General Hospital Psychiatric Unit Research Articles

Lifetime Sexual Behavior of Psychiatric Inpatients

Sexual life of psychiatric patients, including risk behaviors related to sexually transmitted diseases, remains a poorly studied area, especially in those with severe mental illnesses. To assess some aspects of lifetime sexual behavior of psychiatric inpatients. Patients consecutively admitted to a psychiatric unit in a general hospital were interviewed about partner-related lifetime sexual behavior. A semi-structured interview developed by the authors was used to collect information concerning their general sexual experience throughout life, homosexual and heterosexual relations, and relations with partners who were intravenous drug users (IVDU), HIV carriers or suffering from AIDS, and with sex workers. In each of these areas, time elapsed since last sexual contact; number of partners in previous year, frequency of these relations and condom use were investigated. Five hundred forty-six patients (306 men and 240 women) were assessed, and 87.7% of them reported sexual relations at some point during their life. Of these, 90% reported heterosexual and 10% homosexual or bisexual sexual contacts. Further, 11.06% had had at least one partner who was an IVDU; 8.1% an HIV-positive partner, and 32.4% (50% of the men) had paid for sex. Overall 49.79% of the total sample reported never using condoms in their sexual relations, with similar percentages for those with HIV-positive (46%) and IVDU (47%) partners. Of those who paid for sex, 29% never used condoms. Psychiatric patients admitted to a general hospital psychiatric unit have sexual experience close to the general population, with a higher percentage of homosexual contacts and lower rates of condom use, even in higher risk situations, such as men having sex with men, and partners who are HIV-positive or IVDUs. This information obliges clinicians to systematically explore the sexual behavior of psychiatric patients, evaluate risk behaviors, and adopt measures to promote safe sex practices in this population.

DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience

This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy). Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis. The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient's local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation). For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.

Mental Health Care Reforms in Latin America: An Overview of Mental Health Care Reforms in Latin America and the Caribbean

This new column provides an overview of mental health reforms in Latin America and the Caribbean. Progress has been particularly visible in countries that have implemented policies with strong political support (Brazil, Chile, and Belize, among others). However, lessons may be learned from the collective experience of a region that has faced multiple obstacles to reform. Available resources are still insufficient and inequitably distributed, reform implementation is not complete in most countries, and high levels of unmet need exist. Countries face new challenges related to growing psychosocial problems affecting children and adolescents and increasing violence, which require new responses from mental health services.

Electroconvulsive Therapy in General Hospital Psychiatric Units and Community Cooperation in the Chugoku District

Electroconvulsive Therapy in General Hospital Psychiatric Units and Community Cooperation in the Chugoku District

Patterns of care in patients discharged from acute psychiatric inpatient facilities

To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients' discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.

Safety monitoring of patients on atypical antipsychotics

Problem:The use of atypical antipsychotics (aAPs) to treat schizophrenia and bipolar disorder may lead to development of metabolic syndrome. This Clinical Practice Improvement (CPI) project was aimed at improving the...

