Continuity Of Psychiatric Care Research Articles

Clinical and Psychological Characteristics of Patients after First-Episode Psychosis with Cognitive, Emotional, and Volitional Deficiencies: Comparative Analysis

This research featured 139 patients (60 men, 79 women) after the first-episode psychosis. All patients demonstrated cognitive and/or emotional deficiency. The research objective was to compare clinical, sociodemographic, psychosocial, and individual characteristics. The expert clinical assessment revealed three groups. Group I included 29 patients with negative symptoms in the cognitive sphere; group II consisted of 46 people with negative symptoms in the emotional and volitional sphere; group III included 64 people with no pronounced deficiencies. The authors employed the method of clinical psychological interview and various pathopsychological non-standard methods to study the cognitive activity of the patients. The list of psychometric methods included the Beck’s Depression Inventory, a coping behavior questionnaire, a short version of Minnesota Multiphasic Personality Inventory (MMPI), and the Suicide Risk Assessment Scale. The data obtained were processed using SPSS v. 25.0 and Excel 2010. The three groups demonstrated the following statistically significant differences: diagnosis, critical attitude to one’s own condition, and continuity of psychiatric care (clinical characteristics); social adaptation problems (psychosocial characteristics); association and motivation (cognitive activity); suicidal risk (emotions, personality, and behavior). The MMPI and the coping behavior test also showed differences from the test norm, as well as between the groups. A comparative analysis of clinical and psychological characteristics in patients after the first-episode psychosis makes it possible to develop a correct psychorehabilitation program, prevent deficit symptoms, and improve social functioning.

Changes in substance use and engagement in gaming/gambling in persons with severe mental illness during the COVID-19 pandemic and earthquakes: a community study in two points.

External stressors, such as COVID-19 pandemic and earthquake, can cause an increase in substance use and addictive behavior in persons with severe mental illnesses (SMI). We analyzed the changes and predictors of substance use and addictive behavior in SMI during these double disasters in Croatia. Questionnaires exploring the presence of substance or behavior addiction disorder, mental ill health [Depression Anxiety Stress Scales-21 (DASS-21), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), Obsessive-Compulsive Inventory-Revised], coping mechanisms, and perceived social support [Multidimensional Scale of Perceived Social Support (MSPSS)] were administered among 90 participants with SMI included in the RECOVER-E study in May/June 2020 (first COVID-19 wave, Zagreb earthquake) and in December 2020/January 2021 (second COVID-19 wave, Petrinja earthquake). In both time points, a major increase was observed in tobacco smoking (25.0%; 28.6%, respectively) predicted by discontinuation of antidepressants and higher DASS-21 score. Increased sedative use was observed (24.4%; 23.8%, respectively) predicted by higher PSS and ISI scores, lower MSPSS scores, antipsychotic discontinuation and not receiving community mental health team (CMHT) service. In persons with SMI during a double disaster special attention needs to be given to reducing mental-ill health and stress, providing social support and continuity of psychiatric care, through medications and CMHTs.

Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020–2022 longitudinal study

IntroductionThe prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements.MethodWe collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared.ResultsThree out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts.ConclusionsThe continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.

Continuity of Care in Psychiatric Outpatient Practice: Effect On Patient Satisfaction.

Evidence supports the hypothesis that the patient-psychiatrist relationship is a central feature of psychiatric care. It is also known that patient treatment satisfaction will result in improved adherence; therefore, the aim of this study was to investigate the relationship between patient treatment satisfaction and continuity of psychiatric care. The objective of this study was to evaluate the extent to which the continuity of psychiatric care is related to patient satisfaction. This research was conducted as an observational, non-experimental survey of all the patients who attend the NZOZ Centrum Terapii DIALOG in Warsaw, Poland. Patient satisfaction was assessed by using the 10-point subjective scale (1- lowest, 10 – highest level of satisfaction). A total of 160 patients met the inclusion criteria; 92 of them have visited a psychiatrist less than 5 times, 68 of them visited psychiatrist 5 times or more. The probability of the patient’s recommendation of the psychiatrist as calculated by the NPS method was 72,83% of the patients that have visited psychiatrist less than 5 times and 64,71% of the patients that have visited a psychiatrist 5 times or more. The average level of satisfaction was 9,16 points for the first group, and 8,89 points for the second group. The results of this study show the adverse correlation between continuity of psychiatric care and patient satisfaction. Further investigation should be made on how to prevent a decline in the level of patient satisfaction during continuous psychiatric care.

2775 – The issues involved in the management of foreign mentally disordered offenders in the UK at the point of entry

This literature review examines the issues facing foreign mentally disordered offenders (FNMDOs) in accessing psychiatric care in the UK. Studies/reports relevant to FNMDOs in Healthcare, Probation services, Inspectorate of prisons, Crime reduction charities, Department of Health were examined. Keywords searched on MEDLINE and Psychinfo: ‘foreign, mental,*offender,*criminal.*’ According to 2009 statistics, 14% of UK prisons consisted of foreigners of which 80% suffered mental health problems. FNMDOs face a number of issues like negative stereotyping, racism, poor family contact, language/cultural barriers, which hinder accessing psychiatric help. Indefinite detention of foreign prisoners, post-amendment of the UK Borders Act 2007, has been found to result in increased depression and suicidal ideation. Self-inflicted deaths increased since 2006. Research on migration-morbidity hypothesis and refugees/asylum-seekers demonstrates higher psychiatric morbidity. A 2005 meta-analysis reported worse outcomes for institutionalized refugees. Detention centres often have poor healthcare provision, though prevalence of PTSD, depression, anxiety, somatoform disorders is high. FNMDOs face limitations in availability of legal aid and immigration advice across the prison system. Lack of a clear care pathway compounded by poor inter-agency communication and understanding of immigration procedures adversely affects treatment and continuity of psychiatric care. FNMDOs are a vulnerable group with complex needs which may go unidentified. Improving care and outcomes for FNMDOs requires adequate prison staff training, ready interpreter access, facilitation of family visits/cultural contact. Effective multi-agency collaboration in early identification, intervention, clarity in care pathway and immigration advice would result in reduced psychiatric morbidity in this vulnerable group of offenders.

