Inpatient Psychiatric Hospital Research Articles

E-Mental-Health aftercare for children and adolescents after partial or full inpatient psychiatric hospitalization: study protocol of the randomized controlled DigiPuR trial

BackgroundDuring reintegration to daily school life following psychiatric hospitalization, children and adolescents are confronted with various challenges and are at risk for rehospitalization. Tailored post-discharge services could support a successful readjustment and accompany the high-risk transition period after discharge. The study DigiPuR (“Digital gestützte Psychotherapie und Reintegration,” digitally supported psychotherapy and reintegration) aims to establish and to evaluate an innovative digital aftercare program to alleviate challenges during reintegration and improve cross-sectoral care.MethodsDigiPuR is a randomized controlled trial comparing a digital aftercare service with regular aftercare (TAU) (planned N = 150, 25 children/adolescents, 25 parents, and 25 teachers in each group). In the intervention group, direct communication via secure and regular video calls until 8 weeks after discharge and a secure messenger system between the hospital, family, and school, as well as, if needed, external support systems, are established. A longitudinal pre-post-follow-up assessment at admission, discharge, and 8, 24, and 36 weeks after discharge takes place supplemented by a daily smartphone-based ambulatory assessment from a triadic perspective of patients, parents, and teachers. Primary outcomes include whether participants in the intervention group have fewer readmissions and higher treatment satisfaction and health-related quality of life as well as lower symptom severity than participants in the control group.DiscussionThe present study is essential to address the cross-sectoral challenges associated with reintegration into daily (school) life following child and adolescent psychiatric hospitalization and to determine possible needed adaptations in partial or full inpatient settings. If applicability and efficacy of the aftercare service can be demonstrated, integration into regular care will be sought.Trial registrationClinicalTrials.govNCT04986228. Registered on August 2, 2021

Characterizing differences in psychiatric profiles between male and female veterans with epilepsy and psychogenic non-epileptic seizures

ObjectiveWhile previous studies have described psychiatric profiles in patients with psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES), a well-matched comparison between males and females has been lacking. To address this shortcoming, the present study sought to explore sex differences between male and female Veterans with ES and PNES in terms of psychiatric diagnoses, trauma histories, and psychiatric treatment. MethodsA male Veteran sample (PNES n = 87, ES n = 28) was identified matching age and seizure diagnosis with our previously-gathered female Veteran sample (PNES n = 90, ES n = 28). Retrospective chart review was used to obtain demographic, psychiatric, and seizure-related variables. Group differences between PNES and ES were first assessed among males followed by differences between males and females. ResultsMales with PNES were more likely to receive psychiatric treatment (82.6 % vs. 60.7 %, p = 0.017), be prescribed more psychotropics (1.6 vs. 0.9, p = 0.003), and more likely to have childhood physical abuse (27.9 % vs. 3.6 %, p = 0.007) than those with ES. Compared to PNES, males with ES presented to the epilepsy monitoring unit (EMU) significantly later (12.8 years vs. 6.1 years, p = 0.009), and were prescribed more anti-seizure medications (ASMs) previously (2.1 vs. 0.8, p = 0.009) and currently (1.6 vs. 1.0, p = 0.001). Between males and females with PNES, females evidenced more depression (76.7 % vs. 26.3 %, p < 0.001), borderline personality disorder (18.9 % vs. 4.7 %, p = 0.004), suicidality (65.6 % vs. 33.7 %, p < 0.001), and childhood sexual abuse (37.8 % vs. 11.6 %, p < 0.001), while males had higher rates of substance use disorders (37.2 % vs. 8.9 %, p < 0.001). SignificanceA greater psychiatric burden is seen among females compared to males with PNES, especially diagnoses of borderline personality disorder and depression. Higher rates of suicidality and inpatient psychiatric hospitalization may warrant particular consideration in screening and intervention efforts among female Veterans with PNES.

Veteran community engagement and social connection needs following inpatient psychiatric hospitalization.

