is a gap in the understanding of staff's characteristics that may affect their attitudes and perceptions towards PCMs. This study used a cross-sectional design to examine the attitudes and perceptions of staff working at a mental health centre in Israel regarding the use of PCMs and to explore whether staff attitudes differed depending on their professional and demographic background. This study also sought to explore staff willingness to accept a policy of reducing the use of PCMs. The data were collected from 149 staff members (nurses, physicians, and auxiliary staff) working at mental health centre, using a questionnaire developed for this study. The findings indicate a low degree of support for use of PCMs among participants who were older, female, more qualified psychiatric nurses, with longer duration of employment, and those who have not participated in coercive intervention in the past year. The majority of the sample reported a low willingness to reduce the use of PCMs, and a lack of institutional support after participating in a coercive event. High hospital occupancy and insufficient staffing were perceived as contributing factors to coercive incidents. Therefore, availability of trained and experienced staff, elimination of organizational barriers, along with creating and maintaining a safe clinical environment should be a priority. Alternative non-coercive interventions should further be taught and used for managing aggressive and violent behaviour in the psychiatric clinical settings.

Individualized identification of sexual dysfunction of psychiatric patients with machine-learning

Sexual dysfunction (SD) is prevalent in patients with mental health disorders and can significantly impair their quality of life. Early recognition of SD in a clinical setting may help patients and clinicians to optimize treatment options of SD and/or other primary diagnoses taking SD risk into account and may facilitate treatment compliance. SD identification is often overlooked in clinical practice; we seek to explore whether patients with a high risk of SD can be identified at the individual level by assessing known risk factors via a machine learning (ML) model. We assessed 135 subjects referred to a tertiary mental health clinic in a Western Canadian city using health records data, including age, sex, physician’s diagnoses, drug treatment, and the Arizona Sexual Experiences Scale (ASEX). A ML model was fitted to the data, with SD status derived from the ASEX as target outcomes and all other variables as predicting variables. Our ML model was able to identify individual SD cases—achieving a balanced accuracy of 0.736, with a sensitivity of 0.750 and a specificity of 0.721—and identified major depressive disorder and female sex as risk factors, and attention deficit hyperactivity disorder as a potential protective factor. This study highlights the utility of SD screening in a psychiatric clinical setting, demonstrating a proof-of-concept ML approach for SD screening in psychiatric patients, which has marked potential to improve their quality of life.

Academic Mentoring for Psychiatric Trainees During the Pandemic

In most academic settings, mentoring students is a part of the activities of the academic staff. Usually, associate professors, assistant professors and professors are required to mentor graduate and postgraduate students, and in some academic settings postgraduate students are required to mentor junior students. In psychiatric clinical settings, mentoring also extends to the supervision and evaluation of clinical work of postgraduate psychiatric trainees, usually for different parts of the psychiatric training. Depending on the local organisation of academic and clinical work, numbers of mentees per one mentor as well as description of activities may vary greatly across regions. Nevertheless, “mentoring” is not systematically taught and evaluated in the majority of systems but is infrequently self-taught. The situation of COVID-19 pandemic, especially in the first wave, has created a new situation which needed quick adaptations in many of the fields of the academic work, mentoring included. In this presentation, these new situations and lessons learnt will be presented and discussed from the point of the academic centre in Croatia.DisclosureNo significant relationships.

Creating Effective Post-Pandemic Psychiatric Nursing Clinical Experiences Using the Roy Adaptation Model.

The COVID-19 pandemic significantly impacted students in psychiatric clinical rotations. Clinicals were frequently limited or canceled, restricting exposure of student nurses to this experience. Many modifications led to permanent changes in the psychiatric clinical setting. The purpose of this manuscript is to provide a cohesive approach to serving student nurses in the post-pandemic psychiatric clinical setting. A theoretical exploration of the literature framed by the Roy Adaptation Model (RAM) was conducted. Results are presented using the four modes of the theory: Physiological, Self-Concept, Role Function, and Interdependence. Findings include strategies to enhance student learning while supporting students' health and wellness. Educators and practitioners should provide high-quality, safe learning environments for student nurses.