A Crisis of Credibility: Professionals’ Concerns about the Psychiatric Care Provided to Clients of the Child Welfare System

This study examined child welfare and mental health professionals' views of the quality of psychiatric services received by consumers of the child welfare system and explored root causes of perceived quality problems. One hundred and thirty child welfare, mental health and court professionals participated in qualitative interviews individually or in groups. Data analyses identified perceived problems in quality and perceived causes of quality problems. Participants in member checking groups were then asked to comment on and further clarify the results. The participants reported concerns related to overuse of psychotropic medication, overmedicated children, short inpatient stays, and continuity of psychiatric care. Overuse of psychotropic medications and overmedication were perceived to be driven by short evaluations, liability concerns, short inpatient stays and a lack of clinical feedback to psychiatrists from child welfare partners. Medicaid reimbursement policies were at the heart of several quality concerns. These problems contributed to a distrust of psychiatric practices among child welfare professionals. These findings underscore the adverse effects of modern marketplace medicine coupled with low Medicaid reimbursement rates on quality of care for vulnerable groups. Child welfare and mental health professionals and their associated stakeholders may together possess substantial clout to advocate for a reimbursement system and structure that promotes quality service. The findings also point to a crisis of credibility toward psychiatric practice among social service and other non-psychiatrist mental health professionals. Efforts are needed to increase the capacity for psychiatrists and child welfare professionals to communicate effectively with each other and for psychiatrists to receive the information that they need from their child welfare partners to ensure accurate diagnosis and effective treatment.

Accommodation history and continuity of care in patients with psychosis

Objectives: The objective of this study was to determine the relationship between accommodation history and management outcome in patients with psychosis.Method: Demographic information, diagnosis and an accommodation history were taken from patients with psychosis accepted for case management by the Inner West Area Mental Health Service over a 12-month period. The patients were followed up 2 years later to determine their continuity of care and discharge outcome.Results: One hundred 42 patients completed the assessments. Forty-eight percent of patients had spent at least 1 day in a homeless setting in the previous 12 months. Twentytwo percent of patients had long-term (between 2 and 12 months) and six percent chronic (more than 12 months) homelessness. The duration of previous homelessness was significantly inversely correlated with the length of engagement with the service, continuity of psychiatric care at discharge or likelihood of transfer to primary care. Previous interstate mobility was significantly associated with discontinuity of care at discharge.Conclusions: A history of homelessness is common in patients with psychosis using inner urban mental health services and is associated with poorer engagement with psychiatric services.

Accommodation History and Continuity of Care in Patients with Psychosis

The objective of this study was to determine the relationship between accommodation history and management outcome in patients with psychosis. Demographic information, diagnosis and an accommodation history were taken from patients with psychosis accepted for case management by the Inner West Area Mental Health Service over a 12-month period. The patients were followed up 2 years later to determine their continuity of care and discharge outcome. One hundred 42 patients completed the assessments. Forty-eight percent of patients had spent at least 1 day in a homeless setting in the previous 12 months. Twenty-two percent of patients had long-term (between 2 and 12 months) and six percent chronic (more than 12 months) homelessness. The duration of previous homelessness was significantly inversely correlated with the length of engagement with the service, continuity of psychiatric care at discharge or likelihood of transfer to primary care. Previous interstate mobility was significantly associated with discontinuity of care at discharge. A history of homelessness is common in patients with psychosis using inner urban mental health services and is associated with poorer engagement with psychiatric services.

Continuity of psychiatric care: the present model.

Continuity of psychiatric care: the present model.

Measurement of Discontinuity of Psychiatric Inpatient Care

CONTINUITY of psychiatric care is often said to have special virtue. WVhat is meant by such continuity, however, needs clarification. For example, a recent publication of the National Institute of Mental Health (1) relative to community mental health centers contains these statements: Since the elements of the center need not be under one roof, nor even under ia single sponsorship, the administration of the various components must be done in such a manner that the goal of smooth continuity of care is achieved. In some community centers, such as Colorado's Fort Logan State Hospital, emphasis is placed on maintaining continuity of therapists. Since the object is to provide a -complete circle of treatment for patients at the community level . . . The third idea-to provide a complete circle of treatment-has a somber sound, and the first two suggest restless bedfellows. The present study, in an effort to define and quantify continuity of care, at least in a negative way, determines lack of early continuity of care among inpatients new to mental hospitalsin other words, determines the frequency of 'discontinuity of care. Two measures are used. One is the rate at which all persons newly admitted to psychiatric inpatient care had a second inpatient experience in a psychiatric facility other than the facility of initial entry. The second is confined to those patients who had another admission. The first measure gives an estimate of the risk of discontinuity of psychiatric inpatient care, while the second describes the pattern of discontinuity when it occurs. Clearly, even if a patient resumes treatment in the same hospital, there are definitions of discontinuity of care with which the regimen might conform. For example, in the same hospital the second episode might involve different caretaking personnel and a different immediate physical environment. It is presumed here, however, that a different hospital does commonly result in some type of discontinuity and that the measures proposed provide minimum estimates of its frequency. Quantitative studies by others bearing directly on continuity or discontinuity of psychiatric inpatient care were not found.