To understand barriers and facilitators to engaging in community activities for increasing social connectedness among recently psychiatrically hospitalized veterans, a population at elevated risk for suicide. We completed 30 semistructured qualitative interviews with veterans within 1 week of discharge from inpatient psychiatric hospitalization. Our interviews focused on understanding past and current barriers, facilitators, and needs for engaging in community activities after psychiatric hospitalization. Data were analyzed using a modified grounded theory approach. Veterans shared feeling a lack of belonging and discussed several barriers to community engagement including lack of self-confidence, limited knowledge of opportunities, and negative expectations. Veterans identified several ways to facilitate engagement in community activities such as centralizing information on community activities and providing active support posthospitalization. Veterans by and large valued community and the role of community activities for increasing social connectedness. However, more active intervention for supporting engagement in community activities appears necessary to facilitate connection posthospitalization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Understanding suicide: Development and pilot evaluation of a single-session inpatient psychoeducation group.

Suicide is a considerable public health concern, particularly among U.S. veterans. Despite inpatient psychiatric hospitalization being a primary recommended treatment for acute suicidality, available inpatient group treatments remain limited. The current quality improvement project (QIP) aimed to examine the feasibility and acceptability of a newly developed single-session suicide-focused psychoeducation for veterans during psychiatric hospitalization. This project was conducted in two phases among veterans hospitalized for suicidal thoughts or behaviors. The first phase (n = 56) aimed to refine the group content and explore feasibility and tolerability of the group. Following content revisions suggested by Phase 1 findings, Phase 2 (n = 78; Mage = 48.11; 87% male) aimed to replicate and extend tolerability findings, as well as assess the acceptability of the group on an inpatient unit and the alignment of group content with the primary group objectives. Veteran acceptability of the group was high, and content was reported to be new and useful by veterans. Minimal changes in distress from before to after the group were identified. Further, after group participation, veterans reported being more hopeful and motivated to learn skills to cope with their suicidal thoughts and behaviors (STB). Results support the acceptability and feasibility of the newly developed suicide psychoeducation group among veterans on a psychiatric inpatient unit, highlighting the need for future systematic investigations to determine whether the results extend to other settings and populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Rapture

Rapture

Increased symptom severity in adults and adolescents admitting to an inpatient psychiatric hospital during the COVID-19 pandemic

While the negative effects of Coronavirus Disease-2019 (COVID-19) on general mental health are well-established, less is known about the impact on those with severe mental illness. Thus, this study examined symptom severity among psychiatric inpatients admitted prior to versus during the COVID pandemic. Self-reported anxiety (GAD-7), depression (PHQ-9), emotional dysregulation (DERS-SF), sleep quality (PSQI), nightmares (DDNSI), and suicidal ideation (SBQ-R) were examined in 470 adults (n = 235 admitted pre-pandemic) and 142 children and adolescents (n = 65 admitted pre-pandemic) at admission. Adults also completed measures of disability (WHODAS) and substance use (WHOASSIST). Adults admitted during the COVID pandemic reported significantly higher levels of anxiety [p < .001, partial η2=0.18], depression [p < .001, partial η2=0.06], emotion dysregulation [p < .001, partial η2=0.05], nightmares [p = .013, partial η2=0.01], and disability [p < .001, partial η2=0.04] compared to adults admitted pre-COVID. Levels of anxiety [p = .005, partial η2=0.05], depression [p = .005, partial η2=0.06], and sleep quality [p = .011, partial η2=0.05] were significantly higher among adolescents admitted during COVID compared to pre-COVID. The findings help identify areas of prioritization for future mental health prevention/intervention efforts for future disease outbreaks.

Family Caregivers Identify Their Needs from the Inpatient Team during a Loved One’s Inpatient Psychiatric Hospitalization

Introduction: According to existing literature, family-caregiver needs during a loved one’s inpatient psychiatric hospitalization are not fully understood or addressed in practice. We aimed to identify specific, practical family caregiver needs from the inpatient team during a loved one’s psychiatric hospitalization. Methods: Semi-structured interviews were designed and tested through a phenomenological analytical approach. Interviews were conducted with family caregivers (n = 16, one caregiver per loved one) who participated in caring for a loved one (age 18-30 years) during an inpatient psychiatric hospitalization. Results: Four main themes arose: the need to be listened to and collaborated with regarding treatment planning, the need for education and guidance about mental illness, the need for emotional support and validation by the inpatient team, and that family caregivers associate their experience with their perception of their loved one’s experience. Discussion: Interactions with the inpatient team are meaningful to family caregivers, who have needs that are or are not met. Study participants indicated that they feel better supported when they are fully included in their loved one’s care, it matters how information and education are delivered and by whom, and they appreciate dedicated support for themselves. Furthermore, their feelings are influenced by their understanding of their loved one’s experience. Conclusions: Understanding what family caregivers value in their interactions with the inpatient team illuminates areas to design support for family caregivers with a loved one in a psychiatric hospital. Families want support from the whole team for different needs at different times throughout hospitalization and after discharge.

