General Psychiatric Wards Research Articles

Mental healthcare in South Tyrol

Mental healthcare in South Tyrol, as everywhere in Italy, is still characterized by Law 180, which came into force in 1978 under the leadership of Franco Basaglia and Bruno Orsini. The Ministry of Health subsequently set atarget number of beds of 10/100,000 inhabitants. Unlike in other parts of Italy, private clinics play aminimal role in South Tyrol. The "Psychiatric Services" are part of the state healthcare system responsible for all citizens and are also responsible for compulsory outpatient care. According to the concept of community care, also due to the small number of inpatient beds, agreat deal of care is provided on an outpatient basis. Coercive measures can only be used in the case of an illness requiring urgent treatment that the patient refuses, without recourse to endangering circumstances (self-endangerment or danger to a third party). Inpatient hospitalization is only possible if treatment also takes place and the principle of "outpatient before inpatient" also applies in this context, i.e., coercive treatment can only take place as an inpatient if it cannot be carried out as an outpatient. Forensic psychiatry has very few places and mentally ill offenders are often in prison or occupy beds in general psychiatric wards. Compared to Germany there are fewer beds available but staffing levels are better, particularly for nursing. In relation to the number of inhabitants, compulsory treatment is more frequent than in Germany, whereas involuntary hospitalization and physical restraint are much rarer (only possible in Italy by court order).

Learning and achieving basic mental health competence in placement studies with the support of a tool: A qualitative study of student nurses’ experiences

BackgroundLearning basic mental health care competence is often challenging for the bachelor of science student nurses, and many lack basic mental health care competence to ensure safe and confident mental health care practice. Mental health assessment is an integrated part of this competence. ObjectiveThe objective of this study was to explore and describe in depth how student nurses experience learning and achieving basic mental health competence while on mental health placement with the support of a learning tool. DesignAn explorative and descriptive qualitative design was conducted to gain insight on how student nurses experienced learning basic mental health competence when on placement. SettingA diversity of mental health placement settings in which student nurses were involved with patient care or welfare were approached; general psychiatric wards (n = 2), psychiatric ward for elderly people (n = 1), community mental health in-patient facilities (n = 2) and unconventional placements in the community (n = 9). Unconventional placements are a diversity of non-clinical service contexts. ParticipantsThe participants comprised student nurses in their 3rd and final year while on mental health placement. Potential participants received information from course coordinators, the online learning platform, and from teachers in plenary. Using purposive sampling, 14 student nurses were recruited. MethodsIndividual semi-structured interviews were conducted online and in person at two campuses of one university in Norway between August 2020 and December 2021. The interviews were transcribed and thematically analysed as described by Braun and Clarke. ResultsStudents expressed insecurity in a new clinical context. They engaged in new learning situations and realized the diversity of nursing practice. Unconventional placements were described as challenging contexts for learning basic mental health care competence. ConclusionsThis qualitative study provided insight into how student nurses experience learning mental health assessment, and gaining relational, communicative, and ethical competence while on placement. Students revealed their insecurities and challenges in learning in a new context. Awareness of clinical learning opportunities on placement when preparing student nurses to learn basic mental health competence may help improve their confidence.

Initiative to improve handover notes in a tertiary psychiatric hospital

Clinical handover is an important process in hospital settings, but it is often carried out inadequately, posing potentially serious consequences for the patients. This project aimed to increase the effectiveness...

‘Far Away from Home’: adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study

BackgroundThe increasing prevalence and acuity of mental disorders among children and adolescents have placed pressure on services, including inpatient care, and resulted in young people being admitted at-distance or to...

General psychiatric inpatient care for persons with anorexia nervosa—an integrative literature review protocol

IntroductionPeople diagnosed with anorexia nervosa are offered or compelled to undergo various treatments and therapies. In Sweden, the lack of highly specialised eating disorder services means that people with anorexia...

Transdiagnostic Associations between Anger Hostility and Chemokine Interferon-gamma Inducible Protein 10.

