Inpatient Psychiatry Research Articles

Identifying Gaps in Care Upon Discharge from Inpatient Psychiatry Settings to the Community

This literature review examines gaps in care within healthcare systems that negatively impact service users as they transition from inpatient psychiatric settings to community settings. Topics such as historical contexts, readmission rates, intrapersonal factors, and institutional limitations are taken into account to explain the complex relationship between community and inpatient psychiatric services and how they influence current gaps in care. Interventions to address these limitations are explored, which is aimed at examining different models of care and their subsequent impact on gaps in care. In these interventions, concepts such as continuity of care and therapeutic relationships are then proposed as vital factors when addressing gaps in care. Finally, this literature review suggests areas for future research to improve upon gaps in care.

Polypharmacy and anticholinergic burden scales in older adults: a cross-sectional study among psychiatric outpatients in a tertiary care hospital

IntroductionMental disorders are prevalent among older adults, often leading to the use of multiple medications, many with anticholinergic properties. Polypharmacy, common in this population, is a major contributor to anticholinergic burden, which is linked to cognitive and physical decline. This study investigates the relationship between polypharmacy and anticholinergic burden across seven anticholinergic burden scales in elderly patients attending the psychiatric outpatient.MethodsStudy was conducted at a psychiatry outpatient clinic at All India Institute of Medical Sciences, Rishikesh, India, from December 2021 to March 2023. Elderly patients (aged ≥ 60 years) who were on at least one psychotropic medication and had a primary working diagnosis of psychiatric illness were included. All psychotropic medications, including antidepressants, antipsychotics, mood stabilizers, and hypnotics, were evaluated. Anticholinergic burden scales were calculated by the respective tools. Univariate analysis was adopted to determine the factors that may affect polypharmacy.ResultsStudy included 1165 elderly patients aged ≥ 60 years. The prevalence of polypharmacy was 20.43% (n = 238). Clonazepam (n = 364, 17.28%), escitalopram (n = 197, 9.35%), metformin (n = 165, 7.83%), sertraline (n = 141, 6.69%), mirtazapine (n = 129, 6.12%), and lorazepam (n = 110, 5.22%) were among the most frequently prescribed anticholinergic drugs. Univariate analysis demonstrated that all anticholinergic risk assessment scales were closely correlated with polypharmacy, with the strongest association observed for the Anticholinergic Load Scale (ALS) (Odds Ratio = 4.3; p < 0.001). Polypharmacy was also positively associated with adverse drug reactions (Odds Ratio = 1.81; 95% Confidence Interval = 1.27–2.56).ConclusionThe anticholinergic burden in this cohort of elderly psychiatry patients was high, with 95.1% (n = 1108) experiencing a significant burden. Adverse drug events and anticholinergic burden scales were positively associated with polypharmacy, with a stronger correlation between polypharmacy and ALS scores than with other anticholinergic burden scales in older adults.

Predictive accuracy of the Violence Risk Assessment Checklist for Youth in acute institutions: A prospective naturalistic multicenter study.

Acute health and social services for children and adolescents often struggle with youth aggression and violence. Early identification of violence risk during institutional stay can help prevent violent incidents. As such, this study assessed the predictive accuracy of the Violence Risk Assessment Checklist for Youth (V-RISK-Y) aged 12-18 in two different juvenile settings providing 24-hour services for youth. Institutions were included from child and adolescent inpatient psychiatry and residential youth care under child protective services. A prospective, naturalistic observational study design was employed. V-RISK-Y was administered for youth admitted to four acute inpatient psychiatric units and four acute residential youth care institutions. Incidents of violence and threats during the youth's stay were registered by institutional staff. In total, 517 youth were included in analyses, 59 of whom were registered with at least one incident of violence or threats during their stay. Area under curve (AUC) and logistic regression analyses were used to assess predictive accuracy and validity of V-RISK-Y. For the overall sample, V-RISK-Y had good predictive accuracy, and the sum score of V-RISK-Y significantly predicted registered violent incidents. Stratified analyses indicated good predictive accuracy of V-RISK-Y for the inpatient units, but not for the residential youth care institutions. Findings imply that V-RISK-Y is accurate in identifying violence risk for youth admitted to inpatient psychiatric units but has limited predictive accuracy in residential youth care institutions. Future research should explore approaches to correctly identify violence risk in residential care settings.