Use of Prazosin for Post-traumatic Stress Disorder in Adolescents is Associated with Longer Inpatient Psychiatric Hospitalization

Objectives: Prazosin has been shown to be effective in reducing PTSD-related nightmares in adolescents in outpatient studies with modest sample sizes. There are no data on the effects of prazosin on length of inpatient psychiatric hospitalization. Given prazosin’s adverse effects, we hypothesize that prazosin initiation during inpatient psychiatric hospitalization is associated with prolonged length of stay.&#x0D; Patients and Methods: Retrospective chart review identified 255 psychiatric admissions of adolescents with PTSD from 2012-2017 at an academic medical center. The treatment group comprised 101 admissions during which prazosin was initiated. Given a lack of rating scales, number of concurrent diagnoses and discharge medications were used to approximate overall illness severity.&#x0D; Results: There were no statistical differences between the treatment and non-treatment (control) groups with respect to age, gender, number of diagnoses or discharge medications. The mean dose of prazosin was 1.5±0.7 mg nightly with mean duration of 7.6±6.1 days. Length of hospital stay was significantly longer for the prazosin group compared with controls (11.1±6.6 vs 9.5±5.8 days, p=0.04). There was no difference in rates of orthostatic hypotension between groups. Adverse reactions were observed in 41% of individuals taking prazosin with a discontinuation rate of 14% due to intolerable side effects, lack of efficacy or request to reduce polypharmacy.&#x0D; Conclusions: Treatment with prazosin during inpatient psychiatric hospitalization may be associated with increased length of stay for adolescents with PTSD. Further studies are needed to validate these results.

Natural Language Processing of Electronic Patient Records to Predict Psychiatric Inpatients at Risk of Early Readmission to Hospital Using Predictive Models Derived Through Machine Learning

AimsPsychiatric readmissions cause a burden on the healthcare system, incur a monetary cost and cause additional distress to acutely unwell patients. This project explores the use of the free-text of electronic patient records to predict inpatients in psychiatric hospitals at risk of readmission using predictive models generated by machine learning.MethodsFree-text was extracted from the electronic patient records of patients admitted to hospitals in Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) during the five years 2015–2019 inclusive. The anonymised records were obtained via the CRIS (Clinical Record Interactive Search) database. A total of 17208 records were extracted.The free-text entered by clinicians during an admission was extracted and processed using techniques of natural language processing to generate input vectors suitable to be used with machine learning algorithms. tf-idf (term frequency-inverse document frequency) vectors were used.A selection of algorithms were used to train predictive models. Two-thirds of the records were used as training data with the remainder as test data. Baseline model performance was assessed and then best-performing candidates underwent hyperparameter optimisation using five-fold cross-validation to improve performance. Bayesian optimisation was used to automate hyperparameter tuning during cross-validation. Hyperparameters were optimised on the log loss function. As the dataset was imbalanced with negative instances outnumbering positive instances to a significant degree, various techniques such as random undersampling of negative instances in the training data were used to deal with class imbalance throughout this process. Following cross-validation, the best-performing models underwent performance analysis.Models were used to make predictions on the test data. Performance was assessed using F1-measures, precision-recall curves and the average precision metric (equivalent to area under the precision-recall curve). These metrics were chosen due to their suitability in assessing models trained on imbalanced datasets.ResultsThe best F1 score obtained was 0.233 using a Random Forest model trained using unigram tf-idf vectors of 500 token dimension.The best average precision obtained was 0.157 using a Support Vector Machine trained using unigram tf-idf vectors of 2000 token dimension.Both the above results required the use of random oversampling of positive instances to improve performance on the imbalanced dataset.ConclusionThe performance indicates that the models generated are unlikely to have significant practical utility. Nevertheless, this exploratory project has produced a processed dataset with knowledge about its characteristics. This could be used for the further development of models using more complex techniques such as language modelling using neural networks.

