Inpatient Psychiatric Unit Research Articles

Surveying Child and Adolescent Inpatient Psychiatric Units: Demographics, Policies, and Practice

ABSTRACT Background The increasing demand for acute inpatient psychiatric unit (IPU) treatment for children and adolescents in recent years has put significant pressure on hospital systems to provide efficient and effective care. However, there is a gap in the literature regarding the characteristics of IPU care for children and adolescents in the US, making it difficult for institutions to benchmark their performance against nationwide standards or understand generalizability of existing research. Objective To address this gap in the literature by beginning to collect descriptive data on significant variables for youth care from a geographically and institutionally diverse group of on Child and Adolescent IPUs. Method A multi-institutional research team conducted a nationwide (US) survey of child and adolescent IPU clinicians using snowball sampling. Recruitment e-mails were sent to IPU groups in the American Psychological Association and the American Academy Child and Adolescent Psychiatry. Results The study yielded data from 12 institutions with a total of 20 IPUs, representing over 23,000 admissions in the years 2019 and 2020. The results of the survey show wide variability in institutional definitions of key variables (such as readmissions and safety events) as well as large ranges in length of stay, restraints, seclusions, and safety events. Conclusion This study reveals the importance of IPU clinical researchers taking steps to build a robust evidence base for IPU care, including developing consensus definitions of key variables and conceptualizing why high degrees of variability exist in important variables of IPU care. The survey results provide valuable insights for hospital systems, policymakers, and clinicians in the field of child and adolescent psychiatry.

Characterization and Outcomes of Profoundly and Non-profoundly Autistic Individuals Admitted to a Specialized Psychiatric Inpatient Unit.

The prevalence of autism spectrum disorder (ASD) is currently estimated to be 1 in 36 children. While much is known about the impact of ASD on family and community functioning as well as treatment outcomes, less is known about a relatively new categorization of ASD, called "profound autism." The current study evaluated 14 consecutively admitted patients meeting criteria for profound autism to a specialized psychiatric inpatient and partial hospitalization program. We then selected 15 non-profoundly autistic youth admitted immediately before or after each profoundly autistic youth to serve as a comparison. Patient caregivers completed measures about parental stress and the severity and frequency of patient problem behavior, and patients participated in functional analyses of problem behavior and function-based treatment programs during their admission. Results showed profoundly autistic youth spent an average of 14 more days admitted to the psychiatric unit, and they engaged in higher parent-reported severity and frequency of self-injurious and stereotypic behavior. Functional analysis results for profoundly autistic youth showed a higher occurrence of automatically reinforced problem behavior but otherwise similar results. As well, profoundly autistic youth showed a lower percentage reduction in problem behavior at the end of the psychiatric hospitalization than their non-profoundly autistic peers. Profoundly autistic youth seem to require a high level of behavioral support, even after psychiatric hospitalization. Insurance companies and therapists need to recognize these challenges and invest sufficient resources to meet their treatment needs.

The modern role of paraprofessionals in delivering brief psychological interventions

AbstractThe increasing global demand for mental health services, compounded by the COVID‐19 pandemic, has spurred innovative approaches. Among these, the utilisation of paraprofessionals for delivering brief psychological interventions (BPIs) is gaining significant traction across diverse settings and populations. Paraprofessionals (individuals equipped with specialised mental health training but lacking formal qualifications) have emerged as a valuable resource. They have the potential to offer cost‐effective, culturally sensitive and readily accessible support. The integration of paraprofessionals into various healthcare settings, such as inpatient psychiatric units and primary care clinics, underscores their potential to enhance holistic well‐being and early intervention. This integration not only lightens the load on licensed therapists but also broadens access to services while reducing treatment costs. At a global scale, paraprofessionals, armed with local knowledge and community connections, play a pivotal role in improving mental health outcomes among underserved populations. Furthermore, the rise of telemental health, an increasingly crucial aspect of mental healthcare, presents new avenues for paraprofessionals to deliver psychological care. Despite their potential, paraprofessionals encounter challenges related to work‐life balance, boundary‐setting and the stigma attached to their roles. Their integration into healthcare systems requires clear roles and responsibilities, along with continuous support to ensure effective intervention and the well‐being of both providers and recipients. Further research and development are necessary to harness their full potential and meet the increasing demand for accessible mental health services.