Setting the Record Straight

Back to table of contents Previous article Next article Letters to the EditorFull AccessSetting the Record StraightJerod M. Loeb, PH.D.Jerod M. LoebSearch for more papers by this author, PH.D.Published Online:1 Aug 2008https://doi.org/10.1176/pn.43.15.0039I wish to comment on the article titled “Joint Commission to Issue Inpatient Quality Measure” in the June 20 issue on the Hospital-Based Inpatient Psychiatric Services (HBIPS) core measures initiative now under way at the Joint Commission. Because this initiative offers important opportunities for advancing behavioral health care, I want to correct several details in your article, including the reporting requirements for different types of providers.Beginning with discharges on October 1, 2008, both freestanding psychiatric hospitals and psychiatric units in general hospitals may select the HBIPS measure set to help them meet their ORYX requirement. There are seven HBIPS core measures (not five as reported). Complete details are posted at<www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Hospital+Based+Inpatient+Psychiatric+Services.htm>.For freestanding psychiatric hospitals, ORYX requirements can be satisfied by adopting the HBIPS measure set or nine noncore measures. The HBIPS measure set will become mandatory after the set receives National Quality Forum (NQF) endorsement and is placed on the Hospital Quality Alliance agenda.For general hospitals with psychiatric units, HBIPS becomes one of four sets of core measures that can be selected to help them meet their ORYX requirements. It is not mandatory for general hospitals to select the HBIPS measure set.The Joint Commission and all of the partner organizations involved with the HBIPS project have been pleased at the participation from the field throughout the development and testing of these core measures. One hundred and ninety-six freestanding psychiatric hospitals and psychiatric units in general hospitals participated in the pilot test that ran throughout 2007 (more than the 147 reported in the article).Thank you for allowing me to correct the specific Joint Commission policy on HBIPS core measures implementation.Oakbrook Terrace, Ill.The writer is executive vice president of the Division of Quality Measurement and Research at the Joint Commission. ISSUES NewArchived

Greece

The history of mental healthcare offered to people with intellectual disabilities in Greece runs in parallel to that of people suffering from severe psychiatric disorders. Until the early 1980s, it was based on 9 overcrowded and understaffed state and 40 private psychiatric hospitals with a mixed population of patients with psychosis and of those with intellectual disabilities (Madianos et al, 1999). The psychiatric reforms began with Law 1397 in 1983, which introduced the National Health System, and, in the following year, European Council Regulation 815/84, through which financial aid was approved and a 5-year plan adopted. The main goal was the development of a network of community-based services in geographically sectorised areas, to replace the large psychiatric hospitals. Mental health centres, psychiatric units in general hospitals and many other community services were to be established, according to local requirement.

Health Beliefs and Help Seeking for Depressive and Anxiety Disorders Among Urban Singaporean Adults

Health Beliefs and Help Seeking for Depressive and Anxiety Disorders Among Urban Singaporean Adults