Many psychiatric disorders are linked to low grade systemic inflammation as measured by systemic cytokine levels. Exploration of cytokines and immune activity and their role in psychiatric symptoms may inform pathobiology and treatment opportunities. The aim of this study is to explore if there are associations between cytokines and psychiatric symptom clusters. Comparison between patients regularly using and those not using psychotropic medication is also conducted. This was a cross sectional naturalistic study with 132 participants from a general open inpatient psychiatric ward at the Nordland Hospital Trust, Norway. Serum levels of 28 different cytokines were assessed. Psychiatric symptoms the last week were assessed by a self-rating scale (Symptom check list, SCL-90-R) and grouped in defined clusters. Multiple linear regression model was used for statistical analyses of associations between levels of cytokines and symptoms, adjusting for possible confounding factors. We found a positive association (p = 0.009) between the chemokine interferon-gamma inducible protein 10 (CXCL 10; IP-10) and the anger hostility cluster. No associations were found between the other symptom clusters and cytokines. IP-10 and the anger hostility cluster were positively associated (p = 0.002) in the subgroup of patients using psychotropic medication, not in the subgroup not using psychotropic medication. Our analyses revealed a significant positive association between the symptom cluster anger hostility in SCL-90-R and the chemokine IP-10 in the subgroup of patients using psychotropic medications.

The presence of alcohol use disorders over a three months period in a general psychiatric ward of “Alexandru Obregia” Clinical Hospital of Psychiatry”

The presence of alcohol use disorders over a three months period in a general psychiatric ward of “Alexandru Obregia” Clinical Hospital of Psychiatry”

Characteristics of clinical-pharmacological recommendations in psychiatry in Germany.

Psychiatric patients in general, and elderly psychiatric patients in particular, are at risk of adverse drug reactions due to comorbidities and inappropriate polypharmacy. Interdisciplinary and clinical-pharmacologist-led medication reviews may contribute to medication safety in the field of psychiatry. In this study, we reported the frequency and characteristics of clinical-pharmacological recommendations in psychiatry, with a particular focus on geriatric psychiatry. A clinical pharmacologist, in collaboration with the attending psychiatrists and a consulting neurologist, conducted interdisciplinary medication reviews in a general psychiatric ward with a geropsychiatric focus at a university hospital over a 25-week period. All clinical and pharmacological recommendations were recorded and evaluated. A total of 316 recommendations were made during 374 medication reviews. Indications/contraindications of drugs were the most frequently discussed topics (59/316; 18.7 %), followed by dose reductions (37/316; 11.7 %), and temporary or permanent discontinuation of medications (36/316; 11.4 %). The most frequent recommendations for dose reduction involvedbenzodiazepines (9/37; 24.3 %). An unclear or absent indication was the most common reason for recommending temporary or permanent discontinuation of the medication (6/36; 16.7 %). Interdisciplinary clinical pharmacologist-led medication reviews represented a valuable contribution to medication management in psychiatric patients, particularly the elderly ones.

Socio-demographic and clinical profiles of adults with an intellectual disability admitted to acute general psychiatric wards in a Singapore hospital

ABSTRACT Background: People with an intellectual disability have a higher risk of developing mental disorders compared to the general population. Available evidence suggests those with an intellectual disability receiving inpatient treatment in general psychiatric wards may have certain unique characteristics. Method: Data gathered from a retrospective review of records of adults with intellectual disability admitted to general psychiatry wards in a tertiary psychiatric hospital in Singapore were analysed. Results: Of 290 adults with intellectual disability, 62.8% were males. The median age was 38 years. The median length of stay was 12 days and over 80% had at least one previous admission. Nearly 80% had a mild intellectual disability and 64.5% had at least one psychiatric comorbidity, the majority having schizophrenia or psychotic disorder. Physical aggression was the most common primary reason for admission. Conclusions: The specific profile of patients identified in the study would be helpful in determining priority areas for the development of specialist psychiatric services for people with intellectual disability.

Factors Contributing to Risk of Persistence of Positive and Negative Symptoms in Schizophrenia during Hospitalization

The aim of the study was to evaluate factors that may contribute to the persistence of positive, negative and other psychopathological symptoms of schizophrenia. All patients were treated in general psychiatric wards between January 2006 and December 2017. The initial study sample comprised of the medical reports of 600 patients. The main, specified inclusion criterion for the study was schizophrenia as a discharge diagnosis. Medical reports of 262 patients were excluded from the study due to no neuroimaging scans being available. The symptoms were categorised into three groups: positive, negative, and other psychopathological symptoms. The statistical analysis comprised modalities such as demographic data, clinical symptoms, as well as neuroimaging scans linking them to a potential impact of sustaining the mentioned groups of symptoms during the period of hospitalization. The analysis revealed that statistically significant risk factors of persistence of the three groups of symptoms are the elderly age, the increasing toll of hospitalizations, suicidal attempts in medical history, a family history of alcohol abuse, the presence of positive, negative and other psychopathological symptoms on admission to the hospital, as well as the absence of cavum septi pellucidi (CSP). The study showed that addiction to psychotropic drugs and a family history of schizophrenia were more frequent in patients with persistent CSP.