An Exploration of the Co-Occurrence of Hallucinations and Suicidal Mental Imagery Among Psychiatrically Hospitalised Adolescents at High Risk for Suicide.

Adolescents with psychosis-spectrum symptoms are at particularly high risk for suicide, however, little is known about how suicidal cognitions manifest in this population. Suicidal cognitions can occur as verbal thoughts and/or mental images of suicide, and mental images may be indicative of a higher risk for suicidal behaviours. Suicidal mental imagery could be a salient and important suicide-related risk factor for adolescents with hallucinations in particular, however, the co-occurrence of these phenomena has yet to be studied. In a sample of psychiatrically hospitalised adolescents, we hypothesize that hallucinations will be associated with increased suicidal mental imagery and suicide attempts. This chart review study included data from 219 adolescents admitted to a psychiatric inpatient unit. Adolescents completed an assessment battery probing hallucinations, suicidal cognitions, and suicide attempts. Adolescents with past-month hallucinations had higher rates of past-week suicidal verbal thoughts and suicidal mental imagery, but not suicide attempts, compared to those without hallucinations. Adolescents with hallucinations reported a younger onset of suicidal mental imagery, and they endorsed more frequent imagery. Past-month hallucinations were significantly and positively associated with suicidal mental imagery, beyond the effects of internalising symptoms. Suicidal mental imagery was positively associated with past-week suicide attempts, but past-month hallucinations were not. Our findings indicate that hallucinations are linked to suicidal mental imagery, an important yet under-studied risk factor for suicidal behaviour. These data highlight the need for more research exploring suicidal mental imagery among high-risk adolescents experiencing hallucinations to inform suicide risk assessment and intervention.

Psychiatric crises among youth with a history of trauma during COVID-19: A retrospective study of psychiatrically hospitalized children and adolescents

BackgroundYouth hospitalized in inpatient child psychiatry units have a high prevalence of trauma and this population may have been especially affected by the pandemic. ObjectiveThis study examined the clinical and sociodemographic characteristics of hospitalized youth with a history of trauma prior to, during, and after the pandemic. Additionally, youth who reported a trauma history were compared to those who denied having a trauma history. Participants and settingThis retrospective study utilized data gathered from (n = 1101) first admissions to a child and adolescent inpatient psychiatry unit of a New York City hospital during the pandemic. MethodsHospital admission records were reviewed for clinical and sociodemographic variables. Statistical analyses evaluated whether there were significant differences in these variables throughout the pandemic. ResultsThe clinical severity of inpatient youth with trauma increased during the quarantine period compared to pre-pandemic. The percentage of youth admitted for psychosis increased by 3 % (φc = 0.15, p = 0.03), suicide attempt by 14.8 % (φc = 0.15, p = 0.03), and suicidal ideation without suicide attempt decreased by 9.6 % (φc = 0.15, p = 0.03). Clinically, patients with a history of trauma were more likely to have greater comorbidity and clinical severity. Demographically, patients with a history of trauma were more likely to be female or transgender/non-binary (φc = 0.11, p < 0.01), Black or Latinx (φc = 0.14, p < 0.01), and on public insurance (φc = 0.11, p < 0.01). ConclusionsIn an urban area inpatient youth psychiatric unit, the clinical severity of inpatient youth with trauma increased during COVID-19 quarantines. The clinical severity of inpatient youth with trauma was greater than those without during and after COVID-19 and youth with certain minority and marginalized identities were particularly impacted.

Recurrent catatonia in a patient with bipolar disorder and polycythemia: A case report

We report the diagnostic and management challenges encountered in a case of a 57-year-old male patient with bipolar I disorder and comorbid polycythemia secondary to obstructive sleep apnea, who was treated in our inpatient psychiatric unit for suicidal ideation and recurrent catatonia. He was found to have catatonia with a Bush&amp;ndash;Francis Catatonia Rating Scale score of 18. He subsequently exhibited a positive response to the lorazepam challenge test. Before discharge, his daily lorazepam dose was titrated to 6 mg, which led to resolution of catatonic symptoms, and was tapered to discontinuation. During the second hospitalization, the patient&amp;rsquo;s catatonia returned, but due to lorazepam-induced bradycardia, he refrained from taking more than 1 mg of the medication. Divalproex sodium and memantine were initiated as off-label catatonic treatment plus lurasidone for bipolar depression. The patient was also found to have a positive antinuclear antibody titer (1:160). The hemato-immunological abnormalities present in our patient complicated his catatonic condition, underscoring the need to explore medical and neuropsychiatric catatonic factors for accurate diagnosis of this neuropsychiatric syndrome.