Clinical Confidence, Certification, and Connectedness: Impact of a Journal Club for Inpatient Psychiatry Faculty.

Inpatient psychiatry faculty manage complex clinical, administrative, and legal issues amid increasing mental health service utilization rates, limiting time for (1) focusing on lifelong learning and (2) connecting. We examined the impact of a monthly journal club on inpatient psychiatry faculty's (1) confidence that their practice is evidence informed, (2) stress related to board recertification, and (3) sense of connectedness with peers. We employed a primarily qualitative approach using semi-structured interviews and brief survey questions to elicit input from inpatient psychiatry faculty at an academic medical center on their experience participating in a monthly journal club, including perceived changes in one's practice of evidence-based medicine, recertification stress, and connectedness with peers. Thirteen faculty who participated in the journal club responded to at least one survey or interview. Many faculty reported feeling more confident that their clinical practice was evidence informed, less stressed about board recertification, and more connected to peers at 6 and 12 months following the commencement of the journal club. Following in-person attendance, video-based learning (an innovative method of participating in the journal club) was found to be the second most preferred method of participation among respondents. All respondents noted that the journal club was a valuable use of their time and enjoyable. A monthly journal club has the potential to increase hospital psychiatry faculty confidence in evidence-based clinical practice, reduce board recertification stress, and improve sense of peer connectedness. Future research should examine the journal club experience and impact among a larger number of faculty and incorporate additional measures of learning outcomes.

Weapon use during the index offense: a study among forensic psychiatry patients in Ontario, Canada

BackgroundUnderstanding the nature and circumstances around the use of weapons to perpetrate an offense among individuals with mental illness is crucial for evidence-informed policies and actions. However, little is known about the prevalence and factors associated with weapon use during index offenses among patients in the forensic system. Therefore, the present study was designed to address this gap and determine the prevalence and the patient and victim characteristics associated with weapon use during the index offense in a Canadian province.MethodsThis retrospective exploratory study utilized data extracted from the Ontario Review Board reports of 2014/15. Data was analyzed using Stata, and logistic regression was employed to determine the factors associated with weapon use.ResultsApproximately half (48.11%) of the individuals included in this analysis (n = 819) used weapons during their index offense as an instrument of violence. Both patient-related and victim-related factors had a statistically significant association with weapon use during index offenses. Specifically, two patient-related factors (including a history of hospitalization prior to the index offense and diagnosis of personality disorder) were associated with lower odds of weapon use during the index offense. However, only prior hospitalization remained statistically significant after adjusting for victims’ factors. Victim-related factors were associated with both lower and higher odds of weapon use during the index offense. The highest odds of weapon use were found if the victim was an extended family member of the patient, followed by sibling, lover/partner/spouse, parent, and then adult acquaintance. The odds of weapon use during the index offense were lower if victims were healthcare workers, law enforcement professionals, and females when compared to adult strangers.ConclusionThe study highlights the significant role of both patients’ and victims’ characteristics as important factors associated with weapon use during index offenses among forensic patients. Notably, prior hospitalization emerged as a crucial factor with a reduced likelihood of weapon use. Implicitly, this underscores the importance of risk mitigation strategies.

Corrosion of care and disempowerment in acute psychiatry: As seen from the positions of therapists and suicidal patients.

