Inpatient Psychiatry Research Articles

Asymptomatic Urinary Tract Infection Treatment in Adults Admitted to Inpatient Psychiatry: A Retrospective COHORT study.

Introduction: Treatment of asymptomatic bacteriuria remains prevalent despite recommendations against treatment in most patient populations. Rates of asymptomatic treatment of urinary tract infection (UTI) has not been thoroughly evaluated within the inpatient psychiatry population. The objective of this study is to describe the rate of antibiotic use for the treatment of asymptomatic UTI in psychiatric inpatients and investigate factors contributing to overuse. Methods: This IRB approved retrospective cohort study evaluated adults admitted to inpatient psychiatry from May 1, 2021 to May 1, 2022 that received an antibiotic for UTI. The primary outcome assessed the rate of asymptomatic treatment, defined as treatment without urinary symptoms. Secondary outcomes evaluated most frequently prescribed antibiotics, determined the impact of altered mental status (AMS) on treatment, and correlated the incidence of UTI treatment with primary psychiatric disorder. Results: One hundred nine patients were identified and 61 were included for analysis. The rate of asymptomatic treatment for UTI was 84%. The most prescribed antibiotic was nitrofurantoin (48%). All patients with AMS (23%) were asymptomatic. Altered mental status did not significantly impact the rate of empiric treatment (P = .098). Primary psychiatric disorder did not significantly impact rate of empiric treatment for UTI (P = .696). Common disorders in this population were depression, schizophrenia, and bipolar disorder with rates of asymptomatic treatment of 79% (n = 19), 87% (n = 13), and 78% (n = 7), respectively. Discussion: Frequent asymptomatic treatment of UTI was identified in this inpatient psychiatry population. These results emphasize the need for antibiotic monitoring and stewardship in this setting.

Neuroleptic Malignant Syndrome in a Patient with Autism Spectrum Disorder: Case Report

Neuroleptic Malignant Syndrome (NMS) and Malignant Catatonia (MC) are conditions with significant overlap and are classically characterized by autonomic dysfunction, rigidity, bradyreflexia, posturing, lead-pipe rigidity in the former and waxy flexibility in the latter, stereotyping, an increase in creatinine kinase, and/or leukocytosis. Onset after inciting factor ranges from days to weeks, as does resolution with appropriate treatment. The overlap in symptomatology with Autism spectrum disorder (ASD) presents a formidable diagnostic challenge in a situation that must be parsed out with alacrity and accuracy. An 18-year-old male with a history of ASD, developmental delay with limited verbal use (functional age of approximately 5 years), and intermittent explosive disorder initially presented to an outside inpatient psychiatry hospital for worsening agitation that had spanned several weeks. At the outside facility trazodone, haloperidol, and clonazepam were added to his usual home regimen of valproic acid and escitalopram. Over the course of the next two weeks, he developed lethargy, tachycardia, and hypertensive emergency at which point he was transferred to our medical center’s Emergency Department. Due to concern over infection vs NMS/MC, an initial treatment plan consisted of: strict avoidance of all antipsychotics, scheduled acetaminophen for antipyretic care, 100 cc/hr IV fluids for rhabdomyolysis, a respiratory PCR panel, blood cultures, lorazepam 2 mg IV q6h, valproic acid 250 mg IV BID PRN for agitation, and discontinuation of patient’s home escitalopram. As patient was scoring positively for catatonia per Bush-Francis rating scale with scores of up to 20 and notable for marked tremulousness, myoclonic movements, rigidity with negativism, waxy flexibility, gegenhalten, and fever, the psychiatry service recommended starting a bromocriptine trial of 2.5 mg PO every 8 hours due to worry for progression to NMS/MC due to the antipsychotics he had received at the outside psychiatric facility. After down-titrating the bromocriptine dose as his symptoms resolved and up-titrating to doses as high as 7.5 mg every 6 hours when fever and concern for lead-pipe rigidity developed over a week after his symptoms had initially resolved, after nearly a month our patient was able to successfully be titrated down to a home regimen of lorazepam 1 mg at bedtime for the next 6 months. What made this case particularly unique (other than NMS/MC and ASD sharing many characteristics) were the many logistical hurdles that had to be navigated: first, our institution does not have an in-house Medicine-Psychiatry floor or electroconvulsive therapy (ECT), the definitive treatment for NMS/MC; second, there were neither adult nor pediatric inpatient Medicine-Psychiatry facilities in our state equipped with ECT that were willing to accept our patient as a transfer due to his developmental and physiological age, respectively. This case demonstrates the significant overlap in NMS/MC and ASD, illustrates the importance of recognizing these parallels so that appropriate treatment may be initiated (e.g., knowing one’s patient very well before making the decision to treat catatonia presenting as agitation in ASD with antipsychotics), and brings to light the stark reality of logistical challenges in medicine. Our patient’s symptoms resolved with bromocriptine and lorazepam and he tolerated the taper without complications.