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterKotaro Hatta M.D., Ph.D.Hisashi Kurosawa M.D., Ph.D.Heii Arai M.D., Ph.D.Kotaro Hatta M.D., Ph.D.Search for more papers by this authorHisashi Kurosawa M.D., Ph.D.Search for more papers by this authorHeii Arai M.D., Ph.D.Search for more papers by this authorPublished Online:1 Nov 2007https://doi.org/10.1176/ps.2007.58.11.1502AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Hospitalization for Medical Comorbidities Among Psychiatric Patients in TokyoThe purpose of this prospective cohort study was to clarify the incidence and kinds of medical comorbidity for which psychiatric patients should be hospitalized. Gathering such epidemiological data in Tokyo, which has approximately 12 million inhabitants, might inform public policy not only in Japan but also in other countries.The study was conducted throughout Tokyo from April 1 to May 31, 2007. Participating in the study were 21 of Tokyo's 28 general hospital psychiatric units (75%), all three general hospital psychiatric emergency units, and all 11 general hospital psychiatric units specializing in medical comorbidity. Because these three types of general hospital psychiatric units are responsible for treating severe medical illness among psychiatric patients in Tokyo, the study was designed to capture all psychiatric patients admitted for primary medical diagnoses. Information was collected about demographic and clinical characteristics of patients who were admitted and those who were not admitted because no beds were available. The study protocol was approved by an institutional review board. In the two-month period 326 patients were admitted to one of these units for a primary medical diagnosis: 174 to general hospital psychiatric units, ten to general hospital psychiatric emergency units, and 142 to general hospital psychiatric units specializing in medical comorbidity. The mean±SD age of these patients was 61.7±16.2 years, and 150 patients (46%) were male. Of the 326 patients, 194 (60%) were medical cases and the remaining 132 patients (40%) were surgical. Respiratory diseases were the most frequent (61 patients, or 19%), followed by diseases requiring orthopedic surgery (42 patients, or 13%), diseases requiring abdominal surgery (32 patients, or 10%), and gastrointestinal and hepatic diseases (32 patients, or 10%). At discharge 130 patients (40%) had ICD-10 psychiatric diagnoses in the F2 category (schizophrenia and schizotypal and delusional disorders), 91 patients (28%) had ICD-10 F0 diagnoses (organic mental disorders, including symptomatic disorders), and 149 patients (15%) had ICD-10 F3 diagnoses (mood disorders). Among the patients with F0 diagnoses were 59 patients (18%) with dementia and organic amnesic syndrome (F00–F04) and 32 patients (10%) with delirium and other disorders (F05–F07). A total of 88 patients could not be admitted to general hospital psychiatric units because there were no available beds. On the basis of the number of patients who were admitted to general hospital psychiatric units (174 patients) and the participation rate for that type of unit in the study (75%), the estimated total number of patients admitted to that type of unit during the study is 232. Also, on the basis of the number of patients who weren't able to be admitted to that type of unit (88 patients) and the participation rate (75%), the estimated total number of patients who could not be admitted to that type of unit during the study is 117. The numbers of patients admitted to general hospital psychiatric emergency units and general hospital psychiatric units specializing in medical comorbidity were ten and 142, respectively. The participation rates for both of these types of unit were 100%, and there were no patients who were not able to be admitted.Thus a total of 501 patients needed admission over the study period, which suggests an annual total of 3,006 patients. Thus with approximately 12 million inhabitants, the incidence of medical comorbidity for which psychiatric patients should be hospitalized appears to be at least 25 per 100,000 inhabitants in Tokyo. Although previous studies have examined comorbid medical conditions among psychiatric inpatients ( 1 , 2 ), these studies looked at hospitals only and did not use population-based designs ( 1 , 2 ). One population-based study focused only on mortality among psychiatric outpatients ( 3 ). Thus few cohort studies about hospitalization for medical comorbidities among patients with severe mental illness have been conducted. One strength of our study is that it included all psychiatric patients who lived in a defined area during the study period. A limitation is that our findings may be representative only of patients in Tokyo. Acknowledgments and disclosuresThis work was supported by grant H-19-009 from the Ministry of Health, Welfare, and Labor of Japanese Government.The authors report no competing interests.Dr. Hatta and Dr. Arai are with the Department of Psychiatry, Juntendo University School of Medicine, Tokyo. Dr. Kurosawa is with the Nippon Medical School in Tokyo.

Open general medical wards versus specialist psychiatric units for acute psychoses

As international healthcare policy has moved away from treating people with severe mental illness in large inpatient psychiatric institutions, beds for people with acute psychiatric disorders are being established in specialised psychiatric units in general hospitals. In developing countries, however, limited resources mean that it is not always possible to provide discrete psychiatric units, either in general hospitals or in the community. An alternative model of admission, used in the Caribbean, is to treat the person with acute psychosis in a general hospital ward. To compare the outcomes for people with acute psychosis who have been admitted to open medical wards with those admitted to conventional psychiatric units. We searched The Cochrane Schizophrenia Group's study-based register (April 2007). This register is compiled from searches of BIOSIS, CINAHL, The Cochrane Library, EMBASE, LILACS, MEDLINE, PsycINFO, PSYNDEX, Sociofile, and many conference proceedings. We would have included all relevant randomised or quasi-randomised trials, allocating anyone thought to be suffering from an acute psychotic episode to either acute management on general medical wards, or acute management in a specialist psychiatric unit. The primary outcomes of interest were length of stay in hospital and relapse. We extracted data independently. For dichotomous data we would have calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based using a fixed effects model. We didnt identify any relevant randomised trials. The Caribbean practice of treating people with severe mental illness on general medical wards has been influenced by socio-economic factors rather than evidence from randomised trials. This practice affords an opportunity for a well designed, well conducted and reported randomised trial, now impossible in many other settings.

