Psychiatric Inpatient Population Research Articles

The effectiveness of the Addressing Substance Related Offending-Secure (ASRO-S) treatment programme in a secure forensic hospital setting: A service evaluation

The Addressing Substance Related Offending-Secure (ASRO-S) programme is a 20-session, cognitive-behavioural group treatment that aims to reduce offending behaviour by targeting the important factor of problematic substance misuse, adapted for the use in secure hospitals. The aim of the current study was to evaluate the effectiveness of a ASRO-S programme with 10 male participants, aged 25 to 49, within a secure forensic hospital. A review of the literature suggests this is the first service evaluation of the ASRO-S. Following the examination of Q-Q Plots, homogeneity of variance was assumed and a paired sample t-test was used to compare pre- and post-treatment scores on the four psychometric scales. The evaluation found only one significant difference showing an increase in non-planning impulsivity (lack of concern for the future) for group members post-programme, however, this increase remained within the normal range for a psychiatric inpatient population. Future research should explore the use of different psychometrics measures when delivering a substance use treatment programme in secure hospitals as this will allow for a substantive evaluation of the effectiveness of these programmes. Additional to this, it should be investigated whether substance use or offence specific treatment programmes are more effective at reducing risk than mixed participant programmes.

Erratum to: Dose-Specific Adverse Drug Reaction Identification in Electronic Patient Records: Temporal Data Mining in an Inpatient Psychiatric Population

Erratum to: Dose-Specific Adverse Drug Reaction Identification in Electronic Patient Records: Temporal Data Mining in an Inpatient Psychiatric Population

Dose-Specific Adverse Drug Reaction Identification in Electronic Patient Records: Temporal Data Mining in an Inpatient Psychiatric Population

BackgroundData collected for medical, filing and administrative purposes in electronic patient records (EPRs) represent a rich source of individualised clinical data, which has great potential for improved detection of patients experiencing adverse drug reactions (ADRs), across all approved drugs and across all indication areas.ObjectivesThe aim of this study was to take advantage of techniques for temporal data mining of EPRs in order to detect ADRs in a patient- and dose-specific manner.MethodsWe used a psychiatric hospital’s EPR system to investigate undesired drug effects. Within one workflow the method identified patient-specific adverse events (AEs) and links these to specific drugs and dosages in a temporal manner, based on integration of text mining results and structured data. The structured data contained precise information on drug identity, dosage and strength.ResultsWhen applying the method to the 3,394 patients in the cohort, we identified AEs linked with a drug in 2,402 patients (70.8 %). Of the 43,528 patient-specific drug substances prescribed, 14,736 (33.9 %) were linked with AEs. From these links we identified multiple ADRs (p < 0.05) and found them to occur at similar frequencies, as stated by the manufacturer and in the literature. We showed that drugs displaying similar ADR profiles share targets, and we compared submitted spontaneous AE reports with our findings. For nine of the ten most prescribed antipsychotics in the patient population, larger doses were prescribed to sedated patients than non-sedated patients; five patients exhibited a significant difference (p < 0.05). Finally, we present two cases (p < 0.05) identified by the workflow. The method identified the potentially fatal AE QT prolongation caused by methadone, and a non-described likely ADR between levomepromazine and nightmares found among the hundreds of identified novel links between drugs and AEs (p < 0.05).ConclusionsThe developed method can be used to extract dose-dependent ADR information from already collected EPR data. Large-scale AE extraction from EPRs may complement or even replace current drug safety monitoring methods in the future, reducing or eliminating manual reporting and enabling much faster ADR detection.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-014-0145-z) contains supplementary material, which is available to authorised users.

