Inpatient Psychiatric Treatment Research Articles

Case Analysis of Sprint Interval Training for Adolescents With Severe Mental Illness

Case Analysis of Sprint Interval Training for Adolescents With Severe Mental Illness

Outcome of Homoeopathic Intervention in Psychiatric Inpatients Treated in Rural Homoeopathic Hospital, Palghar, Maharashtra, India, 2014–2018: A Retrospective Analysis

Abstract Background Rural homoeopathic hospital has been serving the community in and around Palghar for the past 20 years. Through a Central Government Scheme of Centre of Excellence, it received funds for setting up an inpatient psychiatric unit in 2012 whereby it could serve the wider community by admitting the patients with mental illness in a secure ward. This is the second of two papers on the experience of homoeopathic treatment of psychiatric inpatients and details of the outcome of homoeopathic treatment to patients admitted between 2014 and 2018. Objective Efforts have been made to explore the outcomes of homoeopathic intervention, singly or as adjuvant treatment, for a variety of clinical conditions and to determine the commonly indicated remedies that were found useful. Methodology A standard operating procedure enabled symptom analysis and evaluation; it also enabled to erect the homoeopathic totality and institute treatment along with conducting the follow-up. Retrospective analysis using Outcome Related to Impact on Daily Living scale helped to establish the results of homoeopathic intervention. Results An excellent response to homoeopathic intervention was obtained for several clinical conditions like alcohol withdrawal (76.3%), conversion disorder (82.17%), suicide attempt (85.13%), anxiety disorders (84.19%), depressive disorders (75%) and somatoform (85.17%). The rate of improvement in schizophrenia (60%) and epilepsy (22.6%) was lower. The commonly indicated homoeopathic remedies for each clinical condition were identified. This information would help practitioners to acquire knowledge of a pool of remedies from which they could readily determine the similimum. Conclusion Homoeopathic treatment, either alone or as an adjuvant, is useful in the management of psychiatric inpatients for several clinical conditions. Remedies found useful in different clinical conditions need to be studied in greater depth to identify their leading indications.

Personality trait domains predict psychiatric symptom and functional outcomes.

A review of high intensity, high dose mentalization-based inpatient psychiatric treatment indicated large effect-size reductions in symptoms of depression, anxiety, somatization, and improving emotion-regulation functioning (Allen et al., 2017). This study examined the impact of pathological personality traits has on baseline symptoms and functioning, as well as their impact on the longitudinal course in a large cohort of adult inpatient psychiatric sample (N = 804). The Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) was used to assess trait domains impact on longitudinal outcomes (anxiety, depression, somatic symptoms, and functional impairment) using hierarchical repeated measures modeling. Results indicate Negative Affectivity and Detachment were related to higher admission severity in all four outcome domains. Psychoticism was related to somatic symptoms, while Antagonism and Disinhibition were related to functional impairment. Paradoxically, when symptoms were plotted over 2-week intervals during hospitalization, patients with higher admission PID-5 trait scores exhibited greater improvement over time. The PID-5 appears to contribute to prediction of treatment outcome response above and beyond demographic and burden of illness. Importantly, the findings add to a growing body of literature indicating that impairments in personality traits do not preclude positive treatment response, particularly when treatments target pathological personality features. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Association of aggressivity at adolescence and criminality to severe assault exposure among former adolescent psychiatric inpatients

This study investigated the associations of adolescent aggression, and criminality, to severe hospital-treated assault exposures among young adults (n = 508) with a history of adolescent psychiatric inpatient treatment between 2001-2006. Participants were interviewed during hospitalization using K-SADS-PL to assess psychiatric disorders, and to obtain information on aggressivity. Data on crimes committed were obtained from the Finnish Legal Register Centre, and the treatment episodes for assault exposures from the Finnish National Care Register for Health Care, up to end of 2016. Predictors for severe assault exposure were male sex (OR = 2.1), short temperedness (OR = 2.4), non-violent offending (OR = 2.6), and violent offending (OR = 4.8). These results indicate that the participants most vulnerable to severe assaults were those suffering from a continuum of aggressivity across their lifetime. Our findings can be utilized to identify adolescents at risk of severe assault exposure, and to reduce this risk by focusing on appropriate treatments for these vulnerable adolescents.

Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.

The use of a socially assistive robot in individuals with depression during acute psychiatric inpatient treatment – preliminary RCT results

The use of a socially assistive robot in individuals with depression during acute psychiatric inpatient treatment – preliminary RCT results

Evaluation of a flexible and integrative psychiatric care model in a department of child and adolescent psychiatry in T\xfcbingen, Germany: study protocol (EVA_TIBAS)

BackgroundModel projects for flexible and integrated treatment (FIT) in Germany aim at advancing the quality of care for people with mental disorders. A new FIT model project was established in 2017 at the Department of child and adolescent psychiatry (KJP) of the University Hospital Tübingen (Universitätsklinikum Tübingen, UKT). The study design of EVA_TIBAS presented here describes the evaluation of the FIT model project at the KJP of the UKT. This evaluation aims at quantifying the anticipated FIT model project changes, which are to improve patients’ cross-sectoral care at the same maximum cost as standard care.MethodsEVA_TIBAS is a controlled cohort study using a mix of quantitative and qualitative methods. The FIT evaluation consists of three modules. In Module A, anonymized claims data of a statutory health insurance fund will be used to compare outcomes (duration of inpatient and day care psychiatric treatment, inpatient and day care psychiatric length of stay, outpatient psychiatric treatment in hospital, inpatient hospital readmission, emergency admission rate, direct medical costs) of patients treated in the model hospital with patients treated in structurally comparable control hospitals (estimated sample size = ca. 600 patients). In Module B, patient-reported outcomes (health related quality of life, symptom burden, return to psychosocial relationships (e.g. school, friends, hobbies), treatment satisfaction, societal costs) will be assessed quantitatively using validated questionnaires for the model and two control hospitals (estimated sample size = ca. 300 patients). A subsequent health economic evaluation will be based on cost-effectiveness analyses from both the insurance fund’s and the societal perspective. In Module C, about 30 semi-structured interviews will examine the quality of offer, effects and benefits of the service offered by the social service of the AOK Baden-Württemberg (for stabilizing the overall situation of care in the family) in the model hospital. A focus group discussion will address the quality of cooperation between employees of the university hospital and the social services.DiscussionThe results of this evaluation will be used to inform policy makers whether this FIT model project or aspects of it should be implemented into standard care.Trial registrationThis study was registered at ClinicalTrials.gov PRS (ID: NCT04727359, date: 27 January 2021).

Suicidal Thoughts and Behaviors Among Adolescent Psychiatric Inpatients

Background Given low base rates of suicidal thoughts and behaviors (STBs) in national samples of adolescents, clarifying the sociodemographic and clinical correlates among psychiatric inpatients may afford insights into potential risk factors that predict STBs onset. Method Adolescents (N = 970; ages 12–19 years) admitted for acute, psychiatric inpatient care completed baseline clinical interviews and self-report measures assessing demographics and early life adversity. Lifetime and 12-month STBs prevalence were obtained, allowing for the estimate of STBs persistence (i.e., rates of those with both current and past STBs) and transition rates (i.e., proportion of ideators that transition to plans or attempts). Univariate and multivariate logistic regression tested sociodemographic and clinical correlates of STBs. Results Age-of-onset for STBs occurred in early adolescence. Most patients reported suicide ideation with nearly half of patients making a plan and one-third a suicide attempt. Although relatively modest, the strongest correlates of lifetime attempts were depressive disorders, physical abuse, and non-suicidal self-injury. Knowing a peer that had attempted suicide also increased the likelihood of a suicide attempt, especially among attempters who transitioned from ideation to planned attempts. Conclusion STBs are highly prevalent among adolescents admitted for acute psychiatric inpatient treatment. The modest effects suggest that correlates, particularly those related to suicide attempts, are widely distributed. As a history of physical abuse and knowing a peer with a suicide attempt history are related to transitioning from ideation to action, these may be critical factors to target in the deployment of future suicide prevention and treatment programs. HIGHLIGHTS One-third of adolescent inpatients report a lifetime history of suicide attempts. Approximately 65% of adolescent inpatients with a lifetime plan attempt suicide. Knowing peers who attempt suicide may facilitate the transition from ideation to action.