The Social Media Trend of TikTok Tics: The Rise of Functional Tic-like Disorders During the COVID Pandemic

Alicia (fictional patient name) was a 14-year-old female admitted to the inpatient child psychiatry unit due to suicidal ideation and a complex past psychiatric history that included self-harming behaviors, depression, and anxiety. During the hospitalization, the patient was seen irregularly jerking her arms, bobbing her head, and making vocalizations that included whistling and swearing. She had not been previously diagnosed with tics, and her parents explained these were new phenomenon. Her mother worried that Alicia had developed Tourette’s syndrome (TS). During this time, TikTok videos with the hashtag #tourettes were trending. Popular influencers, with millions of likes, filmed themselves with their “Tourette’s”, with movements including arm and head jerking, as well as sudden vocalizations, all perfectly matching what Alicia was exhibiting.

6.45 A Qualitative Study of Trends in Restraints and Seclusions by Patient Race and Ethnicity on an Adolescent Inpatient Psychiatry Unit

6.45 A Qualitative Study of Trends in Restraints and Seclusions by Patient Race and Ethnicity on an Adolescent Inpatient Psychiatry Unit

1.30 Psychiatric Diagnoses and Clinical Characteristics of Asian American Youth Admitted to a New York City Child and Adolescent Psychiatry Inpatient Unit

1.30 Psychiatric Diagnoses and Clinical Characteristics of Asian American Youth Admitted to a New York City Child and Adolescent Psychiatry Inpatient Unit

Factor analysis and validation of the Bush Francis catatonia rating scale-Spain version

Background and objectivesThe aim of this study was to assess the reliability and validity of the Bush Francis Catatonia Screening Instrument and Bush Francis Catatonia Rating Scale Spain Version (BFCSI-SV and BFCRS-SV) using the ICD-11 and DSM-5 diagnostic criteria as well as other catatonia scales. MethodsOne hundred patients were admitted to the inpatient psychiatry unit at Hospital Universitari Germans Trias I Pujol and two psychiatrists administered the BFCRS-SV to the first 10 patients to assess inter-rater reliability. The BFCRS-SV, BFCSI-SV, Modified Rogers Scale (MRS), Abnormal Involuntary Movement Scales, Barnes Akathisia Rating Scale, and Modified Simpson-Angus Scale were then employed. ResultsThe results showed that 27% of patients had catatonia using the DSM-5 diagnostic criteria. Additionally, 51% of patients had 2 or more BFCRSI-SV items (Sensitivity: 100%; Specificity: 67.12%). The alpha coefficient values were 0.80 and 0.84 for the BFCSI-SV and BFCRS-SV, respectively, and the intraclass correlation coefficient values were 0.902 and 0.903. The area under the ROC curve was 0.971 and 0.96, and the instruments had a strong positive correlation with the DSM-5 score, ICD-11 score, and MRS. The study identified a three-factor model comprising the inhibition, excitement, and parakinetic dimensions. ConclusionsOverall, the results suggest that the BFCSI-SV and BFCRS-SV are valid and reliable tools for the diagnosis of catatonia, especially when using a cut-off score of 5 or higher for the BFCSI-SV and 7 or higher for the BFCRS-SV.