Sedentary Behaviour in the Secure Forensic Hospital Setting: A Study from Dundrum Hospital Ireland

Introduction Secure forensic mental health services offer care and treatment to mentally disordered offenders, with high rates of schizophrenia and major mental illness in these groups. Much of the excess morbidity and mortality seen among patients with schizophrenia is due to cardiovascular disease and obesity. Sedentary behaviour is associated with negative symptoms of schizophrenia and obesity.ObjectivesThe aim of this study was to ascertain the level of sedentary behaviour among inpatients in a secure forensic psychiatric hospital, Dundrum, Ireland, using a structured self-report measure of sedentary behaviours, the SIT-Q tool.MethodsA cross sectional study of self-reported sedentary behaviour was completed amongst the secure forensic inpatient population of Dundrum Hospital (N=94). Demographic details, details pertaining to diagnoses, ward level of dependency and length of stay were collated.ResultsThe majority of patients in the sample were male (89%) and the most common diagnosis was schizophrenia (71.7%). Mean age was 44.7 years (SD 11.42). 58.2% met criteria for obesity. We found high rates of self-reported sedentary behaviour across all wards of the service, with significantly high rates of sedentary behaviour being associated with screen time use in the hospital, including both personal screen time and therapeutic sessions based on screen time.Conclusions Sedentary behaviour among in-patients in secure forensic hospitals is a significant issue. Measuring sedentary behaviour in a systematic manner is possible and identifies a potentially modifiable target to reduce co-morbidity and pre-mature mortality independent of other risk factors in this vulnerable patient group.DisclosureNo significant relationships.

Investigating causes of increased morbidity and mortality within psychiatric patients - Somatic comorbidities of inpatients in a german psychiatric community hospital

IntroductionThe co-occurrence of mental illness and somatic comorbidities is a major cause of increased morbidity and mortality within psychiatric patients, compared to the general population. This may be caused by an unhealthy lifestyle, side effects of psychotropic drugs and systematic barriers in healthcare provision. The underlying mechanisms remain under-investigated.ObjectivesWe systematically investigated relevant barriers and risk factors to the utilization of primary care among severe mentally ill outpatients.MethodsIn a cross-sectional analysis, the psychiatric as well as somatic diagnoses of inpatients of a German psychiatric community hospital were identified. Furthermore, somatic and psychiatric medication, blood values (HBA1C) and sociodemographic data of the patients were analyzed. The frequencies of the somatic diagnoses were presented according to psychiatric diagnoses. By a Chi-Square goodness-of-Fit Test the distribution of somatic diagnoses and drug classes were verified according to the total cohort as well as for each psychiatric diagnosis and in respect to sex.ResultsOur results provide an overview of common comorbidities with regard to the psychiatric diagnosis. The medication, in relation to the recorded somatic comorbidities, as well as the blood values, allow a conclusion to be drawn about the extent and success of the treatment.ConclusionsFor the first time, real-life data on the somatic diagnoses and treatment of patients with a severe mental illness in a German hospital is presented. Our results will be used to create low-threshold interventions for the most relevant somatic comorbidities and to improve primary care of psychiatric patients through linking the care systems.DisclosureNo significant relationships.

Clinical and Legal Considerations Regarding Breastfeeding on Psychiatric Units.

Women in the postpartum period are at especially high risk of developing psychiatric disorders, and in severe cases, they may require inpatient psychiatric hospitalization. Because of the lack of specialized units for peripartum mothers in the United States, this treatment is usually relegated to general inpatient psychiatric units. Despite the clear benefit of breastfeeding for both mother and child, lactation can be a barrier to placement on a general inpatient psychiatric unit and often is not supported during the hospital stay. Limiting access to inpatient psychiatric care for postpartum mothers with mental illness could be considered sex discrimination under the Affordable Care Act (ACA) because of failure to accommodate lactation. With improvements in education and accommodations around breastfeeding, general inpatient psychiatric units could provide appropriate care for this population.