A New Way Forward: How Brain SPECT Imaging Can Improve Outcomes and Transform Mental Health Care Into Brain Health Care.

In the past three decades, brain single-photon-emission-computed-tomography (SPECT) imaging has garnered a significant, evidence-based foundation for a wide array of indications relevant to the field of clinical psychiatry, including dementia, traumatic brain injuries, seizures, cerebrovascular disease, complex neuropsychiatric presentations, and treatment-resistant disorders. In clinical psychiatric practice, however, SPECT remains underutilized. Only a small percentage of psychiatric clinicians use brain imaging technology. In this article, the authors provide a rationale for shifting the paradigm to one that includes broader use of SPECT in the clinical psychiatric setting, primarily for patients with complex conditions. This paper will outline seven specific clinical applications. Adding neuroimaging tools like SPECT to day-to-day clinical practice can help move psychiatry forward by transforming mental health care, which can be stigmatizing and often shunned by the general public, to brain health care, which the authors argue will be more likely to be embraced by a larger group of people in need.

Supporting the Patient on LSD Day

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times. During the 1960s, the therapeutic effects of lysergic acid diethylamide (LSD) were studied in psychiatric clinical settings. In this February 1964 article, nurse Kay Parley writes enthusiastically about this work at one such research hospital. She describes the benefits of LSD therapy for patients with alcoholism, as well as the richness of the experience for the nurse who guides the patient through treatment. "No role is so welcomed on our psychiatric unit than that of 'sitting' with a patient during LSD therapy." Parley vividly describes the nurse's role in these treatments. Her own long hospitalization for "manic-depressive psychosis" and treatment with LSD undoubtedly framed her approach to this therapy. Today there is renewed interest in the therapeutic use of psychoactive substances such as LSD. Penn and colleagues provide an update in "Psychedelic-Assisted Therapy" in this issue.-Betsy Todd, MPH, RN.

Practice and Research on Applied Behavior Analysis in Clinical Psychiatric Settings

Practice and Research on Applied Behavior Analysis in Clinical Psychiatric Settings

The association between self-reported physical activity and objective measures of physical activity in participants with newly diagnosed bipolar disorder, unaffected relatives, and healthy individuals

Background The association between the International Physical Activity Questionnaire Short Form (IPAQ-SF) and objective measures of physical activity has never been evaluated in participants with newly diagnosed bipolar disorder (BD). Our aim was to compare IPAQ-SF to objective measures in participants with newly diagnosed BD, their unaffected first-degree relatives (UR), and healthy control individuals (HC) in groups combined and stratified by group. Materials and methods Physical activity measurements were collected on 20 participants with newly diagnosed BD, 20 of their UR, and 20 HC using individually calibrated combined acceleration and heart rate sensing (Actiheart) for seven days. IPAQ-SF was self-completed at baseline. Correlation between measurements from the two methods was examined with Spearman rank correlation coefficient and agreement levels examined with modified Bland–Altman plots. Results Physical activity energy expenditure (PAEE) from IPAQ-SF was weakly but significantly positively correlated with physical activity estimates measured using acceleration and heart rate in groups combined (Actiheart PAEE) (ρ= 0.301, p = 0.02). Correlations for each group were positive, but only in UR were it statistically significant (BD: p = 0.18, UR: p = 0.007, HC: p = 0.84). Self-reported PAEE and moderate-intensity were markedly underestimated [PAEE in all participants combined: 62.7 (Actiheart) vs. 24.3 kJ/day/kg (IPAQ-SF), p < 0.001], while vigorous-intensity was overestimated. Bland–Altman plots indicated proportional bias. Conclusion These results suggest that the use of the IPAQ-SF to monitor levels of physical activity in participants with newly diagnosed BD, in a psychiatric clinical setting, should be used with caution and consideration.

