General Psychiatry Ward Research Articles

Like cheese and chalk or cross-fertilization? A qualitative exploration of how addiction patients perceive treatment in a general psychiatry ward

Background Addiction has historically been conceptualized and treated differently to other conditions. Studies suggest that healthcare staff perceive patients with substance use disorders (SUD) as a specific subgroup with distinct and challenging needs yet SUD patients frequently receive treatment in general psychiatry settings. Notwithstanding, knowledge of how SUD patients view themselves compared to other psychiatric patients and how they experience treatment in general psychiatry settings is lacking. Methods We conducted semi-structured interviews with 22 SUD patients voluntarily hospitalized in the acute psychiatric unit of a general hospital to explore the lived experiences of SUD patients receiving detoxification in an acute psychiatry ward. Data were analyzed using Thematic Content Analysis. Results Two primary themes and five subthemes emerged: (A) Patient perceptions of the problem and its consequences’, which includes the subcategories (i) Patient views of addiction, (ii) Staff perception of the patients; and (B) Lived experiences within the specific setting with subthemes (i) Interaction with the specific setting, (ii) Interaction with fellow patients, and (iii) Perception of staff by patients. Conclusions Overall, SUD patients had mixed perceptions; while many appreciated aspects of their hospitalization, others faced challenges in having all their needs met. Implementing policy-level interventions, like integrating SUD patient needs into psychiatry ward design and ensuring adequate resource allocation and staff training, could improve care quality for addiction patients in general psychiatry settings.

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.

Challenges in Treating Schizophrenia with LAIs – Analysis of Own Results

IntroductionSchizophrenia is a multifactorial and multifarious disorder with an unidentified etiology and pathogenesis, various clinical symptoms, unpredictable course and definite social significance. It’s social significance manifests in the long inability to work, the decrement of qualification and the burdening of family and social services. Patients find following therapy difficult; they often stop it altogether, which leads to new exacerbations and maintaining a vicious cycle.ObjectivesTo present an analysis of the results of the treatment of patients with LAIs – Trevicta and Xeplion in General Psychiatry Ward of UMBAL "Dr. Georgi Stranski” - Pleven for the period October 2016 – October 2022.MethodsOur retrospective research includes 17 patients treated in General Psychiatry Ward of UMBAL “Dr. Georgi Stranski”- Pleven. A treatment with LAI’s – Trevicta and Xeplion (Paliperidone palmitate) had been initiated in these patients. In consideration of the correct applications of the medication, they are always made by qualified personnel who received training for that purpose in the Ward. For assessment of the patients’ condition are used: Positive and Negative Syndrome Scale (PANSS) and Personal Social Performance (PSP). Standard statistic methods are used for processing results.ResultsOur research includes 17 female patients as the Ward’s profile is such, with the average age of 38.65 years at the initiation of the treatment with Xeplion. Some were later introduced to Trevicta. Of all who participated in the research, 12 patients continue their treatment with regular applications, 2 have changed their address and by unreliable data still continue their treatment and for the other 3 we have no information of their status of treatment. The average count of admissions in the Ward before the initiation of treatment with LAI’s is 3.88 against 0.88 after the initiation. Regarding the PANSS scale – all score in the interval 75-100 points before initiation as opposed to the scores marked after the initiation of the medication that vary in the interval 34-48 points with definite distinctions in P and G items. Regarding the PSP scale – all participants score between 50 and 70 points before the initiation of the treatment as opposed to the scores of 89-95 points after the initiation. During the regular check-ups the patients report of subjective improvement, coupled with reports of objective and positive improvement by family.ConclusionsTreatment with LAIs – Xeplion and Trevicta has an unquestionable positive and lasting effect in the treatment of schizophrenia. Proof of that is the definite improvement of the symptoms, the increased social engagement and interpersonal communication. Everything mentioned is a valid reason to direct the treatment of schizophrenia in the direction of preservation of the personality of the patients.Disclosure of InterestNone Declared

MON-P165: Malnutrition Prevalence in Patients Admitted in a General Psychiatry Ward of an Acute Care Hospital

MON-P165: Malnutrition Prevalence in Patients Admitted in a General Psychiatry Ward of an Acute Care Hospital

The impact of legal coercion on the therapeutic relationship in adult schizophrenia patients.