Atypical longitudinal self-inflicted incised wounds as a cause of death in an ecstasy user.

A 32-year-old chronic drug abuser was found dead at the entrance to his home, covered in blood. Pools of blood, bloody footprints and bloodstains were found across the apartment. A double-edged razor was recovered from the scene. Autopsy revealed multiple incised wounds: two on the palmar aspect of both forearms (37cm and 33cm long, oriented longitudinally). The cuts extended into the subcutaneous adipose tissue, muscles and blood vessels. There was an additional 30cm cut extending across the middle of the torso anteriorly and two more cuts on the anteromedial aspect of the lower legs, set symmetrically (about 23 and 25cm long). These three cuts were more shallow than the upper extremity wounds. No hesitation wounds were identified. Toxicological analysis identified MDMA (ecstasy). The cause of death was exsanguination. The deceased has been using ecstasy for the previous five years and had a history of inpatient psychiatric treatment due to psychosis with delusions and hallucinations. These self-inflicted incised wounds had many atypical features: location (torso, legs and arms), longitudinal orientation and symmetrical distribution, absence of hesitation injuries, use of both dominant and non-dominant hand. The absence of previous suicide attempts and suicide note suggest that these self-inflicted injuries were not planned beforehand, but were abrupt. We hypothesize that this injury pattern is associated with both acute and chronic effects of MDMA.

Stationsäquivalente Behandlung (StäB) im Vergleich mit vollstationärer Behandlung: 12-Monats-Follow-up einer gematchten Kohortenstudie

Effectiveness of Inpatient Equivalent Home Treatment (IEHT) was examined in comparison to standard psychiatric inpatient treatment. IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user's home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. This retrospective matched control study used routine data of 86 patients (IEHT, n = 43, standard inpatient treatment n = 43). Readmission rates and cumulative hospital days were compared within a 12-month-follow-up time period. The readmission rate was lower and cumulative treatment days were longer after IETH. However, both group differences were not statistically significant. The present study indicates that IEHT is not inferior to standard inpatient treatment in terms of the risk of readmission.

45.1 CHILD AND ADOLESCENT PSYCHIATRY INPATIENT HOSPITAL CAPACITY IN THE UNITED STATES: UNDERSTANDING OUR CURRENT STATE

Objectives: In communities across the United States, large numbers of children and adolescents with acute psychiatric presentations are being held for days and weeks in emergency departments and pediatric medical units, awaiting placement for inpatient psychiatric hospital treatment. These settings are not designed to safely and effectively care for these children. The prolonged waiting is usually attributed to an inadequate supply of beds, and the solution seems self-evident: build more beds. This simple statement belies the complexity of determining the adequate number of beds for a given community, a number dependent on a variety of factors including the epidemiology of children’s mental illness, social determinants of health, the functioning of other mental health services, and the availability of community supports. The aim of this session is to provide a detailed background of the scope of our inpatient access problem and its consequences. Methods: Available state and national data will be reviewed and synthesized to describe the availability and distribution of inpatient child and adolescent psychiatry hospital beds. The impact of the limitation in beds on children and adolescents and families as well as healthcare systems will be described. The needs of special populations and the clinical profiles of patients most likely to experience prolonged boarding will be reviewed. As a case example, the efforts of state regulators in Massachusetts to address this problem will be described. Results: Boarding of children and adolescents with acute mental illness has been associated with scarcity and maldistribution of inpatient beds and is highly prevalent and widespread across the United States. The problem appears to have been severely exacerbated during the SARS-CoV-2 pandemic. Conclusions: Boarding of children in emergency departments is associated with elevated safety risks, poor clinical quality, poor patient experience, disruption of nonpsychiatric emergency services, and excessive costs. In order to address this issue, state and local policymakers need tools to determine the number and types of children’s psychiatric inpatient units needed for their communities. ICP, CC, PUP

Commentary: Getting kids what they need, where they are, when they need it: home-based services in a continuum of care - a commentary on Boege etal. (2021).