Users' Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study.

Coercion influences mental health services users' experience of care and can hinder their recovery process, so it is essential to understand how it is perceived in rehabilitation settings oriented towards recovery. To describe and measure users' experience of coercion and explore their perception of the treatment received in an inpatient medium-stay psychiatric rehabilitation unit (IMSPRU). This study, in which 75 service users participated, used a mixed methods approach. Twenty participants were administered a semistructured interview and completed quantitative measures for coercion and 55 additional service users completed the quantitative measurements only. The perception of coercion was measured using the Coercion Experience Scale. The content analysis of qualitative data resulted in two main themes: treatment received and experience of coercion in the IMSPRU. The participants made a distinction between good treatment and mistreatment or unfair treatment. Experience of coercion in the IMSPRU included the feeling of freedom or lack thereof in the unit, forms of formal and informal coercion, and the positive or negative impact of rules on the unit. The quantitative data revealed a low perception of formal coercion among the users. Individuals had different views of what it meant to be treated well, but all agreed on the importance of communication and the need to feel respected. Informal coercion was the most frequent type of coercion identified, but users were often unaware of its existence. Knowledge of how IMSPRU users experience the treatment received from nursing staff and how they perceive coercive situations will help to lay the foundations of a system of care oriented towards good treatment and noncoercive practices.

Cognition in Schizophrenia: Exploring the Dynamics of Improvement and the Influencing Determinants

Background: Cognitive impairments are fundamental characteristics of schizophrenia, significantly impacting the overall functioning of individuals with the disorder. However, the trajectory of cognitive deficits and the factors influencing their changes over the course of treatment remain poorly understood. Objectives: The present study aimed to investigate the changes in cognitive status of patients with schizophrenia and the factors that influence these changes following hospitalization and treatment. Methods: The study utilized a longitudinal design, enrolling thirty hospitalized patients (15 males and 15 females) from the psychiatric inpatient unit of a general educational hospital. Cognitive assessments were conducted upon admission and discharge. A Generalized Estimating Equation (GEE) model was used to analyze the data, accounting for demographic and clinical variables such as age, gender, Body Mass Index (BMI), family history, and smoking status. Results: The findings revealed a reduction in cognitive deficits following hospitalization and treatment. Significant improvements were observed in verbal memory, working memory, and executive function. However, older patients showed poorer performance in motor speed, verbal fluency, and symbol coding compared to younger patients. Male patients and smokers demonstrated lower cognitive functioning, particularly in verbal fluency, symbol coding, and executive function. Conclusions: This study highlighted the positive effect of comprehensive inpatient treatment on reducing cognitive impairments in individuals with schizophrenia. While improvements were noted in several cognitive domains, the persistence of certain deficits, particularly in relation to demographic factors (age, gender, and smoking status), underscores the need for further research and tailored cognitive rehabilitation interventions. A personalized, multidimensional approach to managing cognitive deficits in schizophrenia could lead to better functional outcomes and enhance the quality of life for affected individuals.

Acculturation stress and mental health outcomes in a sample of migrant inpatients: Findings from a naturalistic study.