Epidemiology, Symptoms, and Treatment Characteristics of Hyponatremic Psychiatric Inpatients

Hyponatremia is a common phenomenon in psychiatry occurring as an adverse effect to drugs or following polydipsia. We performed a retrospective in-depth analysis of hyponatremia cases in a large unselected population of psychiatric inpatients. During a 3-year period, all cases of hyponatremia were identified among patients admitted to a large psychiatric state and university hospital by the institution's electronic laboratory database. Demographic, treatment-related, and laboratory data were obtained by consecutive chart review, respectively. Hyponatremia occurred in 347 (4.9%) of 7113 cases, of which the majority (78%) displayed only a mild manifestation. Symptoms were recorded in 28.8% of cases, already occurred in mild forms, and comprised gait impairment (45%, including falls), confusion (30%), sedation (26%), and dyspepsia (41%). Age, female sex, nonpsychiatric drug polypharmacy-particularly with thiazides and/or angiotensin-converting enzyme inhibitors-and diagnosis of a mood disorder were associated with more severe hyponatremia, respectively. The proportion of hyponatremic patients treated with venlafaxine, trazodone, carbamazepine, oxcarbazepine, and first-generation antipsychotics, respectively, was significantly higher in the hyponatremia sample than in the normonatremic population. This was, surprisingly, not the case with selective serotonin reuptake inhibitors or any other antidepressant drug class. We found prescription with second-generation antipsychotics to be significantly associated with less severe hyponatremia.Hyponatremia may be mainly attributed to the syndrome of inappropriate antidiuretic hormone secretion, as indicated by decreased serum osmolarity in our sample. Besides old age and female sex, treatment with certain drugs-rather than whole drug classes-carries a substantially increased risk.

Can Personality Traits Predict the Future Development of Heart Disease in Hospitalized Psychiatric Veterans?

To examine which personality traits are associated with the new onset of chronic coronary heart disease (CHD) in psychiatric inpatients within 16 years after their initial evaluation. We theorized that personality measures of depression, anxiety, hostility, social isolation, and substance abuse would predict CHD development in psychiatric inpatients. We used a longitudinal database of psychological test data from 349 Veterans first admitted to a psychiatric unit between October 1, 1983, and September 30, 1987. Veterans Affairs and national databases were assessed to determine the development of new-onset chronic CHD over the intervening 16-year period. New-onset CHD developed in 154 of the 349 (44.1%) subjects. Thirty-one psychometric variables from five personality tests significantly predicted the development of CHD. We performed a factor analysis of these variables because they overlapped and four factors emerged, with positive adaptive functioning the only significant factor (OR=0.798, p=0.038). These results support previous research linking personality traits to the development of CHD, extending this association to a population of psychiatric inpatients. Compilation of these personality measures showed that 31 overlapping psychometric variables predicted those Veterans who developed a diagnosis of heart disease within 16 years after their initial psychiatric hospitalization. Our results suggest that personality variables measuring positive adaptive functioning are associated with a reduced risk of developing chronic CHD.

Use of narratives to assess language disorders in an inpatient pediatric psychiatric population

A large proportion of child psychiatry patients have undiagnosed language disorders. Adequately developed language is critical for psychotherapy and cognitive-behavioral therapies. This study investigated (1) whether assessment of oral narratives would identify language impairments in this population undetected by assessment of only core language abilities, and (2) the extent to which measures of cognition, working memory, emotional distress, and social function differentially predict core language and narrative development. Results showed that (1) more than twice as many children were identified with language impairment when both narrative and core language assessment were used, and (2) core language comprehension and complex verbal working memory were the strongest predictors of narrative production, while core language comprehension, a less complex working-memory task, and social skills best predicted narrative comprehension. Emotional distress did not predict either. The results emphasize the importance of evaluating child psychiatry patients' language, using both core language and narrative measures.