What does a Peer Support Worker do in a Forensic Mental Health Clinic for Addicted Offenders?

IntroductionPeer support work can be an effective way to support patients and their participation in psychiatric treatment. Unlike in general psychiatry there is less experience with peer support work in forensic mental health inpatient settings. Characteristics different from general psychiatry, e.g., regarding patient structure and background, might lead to different tasks of peer support workers and subjects of conversation.ObjectivesWe aim to present an overview of tasks and conversation topics of a peer support worker in a forensic mental health setting for addicted offenders during an 12 month period. We address tasks on regular and irregular basis and the most frequent conversation topics.MethodsWe used the anonymized work documentation about weekly working activities and conversation notes of the peer support worker to extract information. Extracted data were thematically analyzed and clustered into themes for tasks and conversation topics.ResultsResults reveal several recurring and routine tasks, like joining ward rounds and changes of shift or leading a recovery patient group along with one-to-one conversations with patients according to their request. These topics were expanded by irregular tasks like group discussions for special occasions, e.g., after incidents. During one-on-one conversations, patients addressed topics, e.g., about their substance use history, thoughts and issues about their therapy or ways to achieve their goals in the future.ConclusionsPeer support is a well-accepted offer that can contain various different tasks in groups and in one-on-one settings as well. Although the peer support worker is seated on one ward, there are many requests from other wards, too. There also exists a broad range of conversation topics, some might be also present in general psychiatric wards and others that might be more unique to forensic settings. The broad range of tasks and acceptance of peer support make it necessary to provide corresponding resources like peer support staff and payment.Disclosure of InterestNone Declared

Brief App-Based Cognitive Behavioral Therapy for Anxiety Symptoms in Psychiatric Inpatients: Feasibility Randomized Controlled Trial.

Psychiatric inpatients often have limited access to psychotherapeutic education or skills for managing anxiety, a common transdiagnostic concern in severe and acute mental illness. COVID-19-related restrictions further limited access to therapy groups on inpatient psychiatric units. App-based interventions may improve access, but evidence supporting the feasibility of their use, acceptability, and effectiveness in psychiatric inpatient settings is limited. MindShift CBT is a free app based on cognitive behavioral therapy principles with evidence for alleviating anxiety symptoms in the outpatient setting. We aimed to recruit 24 participants from an acute general psychiatric inpatient ward to a 1-month randomized control study assessing the feasibility and acceptability of providing patients with severe and acute mental illness access to the MindShift CBT app for help with managing anxiety symptoms. Recruitment, data collection, analysis, and interpretation were completed collaboratively by clinician and peer researchers. Inpatients were randomized to two conditions: treatment as usual (TAU) versus TAU plus use of the MindShift CBT app over 6 days. We collected demographic and quantitative data on acceptability and usability of the intervention. Symptoms of depression, anxiety, and psychological distress were measured in pre- and poststudy surveys for preliminary signals of efficacy. We conducted individual semistructured interviews with participants in the MindShift CBT app group at the end of their trial period, which were interpreted using a standardized protocol for thematic analysis. Over 4 weeks, 33 inpatients were referred to the study, 24 consented to participate, 20 were randomized, and 11 completed the study. Of the 9 randomized participants who did not complete the study, 7 were withdrawn because they were discharged or transferred prior to study completion, with a similar distribution among both conditions. Among the enrolled patients, 65% (13/20) were admitted for a psychotic disorder and no patient was admitted primarily for an anxiety disorder. The average length of stay was 20 days (SD 4.4; range 3-21) and 35% (7/20) of patients were involuntarily admitted to hospital. Small sample sizes limited accurate interpretation of the efficacy data. Themes emerging from qualitative interviews included acceptability and usability of the app, and patient agency associated with voluntary participation in research while admitted to hospital. Our study benefitted from collaboration between peer and clinician researchers. Due to rapid patient turnover in the acute inpatient setting, additional flexibility in recruitment and enrollment is needed to determine the efficacy of using app-based psychotherapy on an acute psychiatric ward. Despite the limited sample size, our study suggests that similar interventions may be feasible and acceptable for acutely unwell inpatients. Further study is needed to compare the efficacy of psychotherapeutic apps with existing standards of care in this setting. ClinicalTrials.gov NCT04841603; https://clinicaltrials.gov/ct2/show/NCT04841603.