Factor Predicting the Use of Physical Restrain in Clinical Setting

PURPOSE: The purpose of the study is to identify the factors predicting psychiatric nurses&amp;rsquo; decision to use physical restraint in a clinical psychiatric setting in the Province of Jeddah, Saudi Arabia. &#x0D; &#x0D; METHODS: A descriptive explanatory design was used. 110 nurses working in a psychiatric hospital in Jeddah city were recruited during the period 27th April to 29th June 2017. The outcome was assessed on the following scales: level of knowledge, occupational stress, working environment, nurses&amp;rsquo; attitude toward use of physical restraint and nurses&amp;rsquo; practice toward use of physical restraint. &#x0D; &#x0D; RESULTS: The study participants had sufficient knowledge about the use of physical restraint, experienced high levels of occupational stress, suffered an unproductive working environment and accepted attitudes and practice toward physical restraint. In addition, these variables significantly predicted the nurses&amp;rsquo; use of physical restraint. &#x0D; &#x0D; CONCLUSION: The findings revealed that the level of knowledge and occupational stress scales, the working environment, and nurses&amp;rsquo; attitude and practice toward the use of physical restraint significantly predicted the nurses&amp;rsquo; use of physical restraint. &#x0D; &#x0D; RECOMMENDATIONS: The study recommends the establishment of educational and awareness programmes for nurses to better understand the concept of restraining a patient and the consideration of alternative measures for controlling agitated and violent patients. It also recommends that providing adequate staffing and other resources, maintaining a therapeutic ward environment, and decreasing work-related stress could influence psychiatric nurses&amp;rsquo; decisions to use physical restraint on their patients.

Polygenic risk score as clinical utility in psychiatry: a clinical viewpoint.

Genome-wide association studies (GWASs) have detected many susceptible variants for common diseases, including psychiatric disorders. However, because of the small effect size of each variant, clinical utility that aims for risk prediction and/or diagnostic assistance based on the individual "variants" is difficult to use. Therefore, to improve the statistical power, polygenic risk score (PRS) has been established and applied in the GWAS as a robust analytic tool. Although PRS has potential predictive ability, because of its current "insufficient" discriminative power at the individual level for clinical use, it remains limited solely in the research area, specifically in the psychiatric field. For a better understanding of the PRS, in this review, we (1) introduce the clinical features of psychiatric disorders, (2) summarize the recent GWAS/PRS findings in the psychiatric disorders, (3) evaluate the problems of PRS, and (4) propose its possible utility to apply PRS into the psychiatric clinical setting.

Identifying psychiatric diagnostic errors with the Safer Dx Instrument.

Diagnostic errors in psychiatry are understudied partly because they are difficult to measure. The current study aimed to adapt and test the Safer Dx Instrument, a structured tool to review electronic health records (EHR) for errors in medical diagnoses, to evaluate errors in anxiety diagnoses to improve measurement of psychiatric diagnostic errors. The iterative adaptation process included a review of the revised Safer Dx-Mental Health Instrument by mental health providers to ensure content and face validity and review by a psychometrician to ensure methodologic validity and pilot testing of the revised instrument. None. Pilot testing was conducted on 128 records of patients diagnosed with anxiety in integrated primary care mental health clinics. Cases with anxiety diagnoses documented in progress notes but not included as a diagnosis for the encounter (n=25) were excluded. None. None. Of 103 records meeting the inclusion criteria, 62 likely involved a diagnostic error (42 from use of unspecified anxiety diagnosis when a specific anxiety diagnosis was warranted; 20 from use of unspecified anxiety diagnosis when anxiety symptoms were either undocumented or documented but not severe enough to warrant diagnosis). Reviewer agreement on presence/absence of errors was 88% (κ=0.71). The revised Safer Dx-Mental Health Instrument has a high reliability for detecting anxiety-related diagnostic errors and deserves testing in additional psychiatric populations and clinical settings.