The transition to Schizophrenia spectrum disorder from a first psychotic episode that did or did not appear to be induced by substance use

The first years following a first-episode psychosis (FEP) are crucial. This retrospective cohort study investigates the evolution of first-episode psychosis (FEP), including substance-induced psychosis (SIP), and explores factors influencing the diagnostic conversion to Schizophrenia or Schizophrenia Spectrum Disorders (SSD). Diagnoses of patients discharged from Basurto University Hospital's inpatient psychiatry unit between January 2002 and December 2016 were reviewed. Sociodemographic, clinical, and substance use data, including cannabinoids, opioids, amphetamines, cocaine, and alcohol, were collected. The analysis utilized descriptive statistics, Kaplan-Meier survival curves, and Cox regression. Among 341 patients, 64.8% were male, with a mean age of 33.8 years. Psychiatric family history was present in 33.4% of cases, and cannabis was the most commonly used substance (78.9%). Of the patients, 52.8% received subsequent diagnoses of Schizophrenia or SSD, with 86.9% of these cases occurring within the first five years. No significant differences were observed between patients diagnosed with SIP and other diagnoses in terms of sociodemographic, clinical characteristics, or progression to Schizophrenia or SSD. However, use of cannabis (compared to use of another substance or polysubstance use) was associated with a higher risk to conversion (HR 1.96; p = 0.001). These findings underscore the importance of addressing substance use and treatment adherence in FEP.

Forensic psychiatry patients, services, and legislation in Nunavut and Greenland

Circumpolar regions face unique challenges in establishing and maintaining mental health care systems, including forensic psychiatry services. The scarcity of data and lack of evidence concerning the forensic psychiatry patient (FPP) populations of Nunavut and Greenland exacerbates the challenges of informing best practices and healthcare planning.By comparing the prevalence of forensic psychiatry patients, the mental health care services, and the legislation in these two relatively similar but unique regions, insight may be gained that can help inform healthcare planning.This cross-sectional study includes all forensic psychiatry in- and outpatients in one year from Nunavut (2018) and on February 29, 2020, in Greenland.The Greenland sample (n = 93) was nearly four times larger than the Nunavut sample (n = 15) at the population level. Despite considerable differences in forensic legislation and service supply, the forensic psychiatry patients in the two areas share several similarities. A total of 87% (n = 13) in the Nunavut sample were diagnosed with a DSM-5 schizophrenia spectrum disorder or other psychotic disorder. In Greenland, 82% (n = 76) were diagnosed with an ICD-10 F2 diagnosis (schizophrenia, schizotypal and delusional disorders). Approximately 2/3 of the patients in both populations were diagnosed with substance use disorder, and 60% of the Nunavut FPP received long-acting antipsychotic injections versus 62% in Greenland. Nearly half of the FPPs in both populations had never been convicted prior to entering the forensic psychiatry system; Nunavut 45% versus Greenland 47%. A substantial proportion of Greenlandic FPPs were outpatients compared to Nunavut (83% versus 47%).This study is an essential first step toward describing a Model of Care for forensic psychiatry patients in circumpolar regions; furthermore, the clinical similarities between the two populations provide support for future joint Arctic research and the inclusion of artic forensic patients in international studies.

Eligibility of emergency psychiatry patients for clinical trials studying depression

BackgroundDifferences often exist between people with depression who are eligible for clinical trials and those seen in clinical practice. The impact of exclusion criteria on eligibility has been previously reported for inpatients and outpatients, but has not been assessed for emergency psychiatry patients; a group that overlaps with inpatients and outpatients but also has important distinctives. Understanding the frequencies of commonly used exclusion criteria in this population could inform interpretation of existing data (generalizability) and highlight opportunities/needs for future trials. MethodsWe reviewed 67 clinical trials studying depression using Qualitative Content Analysis to identify common and recurring exclusion criteria. We examined the frequency of these exclusion criteria among a clinical sample of emergency psychiatry patients. ResultsMost clinical trials had exclusions for basic research requirements, age, symptom severity, psychosis, and substance use. Applying 9 commonly used exclusion criteria to the clinical population resulted in a 3.3 % eligibility rate (95 % CI 1.2 %–7.0 %). Exclusions for psychosis (85.1 % of trials), substance use (83.6 % of trials), and suicide risk (65.7 % of trials) would likely exclude 93 % of emergency psychiatry patients. The prevalence of psychosis, substance use, and suicide risk was much higher among emergency psychiatry patients than among previously studied populations. LimitationsSome eligibility criteria could not be measured. The Qualitative Content Analysis consolidated similar exclusion criteria, losing potentially important nuances in wordings. ConclusionsExclusion criteria commonly used in contemporary clinical trials of depression limit generalizability to emergency psychiatry patients, due in large part to exclusions for psychosis, substance use, and suicide risk.