Migrants face numerous risk factors for mental disorders, including stressors and traumatic events during the pre-, peri-, and post-migratory phases. Acculturation stress, a significant post-migratory stressor, can adversely affect mental health during the cultural adaptation process. This study aims to assess the clinical implications of acculturation stress in migrants admitted to a psychiatric intensive care unit, with a focus on identifying predictors of acculturative stress and their impact on clinical outcomes. We conducted a retrospective study of 268 immigrant patients hospitalized between 2004 and 2019 at the psychiatric inpatient unit of the University of Foggia. We collected socio-demographic and clinical data using ad hoc schedules and validated assessment instruments, including the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF), and the Clinical Global Impression (CGI). Diagnoses were based on DSM-IV-TR/DSM-5 criteria. We analyzed associations between demographic and clinical characteristics of patients reporting acculturative stress and those not reporting it, using appropriate statistical methods. The majority of patients were diagnosed with affective (45.1%) or psychotic disorders (31.7%), with 57.1% experiencing their first psychiatric episode. Acculturation stress was reported by 51.9% of patients (N = 139), predominantly among males (71.9%), single individuals (80.9%), and those of Islamic faith (56.8%). Patients experiencing acculturation stress were more likely to be unemployed (57.6%) and without a residence permit (63.3%). This stress was particularly prevalent among patients with psychotic disorders (25.9%) and first-episode psychiatric cases (64.7%). At discharge, patients with acculturation stress showed less improvement on CGI, GAF, and BPRS scores compared to those without such stress. Acculturation stress is influenced by several socio-demographic factors and is crucial for the full symptomatic remission of migrant patients. Culturally-oriented mental health services, including language and cultural integration programs, are essential in reducing acculturative stress and improving the overall well-being of immigrants.

Characteristics and outcomes of infants admitted to a parent-infant inpatient psychiatric unit: A pilot study.

Inpatient parent-infant psychiatric units (PIUs) are considered "gold standard" for treating maternal mental illness, with well-documented positive outcomes for mothers. However, little research addresses outcomes for infants in these units, who often face significant developmental and socio-emotional adversity. This pilot study aimed to evaluate the characteristics and progress of an Australian PIU population, focusing on the impact of PIU admission on infant outcomes. Over 3 months, 31 consecutively admitted mother-infant pairs (dyads) were assessed through interviews, observations, and standardized measures to evaluate maternal and infant characteristics and progress from admission to discharge. Maternal well-being and the mother-infant relationship improved. Infants exhibited high levels of physical (29%) and developmental concerns (80.6%). 22.6% receiving an Axis I infant mental health diagnosis. Infant socio-emotional responsiveness improved significantly, as measured by the modified Alarm-Distress Baby Scale, indicating a positive impact of PIU admission. The small sample size and reliance on clinician-observed measures limit the generalizability of the findings. PIU infants are particularly vulnerable, and PIU admission may ameliorate socio-emotional responsiveness. Further research with larger samples and extended follow-up is needed to determine the most effective intervention strategies during and after PIU admission to maximize benefits for these infants.

Smartphone Screen Time Characteristics in People With Suicidal Thoughts: Retrospective Observational Data Analysis Study.

Smartphone-based monitoring in natural settings provides opportunities to monitor mental health behaviors, including suicidal thoughts and behaviors. To date, most suicidal thoughts and behaviors research using smartphones has primarily relied on collecting so-called "active" data, requiring participants to engage by completing surveys. Data collected passively from smartphone sensors and logs may offer an objectively measured representation of an individual's behavior, including smartphone screen time. This study aims to present methods for identifying screen-on bouts and deriving screen time characteristics from passively collected smartphone state logs and to estimate daily smartphone screen time in people with suicidal thinking, providing a more reliable alternative to traditional self-report. Participants (N=126; median age 22, IQR 16-33 years) installed the Beiwe app (Harvard University) on their smartphones, which passively collected phone state logs for up to 6 months after discharge from an inpatient psychiatric unit (adolescents) or emergency department visit (adults). We derived daily screen time measures from these logs, including screen-on time, screen-on bout duration, screen-off bout duration, and screen-on bout count. We estimated the mean of these measures across age subgroups (adults and adolescents), phone operating systems (Android and iOS), and monitoring stages after the discharge (first 4 weeks vs subsequent weeks). We evaluated the sensitivity of daily screen time measures to changes in the parameters of the screen-on bout identification method. Additionally, we estimated the impact of a daylight time change on minute-level screen time using function-on-scalar generalized linear mixed-effects regression. The median monitoring period was 169 (IQR 42-169) days. For adolescents and adults, mean daily screen-on time was 254.6 (95% CI 231.4-277.7) and 271.0 (95% CI 252.2-289.8) minutes, mean daily screen-on bout duration was 4.233 (95% CI 3.565-4.902) and 4.998 (95% CI 4.455-5.541) minutes, mean daily screen-off bout duration was 25.90 (95% CI 20.09-31.71) and 26.90 (95% CI 22.18-31.66) minutes, and mean daily screen-on bout count (natural logarithm transformed) was 4.192 (95% CI 4.041-4.343) and 4.090 (95% CI 3.968-4.213), respectively; there were no significant differences between smartphone operating systems (all P values were >.05). The daily measures were not significantly different for the first 4 weeks compared to the fifth week onward (all P values were >.05), except average screen-on bout in adults (P value = .018). Our sensitivity analysis indicated that in the screen-on bout identification method, the cap on an individual screen-on bout duration has a substantial effect on the resulting daily screen time measures. We observed time windows with a statistically significant effect of daylight time change on screen-on time (based on 95% joint confidence intervals bands), plausibly attributable to sleep time adjustments related to clock changes. Passively collected phone logs offer an alternative to self-report measures for studying smartphone screen time characteristics in people with suicidal thinking. Our work demonstrates the feasibility of this approach, opening doors for further research on the associations between daily screen time, mental health, and other factors.

