Hospital Treatment Program Research Articles

Achieving functional remission in schizophrenia: a pilot study

IntroductionMany patients with schizophrenia are unable to achieve adequate levels of psychosocial functioning and quality of life despite of the remission of illness symptoms. According to previous reports, only one-third of patients with symptomatic remission reach functional remission. While current pharmacotherapy options seem to be relatively effective for different symptoms of schizophrenia (e.g. positive symptoms), more specific psychosocial interventions that could enable functional remission are yet to be developed.ObjectivesOur objective is to investigate differences in psychopathology, quality of life, functioning, and achieving functional remission before and after specific group treatments developed in our clinic.Methods We will conduct a prospective study including a consecutive cohort of female patients older than 18 years of age, which fulfilled the criteria for schizophrenia and schizoaffective disorder according to the International Classification of Disorders, 10th revision. Exclusion criteria are intellectual disabilities, mental disorders due to known physiological or neurological conditions, lactation or pregnancy, treatment with medications that can provoke psychosis, alcoholism, and other addictions. Patients will be recruited after finished hospital treatment or during individual outpatient controls. The Recovery Helm will be used at the beginning of the treatment, to make individual treatment plan and include patients in specific programs including day hospital treatment and/or outpatient group programs: psychoeducation, relaxation, metacognitive training, and social skills training. Besides collecting sociodemographic data, pre- and post-treatment assessment will include the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the Quality of Life Scale (QLS), and the “Functional Remission of General Schizophrenia” (FROGS) scale.ResultsWe will analyze the changes in psychopathology levels, quality of life, functioning, and achieving functional remission between the two assessment points, taking into account different treatment possibilities.ConclusionsEvaluation of current available programs can help with recognition of specific needs of patients with schizophrenia and provide guidelines for further development of treatment programs that could be helpful in achieving functional remission.Disclosure of InterestNone Declared

Maternal Perspective of Inpatient Methadone Initiation: Opportunities to Increase Retention in Treatment.

Recent trends demonstrate increases in the rates of opioid use among pregnant and parenting women. Treatment for pregnant people with opioid use disorder (OUD) includes medications for OUD, like methadone, as well as comprehensive support services. Still, inpatient treatment engagement is suboptimal and treatment drop out is common. There is little research examining the maternal perspective of the inpatient methadone initiation experience. The primary aim of this qualitative methods study was to explore patient experience and perspective of the inpatient methadone initiation period. All participants were recruited from a single urban university affiliated hospital and OUD treatment program. Data were collected from 30 maternal participants in OUD treatment about their inpatient methadone initiation experience while pregnant using semistructured interviews. Thematic analyses were conducted using an inductive approach after an iterative process of code development and application among a multidisciplinary team of 3 coders. Validity was accounted for through 2 participant feedback interviews and study team review and discussion of findings. Four themes emerged from the maternal interview data: (1) Barriers to Inpatient Methadone Initiation, (2) Facilitators to Inpatient Methadone Initiation, (3) Transition From Hospital Inpatient to Outpatient or Residential OUD Treatment Services, and (4) Opportunities for Enhanced Clinical Support. Maternal participants reported multiple barriers and facilitators to inpatient care during methadone initiation, highlighting opportunities for improvement to effectively engage pregnant individuals in treatment.

Profiles of patients with a personality disorder admitted in a day hospital treatment program: Revealing spectra from the Hierarchical Taxonomy of Psychopathology

Profiles of patients with a personality disorder admitted in a day hospital treatment program: Revealing spectra from the Hierarchical Taxonomy of Psychopathology

Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment.

There are no studies of the safety and effectiveness of telehealth psychiatric treatment of partial hospital level of care, in general, and for borderline personality disorder (BPD) in particular. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors compared the effectiveness of their partial hospital treatment program in treating patients with BPD. For both the in-person and telehealth partial hospital level of care, patients with BPD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups reported a significant improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment was found in both treatment groups. No patients attempted suicide. Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, and improved functioning and well-being for patients with BPD.

Development and Implementation of a Pilot Integrative Day Hospital Program for Youth with Severe Obesity and Mental Health Issues.