Utilization of Psychiatric Team Driven Ketamine Infusions

IntroductionIn 2018 Missouri University Psychiatric Center, an inpatient psychiatric hospital established a ketamine infusion team to treat severely depressed and acutely suicidal clients. Over 80 infusions were delivered over three years, with positive outcomes and minimal side effects.ObjectivesTo evaluate outcomes of an inpatient psychiatric intravenous ketamine team to deliver treatment without anesthisia colloabration, which could open the horizon for future intravenous medications in a psychiatric inpatient setting.MethodsA team consisting of a psychiatrist supported by a psychiatric PA, psychiatric pharmacist, and a mental health nurse devloped a protocol including physical and mental health screening, inclusion/exclusion criteria, dosing, and client monitoring. For data collection, the team monitored vital signs and mental status changes for tolerability and depression screening tools for efficacy.ResultsTable 1:Ketamine Infusion DataTotal Clients32Male15Female17Dosing0.5mg/kg adjusted bodyweight infused over 40 minutesAverage Baseline Depression Screening (PHQ or QIDS)*20.8Average Baseline Follow up Screening (PHQ or QIDS)*7.5Average Change in Screening Score (PHQ or QIDS)*-14.1% Change From Baseline in Screening Score (PHQ or QIDS)*65.5%Adverse Events DocumentedDissociation 5 (15.6%); Nausea/Vomiting 3 (.09%), Extreme Euphoria 2 (.06%); sedation 1 (.03%); BP Increase 1 (.03%)ConclusionsOverall, ketamine infusions were tolerated well with limited adverse drugs reactions reported or observed and were easily addressed by the team without any serious adverse events. Given the rapid improvement of symptoms and overall tolerability, intravenous ketamine infusions conducted solely by a psychiatric-based team advances our field for further treament modalities.DisclosureNo significant relationships.

An Audit of the DNACPR Policy at Malta's Mount Carmel Hospital

AimsA consideration for patient dignity in end-of-life care dictates that good clinical judgment should be exercised in advance resuscitation decisions. The COVID-19 pandemic, and its inherent risks to caregivers, only adds to this importance. Our aim was to audit the standards for the DNACPR policy at Mount Carmel Hospital (MCH), which is Malta's major inpatient psychiatric hospital, against those at Saint Vincent De Paule Residence (SVPR), which is a long-term care facility where DNACPR decisions are taken by geriatricians as opposed to psychiatrists.MethodsResuscitation status designation and rates of form completion were measured in the five chronic psychiatric inpatient wards at MCH. This 98-patient population was compared against an age-matched cohort from SVPR to evaluate differences in decision-making.Medical comorbidities and frailty scores (measured using the Clinical Frailty Scale) were compared between the two groups. As far as age-groups would allow, as many patients with a psychiatric comorbidity as possible were included from SVPR (36).Z-score testing for two population proportions was used to evaluate the differences in resuscitation status designation. The Independent Sample T-Test was used to compare means in medical comorbidity and frailty. A p-value of &lt;0.05 was used to assume statistical significance.ResultsRates of resuscitation form completion were 73.47% and 94.90% in MCH and SVPR, respectively. In those patients with completed documentation, 9.72% of patients were designated as “Not for CPR” in MCH, compared to 61.29% in SVPR.Between these two age-matched cohorts, the mean frailty score was slightly greater in SVPR, which was not statistically significant (5.83 vs 5.48, p = 0.1456). The mean number of medical comorbidities was significantly greater in the SVPR cohort (3.50 vs 2.47, p = 0.0002).ConclusionThis striking difference in DNACPR designation suggests that geriatricians have a higher threshold for determining whether a patient would benefit from CPR compared to psychiatrists. Furthermore, rates of resuscitation form completion at MCH were disappointing. The greater likelihood for chronic psychiatric inpatients to be designated “For CPR” may be due to the perception that this entails a higher level care. In reality, in older, frailer patients, CPR may only prolong suffering, while a “Not for CPR” decision does not necessarily imply an omission of care.In Malta, we've tailored resuscitation training to the inpatient psychiatry setting, which includes stations on decision-making and COVID-19.

The Association Between Sleep Disturbance and Suicidality in Psychiatric Inpatients Transitioning to the Community: Protocol for an Ecological Momentary Assessment Study.

BackgroundPatients are at high risk of suicidal behavior and death by suicide immediately following discharge from inpatient psychiatric hospitals. Furthermore, there is a high prevalence of sleep problems in inpatient settings, which is associated with worse outcomes following hospitalization. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge.ObjectiveOur study objective is to describe a protocol for an ecological momentary assessment (EMA) study that aims to examine the relationship between sleep and suicidality in discharged patients.MethodsOur study will use an EMA design based on a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients 18 to 35 years old with mental disorders (N=50) will be assessed for eligibility and recruited across 2 sites. Data on suicidal ideation, behavior, and imagery; nonsuicidal self-harm and imagery; defeat, entrapment, and hopelessness; affect; and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow up, and data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality.ResultsSouth Birmingham Research Ethics Committee (21/WM/0128) approved the study on June 28, 2021. We expect to see a relationship between poor sleep and postdischarge suicidality. Results will be available in 2022.ConclusionsThis protocol describes the first coproduced EMA study to examine the relationship between sleep and suicidality and to apply the integrated motivational volitional model in young patients transitioning from a psychiatric hospital to the community. We expect our findings will inform coproduction in suicidology research and clarify the role of digital monitoring of suicidality and sleep before and after initial hospital discharge.International Registered Report Identifier (IRRID)PRR1-10.2196/33817