In this edition of CAMH, Boege and colleague's 4-year follow-up study supports intensive home-based treatment as a viable alternative to inpatient hospitalization. Youth receiving home-based multimodal treatment fared just as well as those who remained hospitalized longer, with higher parental satisfaction. This study contributes to a sparse evidence base regarding longitudinal outcomes of psychiatric inpatient and intensive outpatient treatments for children and adolescents. Although mental illness is prevalent and increasing among youth, existing systems of care are often inadequate to provide flexible, effective, interdisciplinary team-based treatments, and supports for children and their families. Innovative approaches to providing evidence-based care and tracking outcomes are needed to strengthen the continuum of care.

Use of a Short-term Psychiatric Inpatient Model to Address Problem Behavior Exhibited by Youth with Intellectual or Developmental Disabilities

ABSTRACT Children with intellectual or developmental disabilities (IDD) are more likely to have co-occurring mental health diagnoses and require hospitalization than their typically developing peers. Inpatient psychiatric treatment for this population can vary considerably and often include providers from numerous disciplines (e.g., psychiatrists, psychologists, social workers). We describe the results produced while treating this population of patients on a short-term inpatient and partial hospitalization psychiatric unit. By receiving multidisciplinary treatment from allied health professionals, including psychiatry, psychology, board-certified behavior analysts, and social work, we obtained an average reduction in problem behavior from admission to discharge from the psychiatric unit of 87.5%. Further statistical analysis of variables that may have contributed to this reduction in problem behavior did not show clear relations. That is, number of treatment sessions, number of medications, or behavioral function did not seem to differentially impact outcomes. This paper will describe the multidisciplinary treatment model and offer guidance to practitioners working with psychiatrically hospitalized youth with IDD.

To expand operations, Oregon hospital must serve share of mandated patients

A hospital company's years‐long effort to expand inpatient psychiatric treatment capacity in Oregon may be nearing a successful conclusion, but only if it agrees to conditions that include a strict breakdown of who is to be served at a proposed new facility.

Written exposure therapy for posttraumatic stress symptoms and suicide risk: Design and methodology of a randomized controlled trial with patients on a military psychiatric inpatient unit

Studies of active duty service members have shown that military personnel who screen positive for posttraumatic stress disorder (PTSD) are more than twice as likely to make a suicide attempt. Evidence-based PTSD treatments can reduce suicidal ideation; however, it can be challenging to provide evidence-based, trauma-focused, PTSD treatment to high-risk patients on an acute psychiatric inpatient unit because the priority of care is stabilization. Treatment for PTSD requires more time and resources than are typically afforded during inpatient hospitalizations. Written Exposure Therapy is an evidence-based, five-session, trauma-focused treatment for PTSD that may overcome the implementation challenges of providing PTSD treatment in an acute inpatient psychiatric treatment setting. This paper describes the design, methodology, and protocol of a randomized clinical trial. The goal of the study is to determine if five 60-min sessions of Written Exposure Therapy enhanced with Crisis Response Planning for suicide risk reduces the presence, frequency, and severity of suicidal ideation, suicidal behavior, rehospitalization, and non-suicidal, self-injurious behaviors. The study also will determine if Written Exposure Therapy for Suicide reduces posttraumatic stress symptom severity among military service members, veterans, and other adult military beneficiaries admitted to an acute psychiatric inpatient unit for comorbid suicide ideation or attempt and PTSD symptoms compared with Treatment as Usual. The study is designed to enhance the delivery of care for those in acute suicidal crisis with comorbid PTSD symptoms.