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience.

An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.

Regard des patients psychiatriques sur leur prise en charge somatique en psychiatrie : enquête et propositions

Literature's data report the existence of numerous somatic comorbidities in patients with mental diseases. In order to improve practices, HAS-labeled recommendations were written in 2015. These recommendations advocate the improvement of current practices, by integrating into the accreditation procedures of institutions the somatic management of patients including a complete somatic examination of any hospitalized patient. Outpatient follow-up is also mentioned, especially when the patient does not have a general practitioner: “the psychiatrist will naturally be in charge of managing the patient's somatic problems”. This text reminds us that psychiatry belongs to the medical world and that it is necessary to improve patient care. Nevertheless, these recommendations may come up against the usual practice of psychiatrists who do not generally carry out a somatic clinical examination. Indeed, the particularity of the French psychiatric practice is that it is rooted in the field of human sciences where subjectivity plays a major role. However, the somatic examination is in essence objectifying, leading to an ethical conflict for the psychiatrist between an adapted somatic management and an optimal psychiatric management. In order to help us in our reflection, we decided to question the patients, by focusing our work on their social representations concerning the psychiatrist and his function. The objective of our work will thus be to discuss the dilemmas resulting from these recommendations in the light of other ethical principles and to propose practical reflections on their implementation with an ethical concern by placing the patient at the center of the care system. In France or internationally, no study on the social representations that patients have of their somatic care has yet been conducted. MethodWe conducted a prospective study in the form of semi-structured interviews with a sample of 21 patients treated in a general psychiatric ward. The interview guide included four themes: definition of the doctor and the psychiatrist, the course of care in psychiatry, the relationship between patients and therapists in psychiatry, and the role of the psychiatrist in somatic care in psychiatry. The results show the ambivalence of patients who wish to receive comprehensive care without expecting psychiatrists to invest in their somatic evaluation. These representations are linked to the heritage of French psychiatry, but also to the subjective link between the patient and his psychiatrist in the psychotherapeutic framework and finally, to the position of specialist assigned to the psychiatrist treating a specific medical field. ConclusionIt is therefore the psychiatrist's ethical responsibility to question the practical implementation of his medical skills (in particular in the field of somatic comorbidities) and his psychotherapeutic skills by adapting them in a singular way to each patient according to his pathology, his degree of autonomy and his social representations in order not to be harmful on the psychic level while wanting to be beneficial on the somatic level. The psychiatrist must inform the patient of his or her competencies and limitations in terms of somatic care and of the specific somatic aspects of the patient's pathology. Finally, patients followed in psychiatry often have a lack of access to care as well as an unfavourable socio-economic level. In this context, they may have difficulty accessing the various medical specialists. Most inpatients benefit from appropriate somatic care thanks to the development of somatic care units in the institutions. Thus, we see that the will to improve the situation in the hospital has led to socio-economically favourable solutions and to the training of competent general practitioners in this field. It is necessary to continue efforts in this direction, but also in general medicine. Even if psychiatrists are aware of patients’ somatic pathologies, take them into account, and occasionally perform a somatic examination, they cannot replace a trained and competent general practitioner.