‘It provided me with a sense of safety that I hadn’t felt in weeks.’ A qualitative case study of service users’ experiences with sensory rooms in psychiatric inpatient units

Introduction Sensory rooms are environments designed to provide sensory input to help service users regulate arousal and manage distress. Sensory rooms are widely implemented in psychiatric inpatient units, but limited knowledge exists on how the sensory rooms are perceived by those who use them. This study investigated service users’ experiences with sensory rooms during admission. Methods A qualitative case study using semi-structured interviews conducted with 20 participants, admitted in acute, intensive, and open inpatient psychiatric units in Copenhagen, Denmark. Participants used the sensory rooms under guidance from occupational therapists or physiotherapists and were subsequently interviewed about their experiences. Interviews were transcribed and subjected to thematic analysis. Results Participants reported that being in the sensory rooms helped them to reconnect to their body and to experience peace of mind. Over time, participants used the sensory approaches to develop self-management strategies and enable participation in activities. Conclusion This study concludes that most of the participants had a positive experience in the sensory room under guidance from one of the unit’s physio or occupational therapists. Participants experienced increased physical and mental calmness in the sensory room and an increased sense of safety which made a difference during their admission and, for several of them, also in terms of their expectations for everyday life following their discharge.

'I Was too Tired to Show Compassion': A Phenomenological Qualitative Study on the Lived Compassion Fatigue Experiences of Nurses Working in Acute Inpatient Psychiatric Units.

Psychiatric nurses are at risk of experiencing compassion fatigue. Despite the economic, emotional and physical effects of compassion fatigue, it has not been sufficiently investigated in the field of psychiatric nursing, and the lived experiences of compassion fatigue, in particular, require further investigation using qualitative methods. The aim of this study was to examine the lived compassion fatigue experiences of nurses working in psychiatric clinics using a phenomenological approach. The study was conducted between December 2023 and February 2024 with 22 psychiatric nurses working in acute psychiatric clinics. Data were collected through individual, in-depth interviews, and analysed using Collaizi's seven-step descriptive analysis approach. Data analysis revealed four main themes and eight subthemes: (1) being a psychiatric nurse (multifaceted role and benefits), (2) tiredness (from traumatic effects to depersonalisation and emotional isolation), (3) causes of compassion fatigue (patient derived, system and working environment derived) and (4) coping methods (individual and expectations). Due to difficult patient profiles and adverse working conditions, psychiatric nurses experience compassion fatigue and may become desensitised to patient needs over time. Institutional support in the form of training for nurses on recognising and coping with compassion fatigue, as well as a safe and workload-balanced working environment, is essential.

Predictors of the length of stay in psychiatric inpatient units: a retrospective study for the Paris Psychiatry Hospital Group.