Satisfaction with in-patient child and adolescent psychiatric treatment: development and psychometric properties of the BEST questionnaires for adolescents and for parents

BackgroundInterest in the assessment of patient satisfaction with in-patient psychiatric treatment has steadily increased and several measurement tools are available for the quantification of patients’ experience. However, they are often uni-dimensional or focus mainly on therapeutic relationship and environment, and neglect other important issues such as information about treatment and participation. The BEST questionnaires were developed as comprehensive instruments that include items on all of the mentioned topics. The present study evaluates the psychometric properties of the BEST in a version for adolescents and for parents. Furthermore, the dimensionality of the satisfaction ratings is analyzed.MethodDescriptive statistics were applied to data of 1582 adolescents (mean age = 15.0 years, SD = 1.65; 62.4% female) and 1998 parents/guardians assessed in seven in-patient units across Germany. The factorial structure of the BEST questionnaires was determined by exploratory and confirmatory factor analyses, including a bifactor model.ResultsThe psychometric quality of the scales was strong. Correlations with another assessment instrument of patient satisfaction were good to high, indicating good convergent validity. Exploratory factor analyses revealed three factors in adolescents that were labelled as: Therapeutic relationship, environment, and general satisfaction and treatment success. For parents, the same three factors could be distinguished. Confirmatory bifactor models suggested that the vast majority of variance was accounted for by the general factor; the three specific factors provided some additional information. Agreement between the subscales of adolescents and their parents was only moderate. Parents were usually more satisfied.ConclusionsThe BEST questionnaires can be considered as reliable and valid instruments to not only assess the “classical” aspects of patient satisfaction, but to also assess newer fundamental topics such as children’s rights and treatment participation. For scientific usage, the total score seems superior because of the high explained variance by the general factor, but the subscale scores provide further information. The use of single items seems advantageous for quality management purposes.

Involuntary Treatment of Minors with Severe and Enduring Anorexia Nervosa.

Anorexia nervosa is among the most lethal of all psychiatric illnesses and is increasingly prevalent in children and adolescents. There are limited treatment options specifically for youth with severe and enduring illness who decline treatment. Although treatment guidelines increasingly favor outpatient family-based treatments, there is a continued role for inpatient psychiatric treatment and involuntary commitment for high-risk patients. Providers may be reluctant to pursue involuntary treatment given its controversial nature, and differences in state's commitment laws complicate the development of clear guidelines for this approach. If parents also oppose treatment, providers must consider involving the child welfare system while balancing the impact of terminating parental rights upon long-term treatment outcomes. The case example of an adolescent with severe and enduring anorexia nervosa who opposed involuntary treatment, as did the legal guardian, highlights Washington's unique mental health laws for minors, which allow for temporary suspension of patient and guardian decision-making authority without terminating parental rights. The article discusses the ethics of involuntary treatment, the intersection of anorexia nervosa with the child welfare system, legal cases establishing commitment criteria for anorexia nervosa, and Washington's mental health laws for minors to inform the treatment approach for high-risk adolescents with severe and enduring anorexia nervosa.

An Ecological Study of a Universal Employee Depression Awareness and Stigma Reduction Intervention: "Right Direction".