Comparative Performance of Two Drug Interaction Screening Programmes Analysing a Cross-Sectional Prescription Dataset of 84,625 Psychiatric Inpatients

Clinical decision support software (CDSS) solutions can automatically identify drug interactions and thereby aim to improve drug safety. However, data on the comparative performance of different CDSS to detect and appropriately classify interactions in real-life prescription datasets is limited. The aim of this study was to compare the results from two different CDSS analysing the pharmacotherapy of a large population of psychiatric inpatients for drug interactions. We performed mass analyses of cross-sectional patient-level prescriptions from 84,625 psychiatric inpatients using two CDSS - MediQ and ID PHARMA CHECK(®). Interactions with the highest risk ratings and the most frequent ratings were reclassified according to the Zurich Interaction System (ZHIAS), a multidimensional classification that incorporates the OpeRational ClassificAtion of Drug Interactions (ORCA) and served as a reference standard. MediQ reported 6,133 unique interacting combinations responsible for 270,617 alerts affecting 63,454 patients. ID PHARMA CHECK(®) issued 5,400 interactions and 157,489 alerts in 48,302 patients. Only 2,154 unique interactions were identified by both programmes, but overlap increased with higher risk rating. MediQ reported high-risk interactions in 2.5% of all patients, compared with 5% according to ID PHARMA CHECK(®). The positive predictive value for unique major alerts to be (provisionally) contraindicated according to ORCA was higher for MediQ (0.63) than for either of the two ID PHARMA CHECK(®) components (0.42 for hospINDEX and 0.30 for ID MACS). MediQ reported more interactions, and ID PHARMA CHECK(®) tended to classify interactions into a higher risk class, but overall both programmes identified a similar number of (provisionally) contraindicated interactions according to ORCA criteria. Both programmes identified arrhythmia as the most frequent specific risk associated with interactions in psychiatric patients. CDSS can be used for mass-analysis of prescription data and thereby support quality management. However, in clinical practice CDSS impose an overwhelming alert burden on the prescriber, and prediction of clinical relevance remains a major challenge. Only a small subset of yet to be determined alerts appears suitable for automated display in clinical routine.

718 – Characteristics of the inpatient population and care received at the bwaila district hospital psychiatric unit in lilongwe, malawi

Introduction Despite the high burden of mental illness worldwide, psychiatric studies in sub-Saharan Africa are sparse. Few have been conducted in Malawi and little information exists about inpatient psychiatric populations within the country. Objectives To describe the spectrum of psychiatric diagnoses and treatment courses of patients admitted to Bwaila Hospital (BH), the inpatient psychiatric unit for the central region of the country. Methods We reviewed medical records of all patients admitted to BH in 2011 and extracted information about demographics, diagnoses, treatments and outcomes. Results Inpatient care was provided to 457 patients. Patients had a mean age of 30 years and 298 (67%) were male. 258 (56%) had a known psychiatric diagnosis and 222 (49%) had been hospitalized for psychiatric care previously. The most common diagnoses were primary psychotic disorder (360), alcohol dependence (96) and mood disorder (37). The most common precipitating cause for admission was medication non-adherence (132), mostly in patients with psychotic disorders. The average length of presenting symptoms was 7 days, average length of stay was 21 days, and most commonly used treatments were chlorpromazine, diazepam, fluphenazine and carbamazepine. Outcomes included stabilization/release (308), transfer to another facility (75), removal by family against medical advice (40), abscondment (25) and death (7), which was mostly due to alcohol withdrawal. Conclusions Primary psychotic disorders and alcohol dependence are the most common reasons for inpatient psychiatric hospitalization at BH. Efforts to increase medication adherence in patients and emphasize the risks of alcohol consumption may lead to decreased psychiatric hospitalizations within Malawi.

Factors influencing weight gain in an Asian population of psychiatric inpatients: A retrospective study in Taiwan

The aim of this study was to investigate the factors associated with weight gain by psychiatric inpatients in short-term treatment. A total of 378 medical records were reviewed, and sociodemographic, clinical, and baseline biochemical data from 221 psychiatric inpatients were analyzed. Evaluation of baseline characteristics indicated that the following were significant predictors of weight gain: Axis I diagnosis, treatment with second-generation antipsychotics and mood stabilizers, length of stay, admission body weight, low-density lipoprotein value, triglyceride level, and triglyceride/high-density lipoprotein ratio. Multiple linear regression analysis showed that the independent predictors of weight gain were length of stay and taking both a second-generation antipsychotic and a mood stabilizer. The triglyceride/high-density lipoprotein ratio was an influencing factor inversely associated with weight gain (P = 0.063). Length of hospitalization and polypharmacy strongly predicted weight gain among psychiatric inpatients receiving short-term treatment.