Clinical profile of acutely ill psychiatric patients admitted to a general hospital psychiatric unit

Helen Joseph Hospital in southern Gauteng Province is one of five specialist hospitals on the academic circuit of the University of theWitwatersrand. Against a background of new mental health legislation, implemented in South Africa during December 2004 with no formal mechanisms in place to monitor mental health services on different levels of care or in regions, a study with three objectives was undertaken, namely: (I) to provide a baseline on psychiatric morbidity and treatment outcome; (II) to establish the state of affairs analysis for mental health care and (III) to establish a framework for cost centre management. The current study focuses on objective one. A retrospective clinical audit was undertaken of mental health service delivery, teaching and research at Helen Joseph Hospital over a one-year period from September 2003 to August 2004. This article reports on the two service delivery datasets identified: the "Inpatient Discharge Summary Report" and the "Consultation/Liaison Report". A total number of 438 service users were admitted and a monthly average of 80 consultation/liaison assessments was conducted during the study period. Persistent unfavourable nursing staff ratios continued, while the number of service users from other African countries was generally underrated. Non-compliance and substance abuse contributed significantly to the admission of service users. Schizophrenia was indicated as the most likely diagnosis in almost a quarter of cases. Morbidity and treatment outcome at Helen Joseph Hospital will only be contextualized after the implementation of a regular clinical audit process in all the facilities of its referral network.

Mental health legislation in contemporary India: a critical review

After 20 years of experience with the legislation, it is now a good time to assess the Mental Health Act 1987 of India. How useful has it been to consumers, carers and the mental health profession? It has been perceived as isolationist because it deals only with psychiatric hospitals and excludes a large number of general hospital psychiatric units from its purview. It is also un-implementable in some parts of the country because of the shortage of resources. From a human rights perspective, it is deficient in two important ways: it failed to establish independent review bodies for involuntary admissions; and it lacks provision for research with people who have a mental illness.

Process of Care in General Hospital Psychiatric Units: National Survey In Italy

To investigate the process of care in Italian public acute inpatient facilities. Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5+/-7.1 days, 37.0+/-55.3 days and 12.0+/-3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during meal times (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurse provision. The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital-community mental health service interface.

Revolving door and human resources in a community mental health system

Background and aims:Andalusia is the most highly populated (7,849,799 hab.) region of the Spanish State. It has all the sanitary domains under its own Health Service (Consejeria de Salud), and it has undertaken a deep reorganization of the psychiatric services, establishing a new model based on the mental health communitarian alternative that is already completely implanted. Rates of readmission are a method to assess the quality of care and an important tool in the planning of services of mental health.The aim of this study is to establish if readmission rates are influenced by Human Resources in Psychiatric Community Devices.Part of FIS Project PI05/90061 ‘Patterns of General Hospital Psychiatric Units Overuse’.Method:MBDS is a system of hospital register that gathers all the discharges produced in the andalusian hospitals. It is totally trustworthy from 1995, and we have processed data up to 2004.Our Data Set register 101234 hospital admissions of psychiatric patients.Results:The number of admissions from patients who enter three times or more throughout the year has been: 22.66%(1995); 24.66% (1996); 31.01%(1997); 30.72%(1998); 34.07%(1999); 35.35%(2000); 36.92%(2001); 32.93%(2002); 31.20%(2003) and 29.36%(2004).On the other hand, it has been an increase in Mental Health Human Resources Rates: 24.23-100.000 inhab-(1998); 24.19 (1999); 26.01(2000); 28.04(2001); 29.83(2002); 29.16(2003); 29.34(2004) and 29.90(2005).Conclusion:Increasing human resources in psychiatric community devices do not change revolving-door rates in general hospital acute psychiatric units in a community mental health system.