Examining the Impact of a Prior Authorization Program on Rural Child and Adolescent Psychiatry Patients and Families

Introduction The objective of this study was to examine the impact of the prior authorization (PA) process from the perspective of rural child and adolescent psychiatry patients' families. Methods All patient families who visited an outpatient behavioral health clinic in rural Appalachia for psychiatry services between July and October 2018 were eligible for the study. Caregivers of children who were prescribed medications eligible for PA or who reported problems with PA were offered a paper survey to complete anonymously and return to a drop box after the visit. Results In total, 37 respondents reported 55 different psychiatric medications affected, primarily stimulants (n=22). Just over 75% (n=28) of respondents reported delays in receiving their medication. Delays ranged anywhere from less than a day to more than a month. During those delays, respondents reported their children experienced many different adverse events when they were not receiving their medication. Commonly reported consequences of the delays included behavioral and emotional issues at home and at school, physical side effects from drug withdrawal, and increased aggression. Respondents also reported an increase in financial burden. In some cases, the educational opportunities available to the children were also restricted. Conclusion Rural families face limited access to psychiatric care and significant unmet needs. The study documents additional burden for rural families related to the PA process, including financial, behavioral, emotional, and educational consequences. This preliminary data indicates a need for further study and highlights the necessity of considering potential burdens for families when creating PA policies.

Patients languishing in emergency departments: A descriptive analysis of mental health-related emergency department presentations in Australia between 2016-17 and 2020-21.

In the context of concerns regarding hospital access block, this paper provides a descriptive longitudinal analysis of mental health-related ED episodes in Australian public hospitals between 2016-17 and 2020-21. We descriptively analysed Australian Institute of Health and Welfare data for mental health-related ED presentations, outcomes and 5-year trends for Australian public hospitals. There were more than 300,000 Australian mental health-related ED presentations in 2020-21. Presentations increased by an average annual rate of 2.8% between 2016-17 and 2020-21, commonly involving first responder (police, paramedic) attendance. From 2016-17 to 2020-21, the average annual rate of mental health-related ED presentations receiving a triage category of resuscitation increased by 13.7%, emergency by 9.4% and urgent by 4.7%. 90% of MH-related ED presentations were completed within 14h, which was longer than the 90th percentile for all ED presentations (up to 8h). Current mental health policies have not stemmed the rising tide of ED presentations. Mental health-related ED presentations are increasing in number and severity, likely due to health systemic and societal factors. Psychiatry patients stay longer in EDs than other patients. Healthcare reforms should be targeted to provide the best outcome based on principles of equity of access.

Gender‐affirming care important to mental health of adolescents

It's ironic that the very places where young people whose gender identity is different from the sex that was assigned at birth seek help — psychiatric hospitals — may cause harm by not affirming the youth's gender identities. Such youth are twice as likely to access psychiatric inpatient care as cisgender peers, and research has shown that the stress these youth face from having to deal with transphobic systems — including, sometimes, unsupportive parents, school staff, and peers — may play a factor in their increased risk of depression, anxiety, suicidal ideation, suicide attempts, and nonsuicidal self‐harm. An editorial in the Journal of the American Academy of Child and Adolescent Psychiatry noted that higher rates of mental health challenges among these young people explain why they access inpatient services more frequently than cisgender peers. Research has found that these young people “often experience discrimination during psychiatric inpatient admissions (e.g., being misgendered during admission intake, facing stigmatization for an evolving gender identity, and receiving care from staff who have not been trained to provide gender‐affirming care), the editorial added. This is despite the fact that organizations such as the American Academy of Child and Adolescent Psychiatry underscore the importance of “psychiatric care that is inclusive and affirming,” for these youth. [McKenna, J. L., Anglemyer, E., McGregor, K. (2023, Jun 24). Gender‐affirming mental health care for transgender and gender diverse youth on pediatric inpatient psychiatry units. J Am Acad Child Adolesc Psychiatry, S0890‐8567(23)00330‐1. http://doi.org/10.1016/j.jaac.2023.05.021. Online ahead of print.]