A false sense of security: Rapid improvement as a red flag for death by suicide.

Postdischarge from inpatient psychiatry is the highest risk period for suicide, thus better understanding the predictors of death by suicide during this time is critical for improving mortality rates after inpatient psychiatric treatment. As such, we sought to determine whether there were predictable patterns in suicide ideation in hospitalized psychiatric patients. We examined a sample of 2,970 adult's ages 18-87 admitted to an extended length of stay (LOS) inpatient psychiatric hospital. We used group-based trajectory modeling via the SAS macro PROC TRAJ to quantitatively determine four suicide ideation groups: nonresponders (i.e., high suicide ideation throughout treatment), responders (i.e., steady improvement in suicide ideation across treatment), resolvers (i.e., rapid improvement in suicide ideation across treatment), and no-suicide ideation (i.e., never significant suicide ideation in treatment). Next, we compared groups to clinical and suicide-specific outcomes, including death by suicide. Resolvers were the most likely to die by suicide postdischarge relative to all other suicide ideation groups. Resolvers also demonstrated significant improvement in all clinical outcomes from admission to discharge. There are essential inpatient psychiatry clinical implications from this work, including that clinical providers should not be lulled into a false sense of security when hospitalized adults rapidly improve in terms of suicide ideation. Instead, inpatient psychiatric treatment teams should increase caution regarding the patient's risk level and postdischarge treatment planning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Meaning in Life Moderates Relations between Personality and Temperament and Nonsuicidal Self-Injury in Hospitalized Adolescents.

Previous research indicates that sensation seeking, emotion dysregulation, and impulsivity are predictive of non-suicidal self-injury (NSSI). A body of research supports that meaning in life predicts improved mental health and well-being, including fewer suicidal thoughts and attempts, yet no research has examined the moderating effects of meaning in life on the relations between personality and temperament and NSSI. Given the growing incidence rates of NSSI among adolescents and the potential lifelong consequences of NSSI, it is imperative to better understand the factors that reduce the rates at which adolescents in a clinical sample engage in NSSI. The present study investigates if the protective factors of meaning in life moderate the relation between personality and temperament variables and NSSI among 126 adolescents (71% female, Mage = 16.1, SD = 1.1, range 13-18, 80% White) residing in an inpatient psychiatric hospital who endorsed NSSI in the last 12 months. Results from hurdle modeling indicate that two subtypes of meaning in life, presence of meaning in life and search for meaning of life, may serve as robust protective factors against engagement in NSSI among a clinical sample of adolescents. Additionally, results suggest that search for meaning, but not presence of meaning in life, variables moderate the relations between personality and temperament and NSSI. Results provide evidence that meaning in life is an understudied variable of importance in understanding how to prevent or treat NSSI. It also underscores the need to develop, refine, and test meaning-making interventions.

Assessing the clinical utility of MMPI-2-RF interpersonal theory of suicide proxy indices in psychiatric hospitalization setting.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF Ben-Porath & Tellegen, 2008/2011) has been applied to suicide risk assessment through derived proxy indices of perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide (Anestis et al., 2018, Joiner, 2005). However, limited research has examined the clinical utility of these proxy indices outside the outpatient setting.This study examined the performance of these proxy indices in identifying past-month suicide ideation intensity and attempts upon admission to a psychiatric inpatient program and changes in suicidal ideation intensity at discharge. We expected these indices and their interaction would be associated with suicide ideation intensity and attempts at baseline and with a lack of significant improvement in suicide ideation intensity at discharge, including when controlling for MMPI-2-RF Suicide/Death Ideation (SUI) scale scores. Participants were 1007 patients in a private inpatient psychiatric hospital in the southwestern United States, 968 of whom completed study measures at admission and discharge. Participants were administered the C-SSRS and MMPI-2-RF upon admission, while the C-SSRS was administered again prior to discharge. A series of moderation analyses were conducted to examine the main and interaction effects of the MMPI-2-RF derived proxy indices on suicidal ideation intensity and suicide attempts at admission. Logistic regression analyses were conducted to examine whether MMPI-2-RF proxy index scores at admission were associated with changes in suicidal ideation intensity at discharge. Neither the proxy indices nor their interaction was associated with all study outcomes. The acquired capability for suicide proxy index and its interaction with other indices were not associated with suicide attempt status at admission. However, high thwarted belongingness proxy index scores were associated with greater suicidal ideation intensity at admission; high perceived burdensomeness proxy index scores were indicative of a lack of significant change in suicide ideation intensity at discharge. These results indicate a need to further examine these proxy indices in high acuity samples.