The quality of the therapeutic relationship between psychiatric patients and their attending physicians plays a key role in treatment success. We hypothesize that mandatory treatment is negatively associated with the quality of the therapeutic relationship. In a cross-sectional study design, data on psychopathological symptom load (as captured with the Brief Psychiatric Rating Scale) and on the quality of the therapeutic relationship (as measured with the Scale to Assess the Therapeutic Relationship) were collected from 113 adult male psychiatric patients and 35 attending physicians. Patients belonged to one of three groups: self-referred or involuntarily admitted patients from general psychiatry wards or patients from medium secure forensic psychiatric units. On average, self-referred patients rated the quality of the therapeutic relationship significantly more positive than did involuntarily admitted patients in general psychiatry wards. Forensic psychiatric patients, on average, gave an intermediate rating of the quality of the therapeutic relationship. There was no association between patients’ ratings and physicians’ ratings of the quality of the therapeutic relationship. Patients’ ratings of the quality of the therapeutic relationship were inversely related to symptom severity in general and hostility in particular. Ratings of the quality of the therapeutic relationship are not associated with patients’ legal status but rather with patients’ symptoms of hostility.

Development of Alcohol Treatment Services Models in Iran

The international data have indicated a growing trend of alcohol use worldwide during recent years. Although alcohol use is against cultural norms and religious law in Iran, anecdotal reports from substance abuse treatment providers show that there is demand for alcohol treatment in the country. A recent national report also documented alcohol use disorders in Iran. Development and implementation of evidence-based and culturally appropriate alcohol treatment services is one of Islamic Republic of Iran Ministry of Health national multi- pronged approach to address burden of alcohol use disorders. During development of national alcohol use disorders treatment guideline, guideline development team reviewed international evidences and guidelines for alcohol and drug treatment and designed a draft model for alcohol treatment. The preliminary model presented in an expert panel of drug treatment specialist and was finalized. Three tiers of treatment facilities were recommended to provide cost-effective treatment response to alcohol problems including out-patient, ambulatory treatment, residential treatment with defined medical monitoring and management and inpatient facilities. The inpatient level sub-categorized to two categories including alcohol treatment section within a drug treatment ward of a general hospital, and specialized alcohol treatment ward or section within a general psychiatry ward. The inpatient facilities need to have an Intensive Care Unit (ICU) or be affiliated to an ICU in another hospital. Since there is high stigma attached to alcohol use in Iran, it is recommended that the alcohol services are integrated within currently available drug treatment and health facilities.

Experimenting with groups in a locked general psychiatry ward

The groups were discussed in terms of the role the mental hospital can play as a container of psychosis. The anxieties and concerns brought by the patients in the groups showed a high degree of disturbance with threats of disintegration and chaos prominent. Madness, violence, inappropriate sexual behaviour, and deprivation were brought in abundance and the staff struggled to deal with this by providing a containment based on attempts to understand. Although containment was far from successful the groups were valued by patients and staff alike and contributed to a more humane atmosphere where patient's concerns were given time and attention.

Risks and pitfalls for the management of refeeding syndrome in psychiatric patients

Aims and MethodWe present two patients who developed refeeding syndrome following admission to a general psychiatry ward. The practical implications of assessing and managing medical consequences in patients with mental illness who start refeeding after a period of starvation are discussed.ResultsPatients presented with overlapping clinical manifestations of mental illness and refeeding syndrome that were difficult to recognise and manage.Clinical ImplicationsAwareness of refeeding syndrome in patients with mental illness may prevent fatal physical complications.