Effects of polypharmacy on sleep in psychiatric inpatients

The relationship between psychotropic drugs and sleep remains poorly understood. In this study, we examined the relationship between the number (and dosage) of concurrently-taken antipsychotic medications and sleep in a psychiatric inpatient population. Eighty-three long-stay inpatients with severe mental disorders were administered the Pittsburgh Sleep Quality Index questionnaire (PSQI). Results showed that increasing antipsychotics dosages were linked to better sleep, although antipsychotic medications only accounted for a relatively small amount of the variance in sleep quality. The results also showed that, when taken in combination with several antipsychotics, SSRI/SNRI antidepressants failed to show the expected disruptive effects on sleep patterns and daytime functions. Altogether, sleep complaints remained pervasive in 70% of this medicated clinical sample. This suggests that the use of the sedative properties of antipsychotic medication has limited efficacy as a treatment option for sleep dysfunctions, and is not an appropriate substitute for other sleep interventions. Altogether, the results support the case for more systematic screening and interventions for sleep problems in patients with severe psychiatric illness.

P-622 - Socio-demographic and clinical differences according to gender in psychiatric inpatients

Previous epidemiological studies clearly demonstrated gender differences in the patterns of mental illness. As a matter of fact, female suffer more from depressive and anxiety disorders, while male suffer more from addictive behaviour and psychotic disorders. The present study was elaborated by the Psychiatric Department Quality Commission of the Coimbra University Hospital in order to identify gender differences in socio-demographic and clinical characteristics of patients that were hospitalized from January to June 2011. We analyzed 417 clinical files and gathered socio-demographic information (gender, age, marital status and job) and clinical information (diagnosis and hospitalization's length). Statistical analysis was performed with SPSS program, using the chi-square's and Mann-Whitney's tests. 53% of the inpatients were women. It was also observed that women were older (p = 0.021), more frequently married and widowed (p < 0.001), were less associated with compulsory admission (p < 0.001), had shorter hospitalizations (p = 0.024) and were more often diagnosed with adjustment reaction and bipolar disorder (p < 0.001), while men were younger (p < 0.001), more frequently single (p < 0.001), more frequently unemployed (p < 0.001), were more subject to compulsory admission (p < 0.001) and were more often diagnosed with addictive disorders and schizophrenia. These results are consistent with the existing literature and enable us to organize the services’conditions according to the needs of our psychiatric inpatient population.

P-891 - Dedicated in-patient team reduced psychiatric hospital in-patient population

Introduction The majority of Irish Mental Health services are delievered in a sectored model. Recently there has been some debate in the literature regarding the advantages and disadvantages of alternative models of service provision including dedicated in-patient teams. Due to a number of local and national factors a dedicated in-patient mental health team was developed in one of the two admission units in St. Ita's Hospital in north county Dublin. Objectives/aims To study the operation of a dedicated in-patient psychiatric team in a stand alone psychiatric hospital. Methodology We reviewed routinely collected service data between January 2009 and June 2010, including admission/discharge data, adverse incidents and mental health act data, to determine the effects of the dedicated in-patient team. Results The dedicated inpatient team resulted in a 22% reduction in the in-patient population compared to the same time period prior to introduction (p Conclusions Our study shows that a dedicated in-patient consultant lead teams can result in a significant reduction in hosptial admissions. Putative causative factors include greater availability of senior decision makers; improved responsiveness of medical staff due to lack of travel time between sites; a more consistent therapeutic environment due to reduced number of medical staff attending the unit.

Antidepressant Clinical Trials and Subject Recruitment: Just Who Are Symptomatic Volunteers?

Antidepressant Clinical Trials and Subject Recruitment: Just Who Are Symptomatic Volunteers?