Phase 3b Multicenter, Prospective, Open-label Trial to Evaluate the Effects of a Digital Medicine System on Inpatient Psychiatric Hospitalization Rates for Adults With Schizophrenia

Objective: Inpatient psychiatric admissions drive the financial burden of schizophrenia, and medication adherence remains challenging. We assessed whether aripiprazole tablets with sensor (AS; system includes ingestible event-marker sensor, wearable sensor patches, and smartphone application) could reduce psychiatric hospitalizations compared with oral standard-of-care (SOC) antipsychotics.Methods: This phase 3b, mirror-image clinical trial was conducted from April 29, 2019-August 11, 2020, in adults with schizophrenia with ≥ 1 hospitalization in the previous 48 months who had been prescribed oral SOC for the preceding 6 months (retrospective phase). All participants used AS for at least 3 months and up to 6 months. Primary endpoint was the inpatient psychiatric hospitalization rate in the modified intent-to-treat (mITT; n = 113) population during prospective months 1-3 versus retrospective phase. Proportion of days covered by medication was the secondary endpoint. Safety endpoints included adverse events related to the medication or patch and suicidality.Results: AS significantly reduced hospitalizations during prospective months 1-3 (-9.7%) and months 1-6 (-21.3% [P ≤ .001 for all comparisons]) in the mITT population versus the corresponding retrospective phase. AS use improved confirmed medication ingestion by 26.5 percentage points in prospective months 1-3 (P ≤ .001) and reduced PANSS scores. Patches were well-tolerated, and no participant reported changes in suicide risk.Conclusions: Compared with oral SOC, AS reduced inpatient psychiatric hospitalization rates for adults with mild-to-moderate schizophrenia. The AS system may aid medication ingestion and is associated with improvements in symptoms, potentially reducing acute-care needs among patients with schizophrenia.Trial Registration: ClinicalTrials.gov identifier: NCT03892889.

Pediatric suicide by violent means: a cry for help and a call for action

BackgroundSuicide is the second most common cause of death among adolescents and young adults. In the pediatric population, gunshot wounds (GSWs) and hangings are common mechanisms of pediatric suicide. Comorbid psychiatric illness is prevalent in this population, but psychiatric resource utilization after self-inflicted traumatic injury is not well characterized.MethodsWe analyzed patients < 18 years old presenting to a level 1 pediatric trauma center after suicide attempt by GSW, hanging, or jumping from a height from 2009 to 2019. The primary outcome was psychiatric resource utilization. Secondary outcomes included prior emergency department (ED) visits to identify prior opportunities for intervention.ResultsOf 6538 pediatric trauma patients, there were 219 GSWs, 7 hangings, and 7 jumps from height, for a total of 233 patients. Of these, 14 presented following a suicide attempt (four GSWs, six hangings, and four jumps, total 6.0%). Half of these patients died due to their injuries. Self-inflicted GSWs had the highest mortality (75%). Most surviving patients were placed on involuntary psychiatric holds (n = 5/7, 71.4%), and three patients were discharged to an inpatient psychiatric hospital (n = 3/7, 42.9%). Five of the 14 patients had prior ED visits (35.7%), and of these, 60% were for suicidal ideation or suicide attempts.ConclusionsAmong pediatric trauma patients, suicide attempts are rare, but are highly lethal, with the highest mortality rate seen in self-inflicted GSWs. Psychiatric resource utilization is high both during and after the hospitalization. Prior ED visits may represent opportunities for depression and suicidality screening in this at-risk population.