For people in suicidal crisis, referral to a psychiatric hospital is common. However, acute psychiatry is characterized by a lack of resources in terms of time and beds, making it challenging for therapists to provide person-centered care. In this qualitative study, we explored the experiences and positionings of therapists and suicidal patients in an acute psychiatric ward in Norway. We generated data through participatory observation and interviews with therapists and patients and analyzed the material using principles from Systematic Text Condensation supplemented with an analysis from a Positioning theory perspective. We developed two themes: Therapists positioned as professionals with authority in a context with restricted action radius, and Patients in suicidal crisis positioned as medical subjects with limited influence. In this resource-limited context, therapists managed their work and obligations by simplifying the patient's suffering and suicidality and by emphasizing medical aspects. Ensuring an efficient patient flow was a high priority. The therapists' authority and actions were closely connected to how patients were positioned and their experiences of the care. Positioning theory provides new perspectives for understanding the power imbalance in the positions of therapists and patients. The findings provide insights into acute inpatient psychiatry as a normative field where the choices and actions of both therapists and patients are restricted. In that sense, both patients and therapists can feel powerless. The findings point to significant limitations in the acute mental health care of people in suicidal crisis.

Community Psychiatry Clinic’s Impact on Dementia Care: Insight from Rythm Community Mental Healthcare Program

AbstractBackgroundDementia, a major concern in India (1‐10% prevalence), is challenging, particularly in rural areas with a significant treatment gap. Community psychiatry offers a promising solution, aiming to provide essential dementia care in underserved rural India, reflecting innovative approaches to extend mental health services equitably.MethodsThis study, employing a descriptive approach, examines the impact of Rythm community psychiatry clinics, an initiative by IQRAA International Hospital and Research Centre, on dementia care. The analysis focuses on key community activities, volunteer roles, provided services, and the engagement of Community‐Based Organizations (CBOs).ResultsSince August 2022, among the 8 Rythm community clinics with a total of 298 psychiatry patients, 4 clinics specifically address dementia cases. In these 4 clinics, 29 dementia cases were identified in the community, ranging in age from 68 to 95 years, with an average age of 77.5 years. Of the 29 cases, 25 were females, and 4 were males, resulting in a male‐to‐female ratio of 1:6. A post‐retirement group in Kodencherry, a CBO, alone identified 17 out of the total 29 cases, constituting 58% of the total. Nearly 90% of patients are under homecare follow‐up due to mobility restrictions, while the rest utilize clinic‐based consultations. Two rural community clinics also serve tribal patients with dementia. Dementia causes vary, including Alzheimer’s, vascular dementia, and Parkinson’s disease. Targeted case‐finding approaches effectively identify dementia cases early in the community through trained community volunteers, leading to referrals to community clinics and home‐based consultations. Caregiver education, behavioral management, symptomatic relief, psychological services, and specialist referrals contribute to comprehensive community‐level dementia care. Medications such as Donepezil, Memantine, Quetiapine, and Melatonin are employed based on symptom profiles, with Quetiapine being a commonly used antipsychotic. The results indicate a reduction in caregiver burden, fewer hospital admissions, increased access to primary and behavioral care, early case detection, referrals, and improved community awareness, subsequently reducing stigma surrounding dementia.ConclusionCommunity psychiatry clinics significantly impact dementia care by offering targeted case identification, caregiver education, and comprehensive services, ultimately contributing to improved community‐level dementia care and awareness.

Institutional Betrayal in Inpatient Psychiatry: Effects on Trust and Engagement With Care.