Psychiatric Units in general hospitals. Problems and perspectives in Europe

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Features of elderly patients admitted to a general hospital psychiatric unit

AbstractBackground: Improved management of elderly psychiatric patients requires further identification of their special needs and problems.Methods: We analyzed the characteristics of 1333 consecutive patients admitted to the Psychiatric Center of Yokohama City University Medical Center, a general hospital psychiatric unit, from January 2000 to December 2003. Patients 65 years old or older (the elderly group) accounted for 12.3% of all patients.Results: The duration of admission in elderly patients was significantly longer than in younger patients (less than 65 years old). Admission history and admission type were significantly different between these two groups. Prevalence of dementia or delirium as a primary or secondary diagnosis was significantly greater in the elderly group. About three‐quarters of elderly patients were diagnosed as having a mood disorder (47.6%), or an organic mental disorder (31.1%). A significantly smaller fraction of patients were placed in seclusion in the elderly group than in the younger group, although the fraction of patients who were restrained did not differ between the two groups. A significantly higher fraction of elderly patients was transferred to general medical or surgical wards in the hospital to continue treatment for physical illness. In the elderly group, physical and mental prognoses were poorest in patients with organic mental disorders.Conclusions: Compared with the younger patients, the elderly psychiatric patients showed peculiar features. They were thought to require the treatments that were adapted to meet their needs.

Current issues in Scandinavian acute psychiatric wards

The aim of the paper is to provide an overview of some of the most important issues faced by acute inpatient facilities in three Scandinavian countries, including reflections and critical remarks for discussion in this field. Information was drawn from scientific articles and official reports published in recent years, as well as the authors' own knowledge of acute facilities in their home countries. Acute inpatient facilities, including General Hospital Psychiatric Units (GHPUs), in all Scandinavian countries have several issues and problems in common, which include the organisation and capacity of acute services, the assessment of dangerousness and suicidality, the use of coercion and efforts to reduce coercion, the need to define and improve the quality of acute services, and the necessity to improve collaboration and continuity between acute services and other services. Although the emphasis some of these issues receive can vary across the three countries, Scandinavian mental health professionals (and policy makers) have begun to systematically share their experiences in developing a growing spirit of collaboration. Despite the role of welfare state and the deployment of substantial resources in Scandinavian countries, mental health practitioners are struggling to implement best practices in acute wards, to develop differentiated forms of acute services, and to reach the right balance and coordination between acute services and other services.

Coming in from the cold. From psychiatric to general hospital. The Irish experience

The metamorphosis from an extensive mental hospital system of care, rooted in a culture and tradition of self-sufficiency and isolation, to the concept and practise of delivery of psychiatric care in general hospitals is described. The obstacles, psychological and practical, to be overcome in this change process are outlined. The place of the general hospital psychiatric unit in psychiatric and general medical care is outlined. Relevant matters of design and management are briefly explored.

Use of restraint in a general hospital psychiatric unit in Japan

Few analyses have been carried out in Japan concerning factors contributing to physical restraint of patients. We compared demographic data for 241 inpatients who were restrained during a 4-year period with data for 1093 inpatients who were not restrained in a general hospital psychiatric unit in Japan. Increased likelihood of restraint use was associated with older age, male gender, off-hours admission, involuntary hospitalization, transfer from other departments of the hospital, frequent hospitalization, absence of previous treatment, physical complications, history of suicide attempts, organic mental disorders, mental and behavioral disorders from psychoactive substance use, schizophrenia, schizotypal and delusional disorders. Importantly, physical complications not only were more prevalent among restrained than unrestrained patients, but additionally in restrained patients physical complications were associated with more prolonged hospitalization and periods under restraint than were associated with assaultive behavior or periods of unconsciousness. In conclusion, general hospital psychiatric units in Japan often treat patients with psychiatric disorders or symptoms that were associated with physical problems. Particular caution is needed in deciding whether such patients should be restrained since hospitalization may be prolonged or functional status compromised.