Background: Adolescents with severe obesity and comorbid mental health issues are the most resistant to traditional weight management approaches and have poor treatment outcomes. Our objective was to implement and evaluate a pilot day hospital treatment program for adolescents with severe obesity, or risk for severe obesity, and significant mental health comorbidities. Methods: This was a prospective cohort study of adolescents 12-18 years of age with severe obesity (BMI >99th percentile), or at risk for severe obesity, and comorbid mental health issues. The intervention, focused on healthy lifestyle and mental health support, was implemented within an existing psychiatric day hospital at a pediatric quaternary care hospital. Anthropometric and mental health measures were analyzed pre- and postintervention. Results: Thirty-two adolescents with a mean age of 14.9 years [standard deviation (SD) 1.6] participated in the pilot integrative day hospital program for a mean duration of 5.2 months (SD 2.3). Eleven participants had primary severe obesity and comorbid mental health conditions (obesity subgroup) and 21 participants had primary mental illness and were at risk for obesity (psychiatry subgroup). We did not observe a significant difference between BMI pre- and postprogram among adolescents in both subgroups. In other words, adolescents in both subgroups achieved weight maintenance. Fear in losing control of overeating and/or being seen by others when eating decreased significantly in the obesity subgroup [mean difference (MD) 0.99; 95% confidence interval (CI): 0.27 to 1.71]. There was a significant decrease in participant-reported depression symptom severity, both overall and within program subgroups. Quality-of-life scores of study participants improved significantly within the obesity subgroup (MD -12.31; 95% CI: -21.69 to -2.93), but not within the psychiatry subgroup (MD -6.35; 95% CI: -13.37 to 0.67). Conclusions and Implications: A day hospital model of care may result in weight maintenance, decreased eating concerns, and improved mental health in adolescents with severe obesity or risk for severe obesity, and significant mental health comorbidities.

Dismantling weight stigma: A group intervention in a partial hospitalization and intensive outpatient eating disorder treatment program.

The authors piloted a weight stigma psychotherapy group at an eating disorder partial hospitalization (PHP) and intensive outpatient program (IOP). This was an optional, transdiagnostic eating disorder group for patients with past/present weight stigma experiences related to being in large bodies. A total of 36 individuals participated in the weekly group from June 2018 to June 2019 during their PHP/IOP episode of care. We present the group's overarching framework of destigmatizing language and intersectional discussions of weight stigma. We also discuss clinical processes that unfolded during this group including simulated dialog from the group. Finally, we present relevant client quotes that provide preliminary support for future exploration in this area, as client subjective experiences of the group were positive. Our preliminary pilot experience suggests that delivering a group of this nature in a PHP/IOP eating disorder treatment setting is feasible and that further work is needed to build upon this antiweight stigma framework as a critical piece of eating disorder treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Results of a Day-Hospital Program for Personality Disorders. Application of the PID-5 and DSM-5 Dimensional Model

DSM-5 dimensional-hybrid model and PID-5 Personality Inventory might be particularly useful in a day hospital treatment program for personality disorders, while the need for treatment for mixed personality disorder and unspecified personality disorder is such as frequent as for borderline personality disorder. Effective treatment programs in the public health system are required. The study shows the results from the day hospital treatment program for personality disorders implemented at San Juan Hospital in Alicante. The treatment involves an intensive and interdisciplinary program that applies the DSM-5 dimensional model and the PID-5 personality inventory to identify therapeutic needs, with both individual and group therapies with a cognitive-behavioural therapeutic approach. Results support the relevance of therapeutic components regarding this program. Moreover, its effectiveness has been demonstrated in achieving significant changes in symptoms, traits, comorbidity, and psychosocial functioning. It also appears to be efficient not only in reducing the number of visits to the emergency and hospital admissions, but also in ensuring continuity and therapeutic compliance, thus reducing public health costs.

Family functioning and therapeutic success in detoxification in dual diagnosis patients

IntroductionVoluntary dropouts before completion of inpatient psychiatric treatment are common in patients with dual disorders. However, the socioeconomic profile and family structure of patients who undergo a therapeutic program may correlate with their motivation and participation in the treatment received, as well as with their subsequent recovery.ObjectivesTo evaluate the family typology of patients with dual diagnosis according to the degree of intrafamily cohesion and adaptability correlated with the prediction of therapeutic success and the risk of voluntary abandonment of hospital detoxification treatment.MethodsA total of 211 patients admitted to an inpatient psychiatric unit with substance use disorders were studied. Data were obtained from two sources: (1) interview of participants, (2) review of participants’ medical records using the Maudsley Addiction Profile (MAP) and the Family Cohesion and Adaptability Assessment Scale (FACES III).ResultsThe 127 subjects who completed the hospital detoxification program had significantly lower MAP and FACES III scores at baseline than the 84 subjects who did not complete the study. Those who did not complete the admission reported greater addictive severity and poorer family functioning. Family cohesion and adaptability measured with FACES III and addictive severity assessed with MAP positively correlated with successful compliance with the hospital treatment program for dual diagnosis patients.ConclusionsThese findings reveal the association of psychosocial and family determinants and addictive severity with treatment completion and subsequent prognostic evolution. Recognizing these predictive characteristics may allow early identification of patients at higher risk of early dropout and prevent it by increasing the intensity of treatment.

Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective "real world" data analysis of fibromyalgia patients.

To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). In this cross-sectional, observational study, "real world" data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (- 0.22), pain-related interference with everyday life (- 0.19), general activity (0.13), general health perception (0.11), punishing response from others (- 0.11), work status (- 0.10), vitality (- 0.11) and cognitive difficulties (- 0.12). Pain intensity or frequency was not an independent correlate. More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

Factor structure and psychometric properties of the clinical impairment assessment 3.0 (CIA) in a clinical eating disorder sample

PurposeThe aim of this study was to investigate the psychometric properties and the factor structure of the Clinical Impairment Assessment 3.0 (CIA) utilizing a confirmatory factor analysis in a large clinical sample of ED patients. MethodsA total of 260 patients between the ages of 18 and 45 who completed assessments in a partial hospitalization or residential treatment program at an ED treatment facility between December 2012 and December 2016 were included in the analyses. Assessment measures included the CIA, EDE-Q, BDI-II, WHODAS, and a demographic questionnaire. ResultsResults favored a bifactor model with a strong general factor and three unreliable subfactors. The CIA showed strong construct validity with other measures of ED pathology (EDE-Q) and health-related QoL (WHODAS). Furthermore, admission CIA scores were predictive of treatment outcomes. ConclusionsThe CIA assesses general psychosocial impairment, supporting the use of a total, but not subscale scores, among symptomatic ED samples in the United States.

Modified Drinking Motives Questionnaire–Revised: Psychometric Validation in a Psychiatric Sample of Young Adults with Predominantly Polysubstance Use

IntroductionMeasures of motives for alcohol use provide an important avenue for understanding underlying psychological reasons that drive substance use and predict distinct patterns of use. The Modified Drinking Motives Questionnaire–Revised (MDMQ-R; Grant, Stewart, O'Connor, Blackwell, Conrod, 2007) measures five drinking motives: social, enhancement, conformity, coping-with-anxiety, and coping-with-depression. The MDMQ-R and its predecessors have previously been validated only in non-clinical normative samples. PurposeTherefore, the present study aimed to validate the factor structure and internal consistency of the MDMQ-R in a diverse psychiatric sample of substance-using young adults that presented with either exclusive alcohol use or polysubstance use. MethodParticipants were 255 substance-using young adults (18–26 years; M = 21.17) admitted to the young adult partial hospitalization treatment program at a private psychiatric hospital (62% female; 78% White; 43% students). ResultsA confirmatory factor analysis revealed that items loaded on their respective latent factors (ps < 0.01; loadings between 0.50 and 0.90; reliabilities between 0.80 and 0.94). However, goodness of fit statistics were not reflective of model fit found in Grant et al. (2007) in the overall sample, as well as in alcohol-only and polysubstance-using samples. DiscussionResults suggest that the factor structure of the MDMQ-R did not replicate in the present sample. Potential explanations and future directions are discussed in light of the results, including generalizability and clinical utility.

HabitWorks: Development of a CBM-I Smartphone App to Augment and Extend Acute Treatment

The month following discharge from acute psychiatric care is associated with increased risk of relapse, rehospitalization, and suicide. Effective and accessible interventions tailored to this critical transition are urgently needed. Cognitive bias modification for interpretation (CBM-I) is a low-intensity intervention that targets interpretation bias, a transdiagnostic process implicated in the development and maintenance of emotional disorders. We describe the development of a CBM-I smartphone app called HabitWorks as an augmentation to acute care that extends through the high-risk month postdischarge. We first obtained input from various stakeholders, including adults who had completed partial hospital treatment (patient advisory board), providers, CBM experts, and clinic program directors. We then iteratively tested versions of the app, incorporating feedback over three waves of users. Participants were recruited from a partial hospital program and completed CBM-I sessions via the HabitWorks app while attending the hospital program and during the month postdischarge. In this Stage 1A treatment development work, we obtained preliminary data regarding feasibility and acceptability, adherence during acute care, and target engagement. Pilot data met our a priori benchmarks. While adherence during acute treatment was good, it decreased during the postacute period. Qualitative feedback was generally positive and revealed themes of usability and helpfulness of app features. Participants varied in their perception of skill generalization to real-life situations. The feasibility and acceptability data suggest that a controlled trial of HabitWorks is warranted.