Patients' experiences of inpatient psychiatry have received limited empirical scrutiny. The authors examined patients' likelihood of experiencing institutional betrayal (harmful actions or inactions toward patients) at facilities with for-profit, nonprofit, or government ownership; patient-level characteristics associated with experiencing institutional betrayal; associations between betrayal and patients' trust in mental health providers; and associations between betrayal and patients' willingness to engage in care postdischarge. Former psychiatric inpatients (N=814 adults) responded to an online survey. Data were collected on patients' demographic characteristics; experiences of institutional betrayal; and the impact of psychiatric hospitalization on patients' trust in providers, willingness to engage in care, and attendance at 30-day follow-up visits. Participants' responses were linked to secondary data on facility ownership type. Experiencing institutional betrayal was associated with less trust in mental health providers (25-percentage-point increase in reporting less trust, 95% CI=17-32), reduced willingness (by 45 percentage points, 95% CI=39-52) voluntarily undergo hospitalization, reduced willingness (by 30 percentage points, 95% CI=23-37) to report distressing thoughts to mental health providers, and lower probability of reporting attendance at a 30-day follow-up visit (11-percentage-point decrease, 95% CI=5-18). Participants treated at a for-profit facility were significantly more likely (by 14 percentage points) to report experiencing institutional betrayal than were those treated at a nonprofit facility (p=0.01). Institutional betrayal is one mechanism through which inpatient psychiatric facilities may cause iatrogenic harm, and the potential for betrayal was larger at for-profit facilities. Further research is needed to identify the determinants of institutional betrayal and strategies to support improvement in care quality.

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.

Mental health disorders before, during and after the COVID-19 pandemic: a nationwide study.

The COVID-19 pandemic and lockdowns prompted a major concern for mental health effects. Comprehensive nationwide studies are lacking on the indirect effect of the COVID-19 pandemic on the population's mental health. We aimed to determine whether the COVID-19 pandemic and lockdowns affected mental health service usage, suicide attempts, and suicides. This comprehensive nationwide register-linked study followed all individuals in Denmark from 1990. The main outcomes were rates of psychiatric admissions, use of psychotropic medication, suicide attempts, suicides, patients in community-based private psychiatry or psychology practices, and referrals to psychiatric hospitals. The impact of the pandemic (March 11, 2020-June 30, 2023) and lockdowns was assessed with log-normal models adjusted for pre-pandemic trends (January 1, 2017-March 10, 2020). We reported Rate Ratios (RR) of the observed and counterfactual rates. We identified the 5 807 714 (50.3% females) individuals living in Denmark on March 1, 2020. The rates of psychiatric admissions (RR: 0.95, 95% Confidence Interval (CI): 0.91 to 0.99, p-value: 0.017) and suicide attempts (RR: 0.85, 95% CI: 0.76 to 0.95, p-value: 0.007) were lower during the pandemic compared to the pre-pandemic trend. The rates of suicides (RR: 0.89, 95% CI: 0.75-1.05, p-value: 0.173), patients in private practices (RR: 1.00, 95% CI: 0.96-1.04, p-value: 0.986), and referrals (RR: 1.06, 95% CI: 0.95-1.18, p-value: 0.307) were not significantly different during the pandemic compared to the pre-pandemic trend. During the first lockdown, rates were lower for psychiatric admissions (RR: 0.85, 95% CI: 0.80 to 0.90, p-value <0.001), suicide attempts (RR: 0.80, 95% CI: 0.69 to 0.94, p-value: 0.007), suicides (RR: 0.67, 95% CI: 0.52 to 0.86, p-value: 0.002), patients in private practices (RR: 0.88, 95% CI: 0.82 to 0.93, p-value <0.001), and referrals (RR: 0.69, 95% CI: 0.60 to 0.81, p-value < 0.001) compared to the pre-pandemic trend. However, during the pandemic, the rate of psychotropic medication users increased by 6% compared to the pre-pandemic trend (RR: 1.06, 95% CI: 1.05 to 1.06, p-value < 0.001). The COVID-19 pandemic and lockdowns did not severely influence pre-pandemic trends of the mental health burden in Denmark's population on a nationwide level.