Shortening the length of hospital stay (LOS) has become a major challenge for psychiatric hospitals in reducing unnecessary costs and improving the patient healthcare experience. We investigated the key factors associated with a long psychiatric hospitalization. This was a retrospective study of 8,870 full-time psychiatric hospital stays (6,216 patients) in the Paris Psychiatry Hospital Group, with a discharge in 2022. We used machine learning tools and univariate and multivariate methods to explore the impact of demographic, pathway-related, and clinical variables on the LOS. LOS >30 days was associated with age >55 years {odds ratio [OR] =2 [95% confidence interval 1.7-2.3]}, admission from outside the sectorization zone [OR=1.2 (1.1-1.3)], admission via a psychiatric emergency unit [OR, 1.2 (1.1-1.4)], and some clinical severity markers, such as psychotic disorder diagnosis [OR, 1.5 (1.3-1.7)], mandatory care [request of a third party, OR, 2.5 (2.1-2.9); case of imminent danger, OR, 2.3 (1.9-2.7)], the presence of seclusion and mechanical restraint measures (highlighting the positive effect of restraint duration), the somatic comorbidity for female sex [OR, 1.4 (1.2-1.7)], and treatment resistance [OR, 1.4 (1.2-1.6)]. Conversely, LOS ≤30 days was associated with being in a relationship [OR, 0.6 (0.5-0.8)], admission during a travel-related psychiatric episode [OR, 0.5 (0.3-0.6)], and personality and behavior disorders [OR, 0.7 (0.6-0.9)]. We found no significant association for features such as sex and a lack of treatment compliance. To our knowledge, this is the first recent study to investigate and highlight the impact of factors related to various illness severity markers, medication adherence, and patient journeys on the length of psychiatric hospital stay. A better understanding of long-stay risk factors might be helpful for optimizing the allocation of medical resources and anticipating tailored therapeutic programs.

Unhoused patients admitted to inpatient psychiatry at an academic, safety-net hospital: a cross-sectional study

ABSTRACT Introduction: There is a lack of data regarding unhoused patients admitted to inpatient psychiatry in the United States. The authors describe demographic and diagnostic features of unhoused patients admitted to an acute psychiatric inpatient unit (PIU) at an academic, safety net hospital. Methods: This is a cross-sectional, retrospective chart review of 57,902 adult patients admitted to the hospital between January 1, 2018 and May 31, 2023. Eleven percent (n = 6304) were admitted to the PIU and were part of further subgroup analysis examining housing status and primary behavioral health diagnoses. Chi-square tests of independence were used to determine associations between categorical variables. Results: The proportion of patients admitted to the PIU who were unhoused (33%, n = 2065) was 3 times greater than the proportion of patients admitted to non-psychiatric inpatient units who were unhoused (11%, n = 5450). On the PIU, unhoused patients compared to housed patients were more likely to be male (67 and 51%), have a psychotic disorder (35 and 19%) or a substance-related disorder (19 and 8%), and were less likely to have a mood disorder (22 and 44%). Conclusion: Understanding demographic and diagnostic factors is important to develop effective interventions to address the needs of unhoused patients on a PIU.

Extended length of stay in an Australian private psychiatric hospital: an observational study of patient, clinical, and treatment characteristics

BackgroundPatient extended length of stay has been scarcely studied in Australian inpatient psychiatric units (IPUs). Previous research has focused on public IPUs, however, private IPUs also care for a large proportion of people with mental illness.ObjectivesThis study aimed to identify patient, clinical, and treatment characteristics associated with ELOS within a private IPU and compare these characteristics with those of public IPUs. It is hypothesised that patients with ELOS will have complex characteristics such as high unemployment status, multiple psychiatric diagnoses and physical health comorbidities.MethodThis cross-sectional study examined characteristics of ELOS in a private Australian IPU between 1st July 2018 and 30th July 2019. A retrospective patient file audit collected characteristics of ELOS patients.ResultsOf the 54 ELOS patients (M = 42.52 years [18.62]) admitted, the average LOS was 55.04 days (SD = 4.4 days). Most patients were female (77.8%), single (44.4%) and their income status was unemployed (25.9%), employed (24.1%) and pensioner (22.2%). The most prevalent psychiatric diagnoses were major depressive disorder (29.6%), eating disorder (24.1%), alcohol or substance use disorder (7.4%), and complex post-traumatic stress disorder (7.4%) respectively.ConclusionThis study highlights patient, clinical, and treatment characteristics prevalent among private inpatients with ELOS. Future research should examine whether these are distinct from admissions that are not prolonged, with the aim to identify and reduce ELOS, and improve patient recovery, hospital flow and capacity.

Pharmacotherapy and electroconvulsive therapy prescription for women with depressive and anxiety disorders in a psychiatric mother-baby unit.