Analiza świadczeń psychiatrycznych dla pacjentów z rozpoznaniem schizofrenii sprawozdanych do Narodowego Funduszu Zdrowia w latach 2009–2018

Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. Schizophrenia is analyzed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In the study, the unitary data of the National Health Fund (NFZ) was used, reported in the years 2009-2018. Patients were identified by the Personal Identity Number (PESEL). The services for adults were analyzed, i.e., people who were at least 18 years old in the year when the services were discontinued, for whom the main disease was schizophrenia classified by ICD-10 codes: F20 to F20.9. Provided services were analyzed according to those specified in the ordinance of the President of the National Health Fund of June 28, 2019 - organizational units and billing product codes. Between 2009 and 2018, the number of patients diagnosed with schizophrenia treated in the public sector increased by 5%. In the analyzed years, the number of in-patients decreased by 9%, while the number of people using out-patient services and community treatment increased by 6%. In forensic psychiatry departments, a very high increase (by 212%) in the number of hospitalized patients was observed. In 2018, the average number of hospitalization days in a general psychiatric ward was 43, in the forensic ward 279. A very low percentage of patients (less than 3%) used day therapy. In out-patient treatment, the mainstay of therapy was a medical consultation; less than 10% of patients used other types of services. In 2018, an average of four visits/consultations per patient was reported. There has been a very high decrease in the number of patients (by 77%) using group therapy, family therapy and support. In 2009-2018, most patients diagnosed with schizophrenia in the public sector were treated using the traditional model of care: medical consultation and psychiatric hospitalization. It is advisable to reorganize the system - implementation and development of comprehensive care coordinated within the community care model. Extending the study with information from the non-public sector would give a full picture of system functioning and facilitate service needs estimation for this group of patients.

Experiences of Mental Health Care Among Women Treated for Postpartum Psychosis in England: A Qualitative Study

Postpartum psychosis has been found to affect 0.89–2.6 per 1000 women. Onset is typically rapid and severe. Early recognition and appropriate treatment are crucial for a good prognosis. Our aim in this study was to understand women’s experiences of mental health care and services for psychosis in the postnatal period. Semi-structured interviews were conducted with 12 women who reported being treated for postpartum psychosis. Findings were analysed thematically. Women reported that healthcare professionals across maternity and mental health services often lacked awareness and knowledge of postpartum psychosis and did not always keep them or their partners/families informed, supported, and involved. Women wanted better collaboration between and within services, and more efficient, appropriate, and timely care. They valued inpatient services that could meet their needs, favouring Mother and Baby Units over general psychiatric wards. Early Intervention in Psychosis services and specialist perinatal community mental health teams were also well liked.

Alcohol Screening on Admission to an Acute Mental Health Ward

AimsAlcohol misuse is estimated to cost the NHS £3.5 billion/year. Only 6% of people suffering from alcohol dependence in England, receive treatment per year, highlighting that alcohol misuse is under-identified. During the COVID-19 pandemic, people have significantly changed their drinking habits, evidenced by government tax receipt data, suggesting alcohol sales increased by 3% to 5% in the UK compared to 2019. Problems associated with harmful alcohol consumption were intensified by the crisis, even though the long-term impacts of COVID-19 on alcohol consumption are uncertain. There was a notable increase of patients with dual diagnosis of mental illness and alcohol misuse on our ward, which is a general adult inpatient psychiatric ward. As such, the aim was to assess and improve alcohol screening on admission to an acute mental health ward.MethodsThrough a System One review, we assessed whether alcohol consumption is documented on admission (within 72 hours) in units, and a validated screening tool is used (AUDIT-C), which was expected in all patients. Their notes were initially retrospectively analysed and subsequently reviewed approximately six weeks following the implementation of interventions.Interventions included presenting the findings of the primary survey to our colleagues during a multidisciplinary team meeting on the ward and a trust-wide audit meeting attended by both junior and senior doctors. Additional interventions included posters outlining the importance of alcohol screening in the interview rooms of the acute wards (including a QR code link to our presentation and findings).ResultsOut of the 17 patients on the ward, 47% (8/17) were not appropriately screened for alcohol misuse during their first 72 hours of admission. 47% (8/17) had no documented alcohol history on admission clerking. Only 12% (2/17) had partially quantifiable alcohol intake, both drinking above the recommended weekly amount. None of the ‘Current Drinker’ patients had AUDIT-C screening. Improvement was noted following the interventions during the secondary survey.ConclusionAlthough alcohol screening in acute psychiatric admissions is often vague or incomplete, simple reminders and education can improve screening. If the alcohol history cannot be obtained from the patient on admission, which is often the case, the clinician should clearly document review of notes for historical alcohol use, to avoid potential complications, such as alcohol withdrawal, delirium tremens or seizures.This project raises further questions on how effective brief interventions for excessive alcohol consumption in acutely unwell/psychotic patients are, encouraging a further area of research.