The relational institution: an ethnographic study of recovery orientation and relational engagement on a psychiatric rehabilitation ward in London

BackgroundIn the UK, inpatient psychiatric rehabilitation services for complex psychosis aim to provide recovery-orientated treatment to patients, with the goal of supporting sustained stepdown into community living. The extent to which rehabilitation services uphold this recovery orientation is associated with better outcomes. However, few studies have been able to ascertain what promotes or prevents recovery orientation in inpatient settings.MethodsWe conducted an ethnographic study of treatment on a National Health Service (NHS) psychiatric rehabilitation ward in London over six months during August 2022-February 2023. Data were collected through participant observation and semi-structured interviews with 9 patients and 14 staff members. Fieldnotes and interview transcripts were analysed using situational analysis.ResultsOur analysis highlights the importance of what we term ‘relational engagement’ between staff and patients to nurture and sustain recovery-orientated treatment. This relational engagement was embodied through small acts of genuine human connection grounded in mutual acceptance and affective bonding; close attention to detail that communicated curiosity and respect; and recognition, appreciation, and encouragement of the slow and gradual progress that characterises recovery in complex psychosis. Yet, this relational engagement was often limited or foreclosed by the social environment of the ward and the wider institutional context. Limiting elements included the dominance of hospital logics geared towards high-throughput acute treatment and risk management; the presence of audit culture that led to a level of standardisation curtailing more genuine human connection; and staff demoralisation driven by events on and off the ward, including system-wide crises and more localised conflicts and disturbances. Some of these conflicts involved discrimination, most prominently anti-Black racism and homophobia, reflecting wider structural inequalities that characterise inpatient psychiatric populations and the healthcare workforce.ConclusionRelationships, often under-prioritised in mental health services, were a key cornerstone of recovery-orientated treatment on a psychiatric rehabilitation ward. The shaping of therapeutic relationships amounted to an active process of relational engagement, which may be afforded or constrained by complex social elements requiring careful consideration in inpatient psychiatry. These social elements go beyond more surface-level factors such as staff training, knowledge, or attitudes and may require structural and system-level interventions.

Seven Identities Co-existing, A Noteworthy Manifestation of Complex Childhood Trauma: A Case Report

Background Childhood trauma increases the risk for psychiatric disorders such as Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD), Depersonalisation/Derealisation disorder (DDD), Post-Traumatic Stress Disorder Dissociative Type (D-PTSD), and Borderline Personality Disorder (BPD). Children who experience prolonged stress, trauma, or abuse during developmental years of growth and change have a wide range of outcomes. Case Presentation We report a case of a 22-year-old female with a significant history of physical abuse and sexual assault who initially presented to the hospital for suicidal ideation with a stated plan. During the patient’s stay at the hospital, we encountered two of the six alternate identities of the patient. The patient revealed she experiences all 7 identities (her true self plus 6 alters) in parallel, recalls the events of each alter, and can intermittently switch between identities; all rare features of dissociative disorders. Conclusion Given our patient’s extensive history of trauma, previous psychiatric diagnoses, and current dissociative presentation, we conclude that a diagnosis of OSDD and defence mechanisms of dissociation and regression may be appropriate. The patient was discharged with clomipramine for Obsessive-Compulsive Disorder and mood, lurasidone for mood, mirtazapine for mood, insomnia, and appetite stimulation, clonidine for nightmares and Postural Orthostatic Tachycardia Syndrome (POTS), fludrocortisone for POTS, gabapentin for Generalized Anxiety and fibromyalgia, and levothyroxine for hypothyroidism, and counselled to follow up with an outpatient therapist specialising in trauma. This case highlights the impact that childhood physical, sexual, and emotional trauma can have on one’s psychiatric presentation and the complexity of diagnosing dissociative presentations in an inpatient psychiatry setting.