Patient characteristics and behaviours associated with self‐harm and attempted suicide in acute psychiatric wards

The study examined events before and after incidents of self-harm and attempted suicide and the characteristics of patients who engage in these behaviours. Psychiatric inpatient populations have an elevated risk of self-harm and suicide, but relatively little is known about the circumstances of these events during an admission. Retrospective case note analysis. Data were collected on conflict (aggression, rule breaking, etc.) and containment (coerced medication, restraint, etc.) during the first two weeks of admission for a sample of 522 acute psychiatric inpatients. One in 10 patients self-harmed, and 4% attempted suicide. Aggression, attempting to leave the ward without permission and medication refusal were frequent precursors to incidents. Pro re nata medication and de-escalation were the most frequent interventions to follow an incident. Self-harm and attempted suicides during the current admission were significantly associated with younger age and a history of self-harm. A minority of the sample were involved in these behaviours, but incidents occurred soon after admission and sometimes repeatedly during the course of a day. Assessment of risk should be completed as early as possible. At-risk patients should be monitored for signs of withdrawal from ward activity, wanting to leave the ward without permission or non-compliance with medication to enable early intervention.

Medical Emergencies In Psychiatric Hospitals

Patients with co-existing medical and psychiatric diagnoses can be challenging to assess, evaluate, and treat. Medical emergencies among psychiatric patients may receive delayed medical responses or remain undetected if medical emergency training and response are not in place, leading to negative patient outcomes, including death. The role of the psychiatric nurse is pivotal in recognizing and responding to acute medical complications in the inpatient psychiatric population. However, little research exists concerning the educational needs of psychiatric nurses on medical emergency situations or on the use of medical emergency treatment in psychiatric facilities. Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center in Pennsylvania has recently launched specific guidelines and educational in-services for nurses and other health care professionals to utilize in determining the need for emergency medical treatment. Current data indicate these guidelines, that have psychiatric nurses playing an integral role, to be effective in improving patient outcomes in medical emergency situations. The purpose of this paper is to demonstrate the need for medical emergency strategies in psychiatric facilities and to stress the important role that psychiatric nurses play in determining the success of implemented medical emergency response strategies.

Boredom proneness in a psychiatric inpatient population

Boredom has been reported as a common experience for service users of acute psychiatric wards. It has been associated with negative mental and physical health. Research has yet to show what factors are associated with boredom proneness within the acute psychiatric population. (1) To investigate the distribution of boredom proneness in a population of mentally ill inpatients according to age, gender, diagnosis, Mental Health Act status and length of stay in hospital. (2) To test the hypothesis that boredom proneness is negatively correlated with autonomous activity levels. Two self-report questionnaires were used with 55 inpatients of acute psychiatric wards: the Boredom Proneness Scale (Farmer & Sundberg, 1986) and the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983). Questions were also asked about individuals' activity engagement during their current admission. Data on age, gender, diagnosis, ethnicity, Mental Health Act status and length of stay were collected from case notes. The highest incidence of boredom proneness was in participants with depression. Those detained under the Mental Health Act appeared less boredom prone than those admitted voluntarily. Boredom proneness was not associated with age, gender or length of stay. There was an association between engagement in more autonomous activities and lower boredom proneness.

Suicide in a large population of former psychiatric inpatients

The aim of this study was to identify predictors of completed suicide in a wide sample of psychiatric inpatients receiving retrospective and prospective DSM-IV diagnoses. We followed up 4441 severe psychiatric patients who were hospitalized for some time during a 35-year period in a private hospital setting. We collected sociodemographic, clinical and temperamental data. Ninety-six patients from the sample committed suicide. There were no sex differences in suicide completion and no differences between major psychiatric disorders, but people who had been hospitalized for anxiety disorders did not commit suicide and people with bipolar disorders were more likely to commit suicide than people with unipolar major depression. Shorter-term treatment with lithium and anticonvulsants, longer-term treatment with antidepressants, history of suicide attempts, suicidal thinking, and single status positively predicted completed suicide. Suicide tended to occur after a mean period of about 14 years of duration of disease. Patients' symptoms during the period preceding suicide were assessed through interviewing patients' physicians or family members. Symptoms occurring in >10% of cases were, in decreasing order, inner tension, racing/crowded thoughts, aggressive behavior, guilt, psychomotor agitation, persecutory ideation, anxiety, and hallucinations. Surprisingly, cyclothymic temperament was less associated with completed suicide as compared to other temperaments. Suicide is likely to occur in a milieu of agitation, mixed anxiety and depression, and psychosis. Longer-term mood stabilizer treatment may reduce the rate of completed suicide.