Nighttime sleep quality & daytime sleepiness across inpatient psychiatric treatment is associated with clinical outcomes

Prior research has demonstrated the strong link between sleep disturbance and mental health outcomes, including the importance of examining nighttime sleep quality and daytime sleepiness as separate constructs in relation to mental health outcomes. As such, the current study examined patients’ self-reported nighttime sleep quality and daytime sleepiness trajectories over the course of inpatient treatment and how these trajectories related to treatment outcomes. Participants were 1,500 adults who voluntarily admitted to an inpatient psychiatric hospital. Mental health outcomes measured were emotion regulation problems, anxiety severity, depression severity, nightmare severity, and suicide risk. Group-based trajectory modeling was used to determine nighttime sleep quality and daytime sleepiness trajectory groups. Multivariate analyses of covariance (MANCOVA) were used to determine between group differences on mental health outcomes. Patients fit into distinct groups based on their trajectories of nighttime sleep quality and daytime sleepiness across inpatient psychiatric treatment: Low, Moderate, and High. Individuals with greater nighttime sleep disturbance and greater daytime sleepiness throughout treatment (High group) demonstrated significantly increased suicide risk, higher nightmare severity, more anxiety, more depression, and more emotion regulation difficulties at discharge. Results suggest an important connection exists between nighttime sleep quality and excessive daytime sleepiness and mental health outcomes for inpatient psychiatry.

Pilot Study: Assessing Personal and Clinical Impacts from a Recovery-Centric Intervention in Inpatient Psychiatry Using Mixed Methods

Objective: The conventional model of biomedical mental healthcare focused on diagnosis, crisis stabilization, and pharmaceutical treatment might be enriched with recovery-oriented programming and improve the overall inpatient experience. This study aimed to assess the impacts of a person-centered intervention on patient-reported recovery measures and clinical progression over time. Methods: Eighteen patients from a tertiary-level regional unit enrolled in the pilot program over an eight-month intervention period. Clinical and proxy recovery data was collected and compared before and after the intervention in a combination of within group and between group assessments using unit clinical performance as a control. Results: Contrary to expectation, intervention participants reported a decline in four of five proxy recovery scores from the pretest to the post-test and concurrent deterioration in routine clinical monitoring scores. Research cohort scores declined in three of six domains with a statistically significant change in one category while unit clinical scores declined in five of six domains with statistically significant changes in three categories. A comparison of mean coefficients indicated more favourable outcomes for research participants in five clinical domains. Conclusions: Concurrent declines in recovery-focused and clinical measures suggest a risk of inpatient regression over time in hospital. The findings support the need for innovative approaches to inpatient service delivery including recovery-focused interventions which might improve clinical progression. The results also indicate the need for rigorous program evaluation which can be facilitated by leveraging existing clinical assessment tools and in considering patient perspectives in determining the effectiveness of interventions.

Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic

Understanding how children's utilization of acute mental health care changed during the COVID-19 pandemic is critical for directing resources. To examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic. This cross-sectional analysis of national, deidentified commercial health insurance claims of youth mental health ED and hospital care took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17 614 and 16 815 youth had at least 1 mental health ED visit in the baseline year (March 2019-February 2020) and pandemic year 2 (March 2021-February 2022), respectively. The COVID-19 pandemic. The relative change from baseline to pandemic year 2 was determined in (1) fraction of youth with 1 or more mental health ED visits; (2) percentage of mental health ED visits resulting in inpatient psychiatry admission; (3) mean length of inpatient psychiatric stay following ED visit; and (4) frequency of prolonged boarding (≥2 midnights) in the ED or a medical unit before admission to an inpatient psychiatric unit. Of 4.1 million enrollees, 51% were males and 41% were aged 13 to 17 years (vs 5-12 years) with 88 665 mental health ED visits. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits (95% CI, 4.7%-8.8%). Among adolescent females, there was a larger increase (22.1%; 95% CI, 19.2%-24.9%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4% (95% CI, 5.5%-11.2%). Mean length of inpatient psychiatric stay increased 3.8% (95% CI, 1.8%-5.7%). The fraction of episodes with prolonged boarding increased 76.4% (95% CI, 71.0%-81.0%). Into the second year of the pandemic, mental health ED visits increased notably among adolescent females, and there was an increase in prolonged boarding of youth awaiting inpatient psychiatric care. Interventions are needed to increase inpatient child psychiatry capacity and reduce strain on the acute mental health care system.

Assessment of a Unit-Level Acuity Tool in Inpatient Psychiatry.

Assessing acuity is deemed essential to staffing in intensive care nursing; however, it has not received sufficient attention in inpatient psychiatry, where acuity can fluctuate greatly within shifts. Staffing and admission decisions rely on the accuracy of this information. The current mixed methods study surveyed nurses from two hospitals within the same hospital system: one using an acuity tool and one naïve to acuity tools. The survey was followed by a focus group on the specific factors influencing acuity and nurses' assessment of needs. Results suggest that the current tool is not satisfactory for nurses who use it to help with staffing or admission decisions and it is not user-friendly. Most nurses from both hospitals indicated they would prefer an electronic version with automated features reflecting up-to-date patient and unit acuity that would assist in interprofessional collaborative admissions decisions and staffing. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 13-18.].

A preventive approach: What the field of child and adolescent psychiatry can learn from neonatology

As a resident physician training in pediatrics, adult psychiatry, and child and adolescent psychiatry, I've had the opportunity to explore three different fields of medicine. While it can sometimes be challenging to navigate the differences between them, this training has allowed me to reflect on what aspects of each field I'd like to incorporate into my career. This past year I've had the chance to spend one half‐day a week as a pediatrician in the Women and Infants’ neonatal intensive care unit (NICU) follow‐up clinic while spending the rest of my week working on various inpatient psychiatry units at Bradley Hospital. My time spent working with the families in the NICU follow‐up clinic has led me to envision a similar preventative care model for children and families at high risk for mental health concerns.

Unspoken: Verbal Sexual Harassment by Patients in Psychiatry

AimsPatient-initiated verbal sexual harassment (PIVSH) is common in the healthcare workplace, however institutes often neglect to address it. Objectives: (1) Define extent of PIVSH among staff at South London and the Maudsley Trust (sLaM), (2) Characterise the impact of PIVSH on staff, (3) Understand barriers to reporting PIVSH, (4) Inform policy and training to support staff.MethodsA questionnaire from Scruggs et al. (2020) was adapted with types of PIVSH on a standardised scale of severity from ‘most’ to ‘least’ harassing. The anonymous, retrospective, online survey was disseminated to sLaM staff via Trust-wide communications, staff networks and Whatsapp groups. Descriptive statistics were used to analyse quantitative data (PIVSH frequency, confidence to respond to PIVSH, reporting practices). Respondents used free text to describe the impact of PIVSH, reasons for not reporting harassment, and views on the role of the Trust and supervisors in addressing PIVSH. Qualitative data were analysed using thematic analysis and externally validated.Results42 responses were received across staff groups. 95.2% respondents had experienced PIVSH in the last year. 26.2% had formally reported an incident of PIVSH, with only 30.8% stating the report had been actioned by a senior. ‘Less severe’ harassment types were the most common, and the type staff were least confident to address. Five themes were identified in thematic analysis: 1.Nature of PIVSH: Unwanted, covert, influenced by victim demographics, the situation, and motivation of the perpetrator2.Response to PIVSH: Victim's emotional and practical response, and of the wider MDT3.Impact on trainee: Personal (desensitisation, feeling unsupported) and professional (time off, moved teams, avoidance of wards)4.Barriers to action: Practical barriers to reporting (lack of time, complexity) and organisational culture (‘patient unwell’ justification, trivialisation, lack of trust in management)5.Areas of improvement identified: Written policy on PIVSH clearly communicated to staff and patients; wider cultural changes of zero tolerance to PIVSH; open discussion and reporting, backed up by education and training; formalised support post-PIVSH eventConclusionThere is a negative impact of PIVSH on staff at sLaM and it is not properly recognised. The NHS is its staff and we cannot afford to neglect their well-being. Action as a result of this survey will include: 1.Creation of a training package with Maudsley Simulation2.Development of informational posters for clinical spaces3.Write up-to-date trust policy on PIVSH