Objective: Right Direction (RD) was a component of a universal employee wellness program implemented in 2014 at Kent State University (KSU) to increase employees' awareness of depression, reduce mental health stigma, and encourage help-seeking behaviors to promote mental health. We explored changes in mental health care utilization before and after implementation of RD.Methods: KSU Human Resources census and service use data were used to identify the study cohort and examine the study objectives. A pre-post design was used to explore changes in mental health utilization among KSU employees before and after RD. Three post-intervention periods were examined. A generalized linear mixed model approach was used for logistic regression analysis between each outcome of interest and intervention period, adjusted by age and sex. Logit differences were calculated for post-intervention periods compared to the pre-intervention period.Results: Compared to the pre-intervention period, the predicted proportion of employees seeking treatment for depression and anxiety increased in the first post-intervention period (OR = 2.14, 95% Confidence Interval [CI] = 1.37–3.34), then declined. Outpatient psychiatric treatment utilization increased significantly in the first two post-intervention periods (OR =1.89, 95% CI = 1.23–2.89; OR = 1.75, 95% CI = 1.11–2.76). No difference was noted in inpatient psychiatric treatment utilization across post-intervention periods. Unlike prescription for anxiolytic prescriptions, receipt of antidepressant prescriptions increased in the second (OR = 2.25, 95% CI = 1.56–3.27) and third (OR = 2.16, 95% CI = 1.46–3.20) post-intervention periods.Conclusions: Effects of RD may be realized over the long-term with follow-up enhancements such as workshops/informational sessions on mindfulness, stress management, resiliency training, and self-acceptance.

Do no harm in due process - a historical analysis of social determinates of institutionalization in the USA.

Involuntary hospitalization has been a fundamental function of psychiatric care for mentally ill persons in the USA for centuries. Procedural and judicial practices of inpatient psychiatric treatment and civil commitment in the USA have served as a by-product of socio-political pressures that demanded constant reform throughout history. The origin of modern commitment laws can best be understood through the lens of cultural paradigms that led to their creation and these suggest caution for future legislative amendments.

L’article 122-1 et après ? Devenir des patients reconnus irresponsables sur le plan pénal, entre 2015 et 2019, dans l’Ouest de la France

ObjectivesArticle 122-1 of the French Penal Code regulates the status of non-criminally responsible (NCR) subjects due to an abolition of their judgment. Although little epidemiological data are available regarding the application of article 122-1, the French judicial literature reports a 0.2 to 0.5% rate of non-conviction due to psychiatric reasons. More recent studies report a higher rate, around 5%. The goal of our study was to determine the future of subjects considered to be NCR due to the abolition of their judgment, following article 122-1 §1 of the French Penal Code and to highlight a link between their pathology, their offenses and their management. Materials and methodsThis is a retrospective chart review, that included all the forensic assessments that took place between 2015 and 2019, of an expert psychiatrist, practicing at the Rennes Court of Appeal, and that resulted in a judgment of non-criminal responsibility. Information was retrieved from the Regional Health Agencies of the western region of France about the evolution of these subjects since their examination by the expert. Medico-psycho-criminological data was gathered, including the psychiatric profile, the committed offenses and the expert's conclusions regarding criminal accountability or non-criminal responsibility as well as the need for referral to the medical care or judicial system. Results58 of the 103 initially identified charts were retained. Our sample consisted mainly of single men with no children, lacking professional qualifications but mostly employed. A majority of them had a positive psychiatric history, a history of substance use but no criminal history or childhood trauma. The ages ranged from 17 to 82 years, the mean age being 41 years (SD=16 years). When the psychiatric expertise identified an abolition of judgment and non-criminally responsibility, 51.46% (95% CI: [41.40-61.43]) of the subjects were referred to in-patient psychiatric treatment. In 2020, 19,42% of subjects were hospitalized in a psychiatric unit, 18,45% were on compulsory outpatient treatment and 17,48% were no longer on compulsory treatment. Psychotic disorders were identified in 75,73% of the sample. For the same offense, this psychotic sub-population was more often hospitalized than the non-psychotic sub-population. Additionally, psychotic subjects were more often hospitalized in the event of a crime (injury to persons or sexual crimes) than of misdemeanor (31,83%). ConclusionsWhile we expected an overwhelming majority of hospital management following the recognition of the non-criminal responsibility, our study does not highlight a predominant outcome. Nonetheless, our initial hypothesis was confirmed by the trends we were able to identify: subjects considered to be non-criminally responsible tend to stay hospitalized, especially when they are psychotic and have committed a crime.