The purpose of this study was to understand the pharmacotherapy and electroconvulsive therapy (ECT) prescription of women with depression and anxiety admitted to an Australian inpatient psychiatric mother-baby unit (MBU) and compare prescription to national clinical practice guidelines. A retrospective audit was conducted on women diagnosed with depression or anxiety admitted to a public psychiatric inpatient MBU from March 2017 to July 2019. Data was captured at three time points to assess demographic, clinical and pharmacotherapy treatment characteristics. Descriptive statistics were completed. Of the 74 women, 57 women had depression, with 73% prescribed Selective Serotonin Reuptake Inhibitors (SSRIs) and 14% provided ECT during admission. For women with anxiety (n = 17), 23% were prescribed a benzodiazepine with concurrent antidepressant prescription. SSRI prescription increased, with other antidepressant prescription up trending through admission. Atypical antipsychotic prescription was increased initially and trended downwards at discharge. This study explored the therapeutic armamentarium employed for the treatment of mothers admitted to an inpatient psychiatric MBU with depression and anxiety. The results point to the intricate prescribing practices in a naturalistic setting and highlight that prescribing practices were in line with national guidelines.

Evaluating Adolescent Patient Outcomes and Staff Member Injuries at a General Psychiatric Inpatient Unit.

Short-term pediatric psychiatric hospitalization is used to manage acute-crisis behaviors. Few studies have detailed their clinical model and key metrics such as patient behavioral health outcomes and staff experience. This study describes a model which emphasizes group therapy based on dialectical behavior therapy during brief inpatient stays (average length of stay of 8 days). The study variables assessed included patient symptoms of depression, anxiety, and anger at discharge, patient satisfaction, and staff safety. The program produced significant improvements in adolescent depression, anxiety, and anger, and patients reported high satisfaction with the services received. However, there was a high rate of staff injuries, correlated with staffing ratios and the time of day. The key findings from this study demonstrate the effectiveness of brief inpatient programs and highlight variables that may impact staff experiences on these units, which could serve as further discussion points to improve clinical care.

Evaluation of a Dialectical Behavior Therapy Didactic for Medical Trainees in an Acute Adolescent Inpatient Psychiatric Unit.

Dialectical behavior therapy (DBT) is an evidence-based treatment for patients with suicidality and emotion dysregulation. There is increasing evidence of using DBT in psychiatric inpatient units for youth. On inpatient units, the majority of treatment is provided by psychiatry trainees, often with limited therapy experience. The study's objective was to assess the impact of a 1-h weekly DBT training for a range of medical trainees rotating through a child and adolescent acute inpatient unit. Participants were 55 medical students, psychiatry residents, and child and adolescent psychiatry fellows who rotated on an inpatient unit for youth and participated in a 1-h DBT didactic. There was one group who attended less than four sessions and the other attended 5 or more sessions. A pre- and post-method design was used to collect data on participants' confidence, competence, and knowledge of DBT and working with suicidal youth. Comparing pre- and post-data for all participants, the DBT training was found to lead to significant benefits for trainees' comfort with therapy, prioritizing therapy during inpatient care, knowledge of DBT, comfort with DBT, and confidence in treating children and adolescents with suicidality. There were no significant differences in the type of trainee or dose of training. This study supports the benefit of a brief DBT didactic to provide training to a wide range of trainees to improve therapeutic care in an inpatient psychiatric unit for youth.

Staff Perspectives: Why are adolescent inpatients secluded and what causes changes in rates of seclusion on a unit?

The use of seclusion in Adolescent Inpatient Psychiatric Units is being heavily scrutinised due to its forceful nature and potential to cause harm. This study aimed to understand staff perspectives on reasons for seclusion in an Adolescent Inpatient Psychiatric Unit. A mixed methods approach that included the Attitudes to Seclusion Survey followed by a semi-structured interview on the reasons for seclusion was used. We recruited 31 participants who worked on the unit of which 27 were involved in seclusion. The findings showed that the majority of staff view seclusion as undesirable and believe it should only be used out of necessity. However, there was disagreement among staff about the reasons why adolescents were secluded and whether those reasons were justified. Staff identified factors that contributed to increases in seclusion but also provided several ways in which seclusion could be reduced. These findings highlight a need for precision on what constitutes justifiable use of seclusion to reduce the potential for misuse. It also shows opportunities exist for further reduction in seclusion through teamwork and communication.