Caregiver Strain and its Associated Factors in Autism Spectrum Disorder in Karachi, Pakistan.

Todetermine the frequency of caregiver strain and its associated factors in Autism Spectrum Disorder (ASD) at a tertiary care teaching hospital in Karachi, Pakistan. An analytical cross-sectional study. Place and Duration of the Study: Psychiatry inpatient and outpatient units at The Aga Khan University Hospital, Karachi, Pakistan, from December 2018 to December 2019. The study participants were caregivers of ASD. Data were collected from the inpatient and outpatient departments using Caregiver Strain Questionnaire (CGSQ), and a demographic questionnare. Data were analysed using descriptive and inferential analysis. A total of 76 caregivers participated in the study. Among them, 61 (80.3%) were females and 15 (19.7%) were males, with mean age of 37.09±6.91 years. The overall caregiver strain (both subjective and objective) was reported to be severe by 11.8%, moderate by 47.4% and low by 40.8%. About 50% of the participants had a low objective strain on CGSQ whereas 59.2% of the participants subjectively felt the strain to be at moderate level. An association was found between the gender of the participants and subjective strain (p=0.016), and gender with internalised subjective strain (p =0.002). Parentingof a child with ASD involves challenges and demands support. This study supports the recommendation that the caregivers need access to appropriate means to channelize their strain and manage their role productively. Autism, ASD, Stress, Burden, Caregiver, CGSQ, Pakistan.

Review of Consent to Treatment Documentation in University Hospital Wishaw Inpatient Psychiatry

AimsTo establish if the Mental Health Act Code of Practice was being followed in the mental health inpatient ward population in Wishaw General Hospital. Specifically, those who were subject to detention with a Compulsory Treatment Order (CTO) under the Mental Health Act and whether or not documentation of consent to treatment was being kept.MethodsOver the course of one week beginning on 1st December 2022, we reviewed the inpatient population within acute psychiatric wards (Wards 1-3) at Wishaw General Hospital to determine the nature of patient admissions, informal or under detention, specifically Short Term Detention Certificate (STDC) or Compulsory Treatment Order(CTO). A total of 57 inpatient notes were evaluated, including those of 10 patients with STDC and 14 with CTO. From these 14 patients, we determined whether T2b(240) or T3b(240) forms were clearly documented in both paper and electronic records (MORSE).ResultsOne of the three patients on Ward 1 who were subject to CTO had both electronic and physical documentation of the T3B form. In the physical notes of two patients, the T2B or T3B form, as well as the reason and specific treatment, were adequately described.Seven of the eight patients subject to CTO in Ward 2 had adequate documentation of the cause and particular treatment, as well as clear documentation of the T2B or T3B form in their physical notes. None of these patient’' electronic notes contained any documentation. As the last patient was less than two months into CTO, they did not fit the criteria for the T2B or T3B consent forms.All three patients subject to CTO from Ward 3 had clear documentation of T3B forms in their physical notes, as well as appropriate documentation of their cause and treatment. There was no documentation on these patient’' electronic notes.ConclusionOverall, the clinical documentation was accurate with strict adherence to mental health act code of practice. 100% of patients requiring consent to treatment documentation either via T2B or T3B form were completed and available for review in the paper notes. Of note however, only 1 patient had CTO documentation and consent to treatment documentation available on electronic records (MORSE) which would allow remote viewing.We propose the practice to upload detention certificates and consent to treatment forms to Electronic data (MORSE within the “files” tab). This information will be shared with ward staff to encourage copy and filing of documentation within this section on MORSE (electronic records).