Managing the risk of suicide in a psychiatry clinic: An ethnographic study on the work atmosphere of nurses during the Covid-19 pandemic

The aim of this study was to describe the approaches of nurses working in an inpatient psychiatry clinic during the pandemic period to managing suicide risk in the context of their work atmosphere. This ethnographic research design used a sample of 13 psychiatric nurses in a psychiatric clinic in Ankara, Turkey. Data were collected with in-depth interviews and 612h of observation. Qualitative thematic analysis was used for data analysis. Two themes emerged from the data analysis, including ‘De-prioritizing the uniqueness of the patient in managing suicide risk’ and ‘A condition that remains important for uniqueness: personality disorders’. The current risk assessment methods for suicide, pandemic measures, and past inadequacies in the approach to patients with personality disorders have revealed the risk of alienating from the individual risk factors as well as the patients' history in risk management. Risk management practices that consider the psychosocial assets of patients at risk of suicide, addressing the risk level with a safe measurement scale and performing triage according to this grading system can provide an atmosphere that allows nurses to make risk assessments greater self-confidence.

7173 Cabergoline Induced Psychosis in a Patient with no Previous History of Psychiatric Disorder

Abstract Disclosure: B. Aryal: None. K. Kim: None. A. Shafi: None. M. Ganesh: None. Introduction: Cabergoline is a dopamine agonist (DA) used to treat prolactinomas. It is well established that DAs may cause psychotic symptoms. However, very few cases report cabergoline-associated psychosis in patients without personal or family history of psychiatric disorders. We report a rare case of cabergoline-induced psychosis in a patient with a prolactinoma without any underlying psychiatric disorder, which was managed with the addition of olanzapine. Case: A 41 year old male with no history of psychiatric disorder was started on cabergoline 0.5mg twice a week for a newly diagnosed prolactinoma. 4 weeks later, he presented to the emergency room for aggressive behavior and confusion for the past 2 weeks. He endorsed visual and auditory hallucinations. Cabergoline was discontinued. During hospitalization, he attempted suicide and required 1:1 observation. He was started on olanzapine per the inpatient psychiatry team. Surgical resection of the prolactinoma was considered given his acute psychosis associated with cabergoline. However, complete resection of the tumor was deemed impossible given encasement of the internal carotid arteries. After discussion with the patient, he underwent re-challenge with cabergoline 0.25mg weekly while on olanzapine under 1:1 observation in the ICU. He was monitored for 2 weeks and eventually discharged home on cabergoline 0.25mg twice a week and olanzapine with improvement in prolactin levels to 4973.7 ng/mL after 4 weeks. He continued to remain free of psychotic symptoms upon follow up as an outpatient. Discussion: Psychosis is a rare side effect of DA mediated via D2/D3 receptors in the mesocortical and mesolimbic pathways. Several cases report psychosis associated with cabergoline in patients with a history of psychiatric disorders. However only one case reports de novo psychosis. Our patient developed severe psychosis while on low-dose cabergoline for 4 weeks. This rare case of de novo cabergoline-associated psychosis re-emphasizes that psychosis may occur regardless of previous history of psychiatric disorder and independent of the dose or duration of cabergoline. Treatment of a prolactinoma in the setting of cabergoline-associated psychosis requires a multidisciplinary approach. Alternative treatment of surgical resection was considered for our patient. However surgical resection was not plausible given difficult surgical anatomy. Therefore he was monitored closely to re-initiate cabergoline while on olanzapine. Several cases report successful use of clozapine, aripiprazole, and quetiapine for patients with psychiatric symptoms while on cabergoline. Patients who are on cabergoline should be closely monitored for any psychotic symptoms. Further studies are warranted to identify patients at risk of developing psychosis while on cabergoline to tailor an individualized approach to therapy and monitoring. Presentation: 6/2/2024

A Retrospective Study of Pattern of Abnormal Findings in Routine Screening Investigations Done of Psychiatry Inpatients in Tertiary Care Teaching Hospital