MDT Clinics on a General Adult Acute Psychiatric Ward: Staff's Views and Person-Centred Care

AimsPerson-Centred Care (PCC) focuses on knowing the person behind the patient, engaging them as an active partner in their treatment, encouraging self-management and shared decisions. Inpatient multidisciplinary (MDT) clinics offer an opportunity for PCC by working collaboratively with service users (SU) in developing care plans. The aims of this project were to explore staff views and levels of satisfaction regarding the running of MDT clinics, to assess the quality and efficacy of changes made to MDT clinics, and to identify areas of practice which need improvement.MethodsIn April 2021, MDT meetings of an acute inpatient clinical team were repurposed to 30-minute clinics with SU and relevant key professionals present, focusing on SU needs. Two staff surveys were completed in June and October 2021. Following the first survey, changes were made to the days clinics were run, attendance schedule, and staff allocation of responsibilities for efficient clinic running. In the second survey, a 14-question questionnaire was sent to all 48 staff members. The questions explored staff experience of MDT clinics. The measures were both qualitative and quantitative.ResultsThe overall response rate was 31.25%, of which 40% by medical and 40% by nursing staff. Staff reported there was a positive impact in the collaborative development of care plans, including improved SU involvement, increased involvement of families, improved contribution from different professionals, and formulations providing greater insight. They reported improved task orientation, directed responsibility for task completion within the team, and enhanced role and responsibility of the named nurse. They thought there was less time for 1:1 work, but that the “overall benefits are worth it”. Improved relationship with SU was reported by 85%, increased engagement with SU care by 93%, and identifying clear goals for care plans by 93%. Nevertheless, problems with planning and logistics were reported by 77%. Main challenges included time management especially with external visitors or combination of remote and face-to-face attendees, relatively poor attendance of CMHT and family members, difficulties with informing and preparing SU ahead of their clinic times, number of attendees, and dissemination of MDT care plans.ConclusionRepurposing MDT meetings to MDT clinics focusing on SU needs has a positive impact in inpatient clinical practice. MDT clinic planning and improving the involvement of community teams and family members can contribute to an optimal purposeful inpatient admission. Conducting inpatient MDT clinics can be a crucial part of working collaboratively with SU and PCC.

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: "From Dusk Till Dawn".

IntroductionDay and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes.MethodsDemographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn).ResultsDuring the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates.DiscussionThe main finding of our study is the relationship between “daytime hours” and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.

Association between brain-derived neurotropic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP) and psychiatric symptoms in medicated and unmedicated patients

BackgroundThere is evidence that brain-derived neurotropic factor (BDNF) plays a protective role in the brain. Peripheral levels of BDNF correlate with its concentration in the brain. Previous studies have revealed lower serum BDNF levels in patients with mental illnesses. In most studies serum BDNF correlates negatively with psychiatric disorders and disease severity. Most studies in this field are on psychiatric diagnosis and personality traits. The aim of our study is to explore associations between general psychiatric symptoms, independent of diagnostic groups, and serum BDNF as well as the inflammatory biomarker high-sensitive CRP (hs-CRP). Comparison between the group regularly using psychotropic medication and those not using psychotropic medication is conducted.MethodsThe study is a cross sectional study with 132 participants from a general open inpatient psychiatric ward at the Nordland Hospital Trust, Bodoe, Norway. Participants were assessed on serum levels of BDNF and hs-CRP. Psychiatric symptoms were assessed by a self-rating scale (Symptom check list, SCL-90- R). Multiple linear regression model was used for statistical analyses of associations between levels of BDNF, hs-CRP and symptoms.ResultsWe found a positive association (p < 0.05), for most SCL-90 symptom clusters with BDNF in the psychotropic medication-free group. No associations were found in the group of patients using psychotropic medication, except one, the paranoid ideation cluster (p 0.022). No associations were found between hs-CRP and symptom clusters.ConclusionWe found no relation between symptom clusters and the inflammatory biomarker hs-CRP. Serum BDNF levels were positively associated with intensity of psychiatric symptoms in the group of patients not using psychotropic medication. Our findings are in conflict with several previous studies reporting increased hs-CRP as well as decreased rather than increased BDNF in mental suffering. Patients on psychotropic medication may not require the same upregulation because the medication is modulating the underlying biological pathology.