Practice and reflection on management of donated drugs during new crown pneumonia epidemic

Objective: This paper explores the management of donated drugs in public health emergencies, and establishes a set of operational management methods for donated drugs, so as to provide reference for the following similar events. Methods Review the relevant literature and management methods of donated drugs, summarize the management models and problems of donated drugs in other medical institutions, and formulate the selection list and management methods of donated medicines for New Crown Pneumonia to guide the donated medicines management work in our hospital by referring the new coronavirus pneumonia prevention and control program issued by the General Office of the National Health and Health Commission and our hospital's outpatient diagnosis and treatment program. Results A set of operational management measures for donated drugs was established, It includes the establishment and improvement of covid-19 donation drug management team, the development of donation drug selection catalog, donation drug receiving and qualification verification, the storage, distribution and use of donated drugs, donation drug accounting management and publicity, and the treatment of some remaining donated drugs. The total utilization rate of donated drugs was 86.64%. Conclusion In public health emergencies, Chinese pharmacists have accumulated a lot of experience in the management of donated drugs, and put forward some good management strategies. The development of guidelines for the selection and use of donated drugs and the informatization and systematization of the management of donated drugs need to be further strengthened and promoted.

Effects of Otago exercise combined with action observation training on balance and gait in the old people.

This study aimed to investigate the effects of Otago exercise combined with action observation (AO) training on the balance, and gait in the old people to prevent falls in the community. A total of 30 old women participated and randomly assigned into three groups: AO plus Otago (n=10), Otago (n=10), or control (n=10). The AO plus Otago and Otago groups performed 50 min of strength training and balance exercises from the Otago Exercise Program 3 times a week for 12 weeks. The AO plus Otago group received an additional 20 min of training 3 times a week. We used the electronic muscle dynamometer to changes in strength, Timed Up and Go (TUG) test to evaluate dynamic balance, and the short version of the Falls Efficacy Scale-International was used to evaluate the fear of falls, and GAITRite was used to evaluate changes in the spatiotemporal parameters of walking. The muscle strength significantly increased in the AO plus Otago and Otago groups compared to the strength before training. The TUG test showed a significant improvement in the dynamic balance in both intervention groups. A significant increase was observed in the walking speed, cadence, step length, and stride length in both intervention groups. We also noted a significant change in the efficacy measures for falls. It is expected that Otago exercise combined with AO training will be used as an intervention method in hospital treatment programs and the old people facilities for preventing falls in the old people.

P.857 A psychiatric day hospital treatment program and its impact on psychopharmacological treatment

P.857 A psychiatric day hospital treatment program and its impact on psychopharmacological treatment

Predictors of Partial Hospital Readmission for Young Children with Oppositional Defiant Disorder.

This study aimed to: (1) examine rates of readmission among young children with oppositional defiant disorder (ODD) following discharge from a psychiatric partial hospital treatment program, and (2) examine child factors (i.e., age, sex, co-occurring diagnoses, suicidality) and family factors (i.e., parental depression, stress) as prospective predictors of readmission. Participants were 261 children (ages 3-7years) who entered the study at the time of their initial program admission and who met DSM-IV criteria for ODD. Of these 261 children, 61 (23%) were subsequently readmitted, with most readmissions occurring within 1year. Cox regression survival analyses demonstrated that younger child age, child suicidal thoughts and behavior, and child PTSD diagnosis were associated with decreased time to readmission. Findings suggest that young children with ODD who present with co-occurring suicidality or PTSD are at risk for readmission following partial hospitalization, with implications for treatment and aftercare planning.

Inclusion of Alcoholic Associations Into a Public Treatment Programme for Alcoholism Improves Outcomes During the Treatment and Continuing Care Period: A 6-Year Experience.