Examination of insomnia and insomnia treatment in psychiatric inpatients

Despite the high comorbidity of insomnia with psychiatric illness, few studies have examined insomnia or insomnia treatments in psychiatric inpatients. The present study had two overall goals. First, we sought to describe insomnia symptoms in 76 US veterans hospitalized for a wide-range of psychiatric illnesses. Next, we sought to examine whether participation in one session of group therapy for insomnia was associated with improvement in Insomnia Severity Index (ISI) scores for a subset of these inpatients (n = 19). Data were extracted from the clinical charts of 140 inpatients admitted into the 26-bed psychiatric ward at the New Mexico VA Healthcare System. The majority of the veterans had clinical insomnia in the moderate-to-severe range, and only 18% of the sample reported no clinically-significant insomnia. There was a significant reduction in ISI scores approximately 1 week after attendance at the group therapy session, which appears to be unrelated to the length of hospitalization, but might be related to psychiatric stabilization. This is the first study to examine insomnia symptoms in a mixed, psychiatric inpatient population. Group therapy for insomnia might be a particularly useful treatment option given polypharmacy and substance dependency issues often arising in this population.

A pilot study: pain, fatigue and stress in maternal relatives of adolescent female psychiatric inpatients assessed for juvenile primary fibromyalgia syndrome

This study was designed to assess the presence of pain and impaired functioning in the maternal relatives of adolescent females in an inpatient adolescent psychiatric population. We compared the relatives of adolescents who met the criteria for juvenile primary fibromyalgia syndrome (JPFS) to relatives of adolescents who did not meet the criteria for JPFS. A total of 55 biological maternal relatives of adolescent females admitted to a psychiatric unit were recruited to participate in the study. Participants completed four self-administered questionnaires: Multidimensional Fatigue Inventory, Fibromyalgia Impact Questionnaire, Medical Outcomes Survey (SF36v2), and the EPIFUND Health Survey. The maternal relatives of adolescents who met the criteria for JPFS did not score higher than the maternal relatives of adolescents who did not meet the criteria for JPFS. However, all maternal relatives consistently scored higher on self-reported measures of pain, impaired functioning, fatigue, and fibromyalgia symptoms than the average patient diagnosed with fibromyalgia or a chronic pain syndrome. Mood disorders and pain disorders share genetic risk factors and vulnerability. Future research is needed to further delineate other factors impacting the maternal caregivers' functioning. These could include stress associated with an adolescent child with psychiatric issues severe enough to warrant hospitalization.

Development of the Edmonson Psychiatric Fall Risk Assessment Tool

The purpose of this study was to develop a fall risk assessment instrument for the inpatient psychiatric population. Nine risk factors were identified through a review of the literature. The instrument was applied retrospectively to patient records, and the percentage of those who fell who triggered each of the items in each domain was calculated. The expected value of the population and weighting system were established. The Morse Fall Scale and Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) were administered simultaneously to inpatient psychiatric patients. Sensitivity of the EPFRAT was 0.63, compared with 0.49 for the Morse Fall Scale; specificity of the EPFRAT was 0.86, compared with 0.85 for the Morse Fall Scale. Initial psychometric testing of the EPFRAT indicates the instrument is more sensitive in assessing fall risk in the acutely ill psychiatric population than those currently available. Additional psychometric testing is needed to determine the reliability and validity of the EPFRAT.