Antipsychotic prescribing quality and ethnicity — a study of hospitalized patients in south east London

A number of studies have shown qualitative and quantitative differences in prescribing of antipsychotics according to patient ethnicity. Black patients tend, for example, to be prescribed higher doses of antipsychotics than whites. Few studies have controlled for other factors which may influence prescribing practice and confound results. This study sought to determine whether or not ethnicity was associated with antipsychotic polypharmacy, high dosage and antipsychotic costs before and after adjustment for potential confounding. We approached inpatients on acute general psychiatry wards at the Maudsley, Bethlem and Lambeth hospitals in south east London. Prescription details were noted. Subjects were interviewed and social and clinical details were recorded. In all, data on 23 potential confounders were collected.A total of 210 patients were approached of whom 153 agreed to take part. Of the 23 potential confounders, only use of English as a first language and duration of illness differed significantly between blacks and whites. Categorical findings were adjusted for these factors and other potential confounders such as age and gender. Total antipsychotic daily dose was 82.2% of licensed maximum in blacks, and 77.2% in whites (p=0.48). Antipsychotic polypharmacy was seen in 23.2% of blacks and 16.9% of whites (adjusted odds ratio (OR) 1.11; 95% CI, 0.45-2.75). High dose (> 100% of maximum dose) antipsychotic regimens were prescribed to 15.9% of blacks and 16.9% of whites (adjusted OR, 0.71: 95% CI, 0.27-1.90). Mean monthly cost of treatment was significantly higher in blacks than whites (182.79 vs 143.08 British pound; p=0.02; adjusted OR (> 150 British pound/month), 2.45: 95% CI, 1.19-5.08). Prescribing quality was similar for blacks and whites. Black ethnicity was associated with significantly higher mean monthly medication costs.

Attempting to Understand the Increase in the Numbers of Forensic Beds in Europe: A Multi-site Study of Patients in Forensic and General Psychiatric Services

The study aimed to shed light on the recent dramatic increase in the number of forensic beds in Europe. A total of 184 patients being discharged from forensic hospitals and 122 from general psychiatry wards in sites in Canada, Finland, Germany, and Sweden were assessed and followed for two years. Information was collected from multiple sources. Forensic patients were distinguished from general psychiatric patients primarily by their histories of physical violence towards others and the trait of callousness. At discharge, the level of risk for future violence was similar among the general and forensic patients, but associated factors differed. The increase in forensic beds appears to be a response to violent behavior on the part of male patients with schizophrenia.

Concurrent Psychiatric Illness in Inpatients with Post-traumatic Stress Disorder

The discharge diagnoses of 374 inpatients on a VA Medical Center general psychiatry ward were reviewed. Sixty-three (16.8%) were diagnosed as having posttraumatic stress disorder (PTSD). The mean number of diagnoses was 2.9 for the PTSD group, compared with 1.4 for the non-PTSD patients. The most common comorbid conditions in the PTSD patients were alcohol abuse, unipolar major depression, substance abuse, atypical psychosis, and intermittent explosive disorder. All of these disorders except substance abuse occurred significantly more frequently in the PTSD patients than in those free of PTSD. Schizophrenia and organic mental disorders occurred significantly more frequently in the non-PTSD group. These results suggest a need for thorough psychiatric evaluation in patients with PTSD and the need to evaluate for PTSD when combat veterans present with one of several psychiatric syndromes mentioned above.

The diagnosis of depression in different clinical settings. An analysis of the literature on the dexamethasone suppression test.

The dexamethasone suppression test (DST) has performed well as a diagnostic test for depression in many specialized research settings. Clinical epidemiological methodology enables prediction of its diagnostic value in a variety of clinical settings different from those in which the DST has been studied. We reanalyzed the published data on the test's performance as a confirmatory diagnostic test for endogenous depression or major depressive disorder and modeled target populations, taking into consideration available data on the epidemiology of depression and variations in the test's performance according to clinical characteristics of the patients evaluated. The problems with which patients present in different settings will contribute to lower prevalence of the disorder and lower sensitivity and specificity of the test on general psychiatry wards, in psychiatric office practices, and in medical outpatient departments. As a result, the positive predictive value of the test, which is high on research wards (92 per cent), is likely to be lower on general psychiatric wards (82 per cent) and much lower in psychiatric office practice (52 per cent) and in general medical settings (29 per cent). Clinicians who use the DST in the diagnosis of depression should be aware of clinical and epidemiological variables that will affect its diagnostic value in different settings.