Abstract Introduction: Physical comorbidity in persons with mental illness is a rule rather than exception. Hence, regular screening investigations in psychiatry inpatients help to detect physical illness at early stage. Aims and Objectives: The aim of this study was to evaluate the results of various screening investigations, referral patterns, and physical comorbidities in psychiatric inpatient records. Methodology: This was a descriptive, analytical, record-based study conducted in the psychiatry department of a tertiary care teaching hospital, wherein case notes of all inpatients admitted to the psychiatry unit during 6 months (January–June 2023) were studied. Inpatient records were evaluated for sociodemographic details, indication for admission, investigations as needed, any physical comorbidity, treatment history, referral patterns, and their outcomes. Records with incomplete details and known physical illnesses mentioned were excluded. Results: Total 100 patients’ records (63 males; mean age = 35 years, 37 females; mean age = 41 years) were included in the study. The common diagnosis was mood disorder 36% (n = 36), followed by substance use disorder 30% (n = 30) and schizophrenia 22% (n = 22). On evaluating investigations, abnormalities found were anemia, diabetes mellitus, hypertension, and thyroid disease (42% [n = 42/100], 24% [n = 24/100], 22% [n = 22/100], and 22% [n = 22/100], respectively). Magnetic resonance imaging (MRI) brain changes were seen in 75% of patients with acute behavior disturbances (n = 4) and MRI spine changes in all major depressive disorder patients presented with backache (n = 4). Ultrasonography abdomen findings were abnormal in 68% (n = 26/38), of which 80% (n = 21/26) had substance use disorder. For the management of abnormal findings, the referral consultation rate was 76% (n = 76/100); 86% (n = 66/76) of patients required more than one consultation with total 154 referrals. Conclusions: The investigations as indicated help in early detection and management of physical illness which mostly remains out of sight due to psychiatry illness.

Psychiatrists' Experiences, Training Needs, and Preferences Regarding Prescription and Management of HIV Pre-exposure Prophylaxis (PrEP) Within Psychiatric Care.

People living with mental illness (PLWMI) experience a disproportionate prevalence and incidence of HIV. Preventing HIV among PLWMI is a priority for multiple domestic public health agencies. As key clinicians for this group, psychiatrists may have an important role to play in increasing PrEP use among PLWMI. A national survey of psychiatrists (N=880) about integrating PrEP prescription into psychiatric practice was conducted between November 2022-October 2023. Specifically, we inquired about experiences with PrEP prescription, patient request for PrEP, and interest in prescribing PrEP. We also inquired about barriers to PrEP prescription in psychiatry and preferred models for implementing PrEP prescription in psychiatry. We found that 19.3% of psychiatrists had received a request for PrEP from a patient, 17.3% had prescribed, and 53.9% were interested in prescribing. The greatest percentage of psychiatrists who prescribed PrEP were practicing primarily in inpatient psychiatry (28.8%). Practicing in one of the federal Ending the HIV Epidemic (EHE) priority jurisdictions (aOR=2.08 [1.23-3.54], p=0.003) and greater self-confidence in PrEP-related tasks (aOR= 2.10 [1.67-2.65], p<0.001) were associated with higher likelihood of PrEP prescription. Limited knowledge of PrEP was the barrier endorsed by the greatest percentage of psychiatrists (76.3%). Most preferred a hypothetical model in which a psychiatrist prescribed an initial course of PrEP with prompt primary care or infectious disease follow-up (63.1%). Most psychiatrists were interested in prescribing PrEP. Training is needed to enable PrEP implementation in psychiatric practice including development of collaborative practice models to engage psychiatrists across a diversity of settings.

Characterising the nature of psychiatric disorders and patterns of antipsychotic medications prescribed in a psychiatric ward in a public hospital in Tasmania.