To investigate whether inclusion of self-help groups into the hospital treatment programme improves the prognosis of alcohol dependence through the treatment period; and to examine therapeutic adherence and prognosis during continuing care. Patients attending the treatment programme at the 'Hospital 12 de Octubre' were randomized into two groups. In Group A (n = 123), patients received the usual treatment included in our programme, whereas in Group B (n = 126), patients also attended self-help groups. Patients were assessed with psychological scales at baseline, at the end of the treatment period and after completing the continuing care visits. Data were collected over a total of 6 years. During the treatment period, patients in Group B accumulated more months of abstinence and dropped out less. During continuing care, patients in Group B accumulated more months of abstinence and therapeutic adherence was higher. Variables that were associated with these results during the continuing care period were: visits to the GP, scores on anxiety, impulsivity and meaning of life scales, and belonging to the group that attended the alcoholic associations. Mutual help groups incorporated into a public treatment programme appear to improve outcomes during treatment and on into continuing care. This experience supports cooperation between public health centres and alcoholic associations in treating alcoholism. Including alcoholic associations into the public treatment programme for alcoholism of the 'Hospital 12 de Octubre' in Madrid was shown to be associated with better outcomes in terms of months of accumulated abstinence, dropout rates and therapeutic adherence, during the treatment and continuing care periods.

Bulimia nervosa in Singapore: Clinical profile, comorbidity and gender comparisons

IntroductionThough eating disorder cases have been on the rise in Asia, little is known about them. Bulimia nervosa (BN) has been associated with poor treatment outcome and high mortality risk, and is the second most commonly diagnosed eating disorders in Singapore, after anorexia nervosa (AN), yet no report thus far has explored this condition.ObjectivesThe current study seeks to describe the clinical population diagnosed with BN in our hospital treatment program, as well as to compare their clinical characteristics with a previously published local study on patients with AN.MethodRetrospective medical records review was carried out for patients diagnosed with BN in our hospital's eating disorders treatment program. Patient records from 2003 to 2013 were retrieved and analyzed. We also further compared presenting characteristics across genders and with AN patients.ResultsBetween 2003 and 2013, 348 patients were diagnosed with BN by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). BN patients presented with high rate of self-harm behaviors (37.1%), previous suicide attempts (19.0%) and psychiatric comorbidities (67.5%), many of which require inpatient treatment. Significant differences were found between genders and in comparison with the AN patients.ConclusionOur results suggest that many patients with BN present with severe psychiatric comorbidities, in some aspects more severe than the AN population. The current study appeals for the development of more effective detection and treatment of vulnerable populations in Singapore. We further discuss about the potential roles of mental health literacy and stigmatization in influencing treatment-seeking behaviors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Impulsivity‐related traits distinguish women with co‐occurring bulimia nervosa in a psychiatric sample

This study investigated impulsivity-related personality traits using the Revised NEO Personality Inventory (NEO PI-R) in women diagnosed with co-occurring bulmia nervosa and borderline personality disorder (BN-BPD), borderline personality disorder (BPD no-BN), or major depressive disorder (MDD-only). The sample included 672 adult female admissions to a psychiatric day hospital treatment program. The NEO PI-R facets of impulsiveness (N5), excitement-seeking (E5), self-discipline (C5), and deliberation (C6) provided a proxy assessment of impulsivity-related traits tapping negative urgency, sensation-seeking, lack of perseverance, and lack of premeditation/planning. After adjusting for age, BN-BPD displayed significantly higher levels of negative urgency and lack of premeditation than BPD without co-occurring BN. Women with BN-BPD also had significantly higher levels of impulsivity traits than MDD across domains, except for lack of perseverance. Impulsivity-related traits of negative urgency and lack of premeditation significantly differentiated women with versus without co-occurring BN among women with borderline personality disorder. Lower levels of impulsivity-related traits in women with MDD indicated that effects were not simply attributable to any form of psychopathology. Of the impulsivity traits, negative urgency demonstrated the strongest effect, providing further evidence of the important relationship between negative urgency and the expression of bulimic symptomology. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1093-1096).

Evaluation of an Ecologically Valid Group Intervention to Address Sleep Health in Families of Children With Allergic Diseases.

Sleep issues in children with allergic diseases may be a result of illness related factors (e.g., itching, wheezing) and/or poor sleep habits due to disrupted routines and parental permissiveness. However, the ability of parents to attend a multi-session sleep intervention may be limited. Thus we examined the validity of a one-time sleep health group intervention for parents of children with allergic diseases. Ninety-three parents of children who were admitted to a two-week intensive day hospital treatment program completed measures of child sleep habits (Children's Report of Sleep Patterns), parent sleep habits (Sleep Hygiene Inventory), parent sleep quality (Pittsburgh Sleep Quality Index), and parental insomnia symptoms (Insomnia Severity Index) before the group intervention and one-month after program discharge; 54 parents attended the sleep health group. Sleep habits and sleep quality improved for both parents and children at the one-month follow-up. However, improvements were seen regardless of group attendance. Potential reasons for the lack of difference between those who did and did not participate in group are presented, and implications of this study for pediatric psychologist in practice are discussed.