We present an evaluation of antipsychotic prescribing in an inpatient psychiatry ward in Hobart, Tasmania, to establish pattern of use, alignment with other psychiatric wards orcentres and the recommendations in the Royal Australian and New Zealand College of Psychiatry Clinical Practice Guidelines, and to determine predictors of polypharmacy. A descriptive cross-sectional survey design was used. Data from 118 patients discharged from the Royal Hobart Hospital (RHH) Mental Health Inpatient Unit between 01/02/2021 to 01/08/2021 were evaluated. Antipsychotic polypharmacy (APP) was observed in 40% of patients. When low doses of adjunctive ('PRN') use of olanzapine and quetiapine were excluded, the APP proportion was 35%. APP was predicted by age and by a schizophrenia diagnosis. Long-acting injections (LAIs) were used in 46% of the patients. The most common LAI was risperidone (52%). Average daily dose of antipsychotic at the time of discharge was 529mg chlorpromazine (CPZ) equivalents. High dose antipsychotics (more than 1000mg CPZ equivalents per day) was observed in 13% of the patients. The observed prescribing practice is consistent with other clinical settings. Antipsychotic prescribing practice should, however, continue to be monitored to ensure adherence to best practice guidelines.

Interventions for smoking cessation in inpatient psychiatry settings.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. To assess whether the effects of smoking cessation interventions differ according to psychiatric diagnosis or type of intervention or comparator condition.

A qualitative study examining medical students′ expectations of psychiatric inpatient and intensive care settings

Background There is limited literature to date regarding medical students’ expectations of the psychiatric inpatient environment. This study aims to explore what medical students expect from psychiatric wards and psychiatric intensive care units prior to their placement. Psychiatric intensive care, arguably the most intense experience students will have in psychiatry, was used to highlight the full extent of student preconceptions. Methodology: Students were invited to complete a semi-structured questionnaire over a six-month period, from July to December 2021. Questions explored emotions prior to placement, expectations of the ward atmosphere, layout, patient behaviour and care strategies. 37 responses were received. Analysis followed the well-recognised six stages of thematic analysis. Results: Five themes emerged from the data: (1) Mixed feelings about placement; (2) Varied views about patient behaviour and illness; (3) Restrictive and controlled practice; (4) Similarities to acute general hospital care; (5) Care with empathy and compassion. Some of the expectations of students were markedly different to the reality of psychiatric inpatient and intensive care settings, with ideas of patients being physically restrained, unconscious and attached to ventilators. Conclusion: This study offers a unique insight into what medical students expect from psychiatry inpatient and intensive care settings, an issue that all clinicians who have student contact should be aware of. Results can better inform student preparation and placement supervision, leading to more meaningful learning and improved wellbeing.

Analysis and Determinants of Restraint Practices in Psychiatry Inpatients from a Tertiary Care Hospital in India: A Retrospective Study

Background: Restraint practice has been employed in psychiatry setting to manage patients with risk of aggression and violence. The restraint practice is also linked with the ethical, legal, and human rights of individuals and regulation has seen policies and laws on it across the globe. It is critical to assess the factors associated with restraints and its relationship with clinical variables in the Indian scenario. Materials and Methods: It was a retrospective chart review design study. It was conducted in the psychiatry department of a tertiary care hospital. The duration of the study considered from January 2024 to October 2024. We have considered purposive sampling (n = 68). We have included all patients with h/o restraints in ward stay will be included (restraint register) and excluded ward patients with no h/o any restraint and those with h/o medications given for sedation but not restraint. Results: This hospital has a 9.25% prevalence of restraint use. The main diagnoses found were alcohol use disorder presenting with delirium tremens (46.9%), mood disorder with manic or mixed episode (31.3%), schizophrenia and schizoaffective disorder (9.4%), other psychotic disorder (9.4%), and severe depression with psychotic symptom (3.1%). The main reasons for restraint were agitation/disorientation (46.9%), actual violence (46.9%), and threats of violence (6.3%). Conclusion: According to this study, receiving chemical and/or physical restraint was more frequently linked to male gender, young age, lower and middle socioeconomic status, alcohol use disorder diagnosis presenting with delirium tremens, and mood disorders presenting with mania or mixed episodes.