Inpatient Treatment Facility Research Articles

Treatment of Childhood Emotion Dysregulation in Inpatient and Residential Settings.

Children hospitalized in inpatient and residential treatment facilities often present with severe emotion dysregulation, which is the result of a wide range of psychiatric diagnoses. Emotion dysregulation is not a diagnosis but is a common but inconsistently described set of symptoms and behaviors. With no agreed upon way of measuring emotion dysregulation, the authors summarize the existing contemporary treatment focusing on proxy measures of emotion dysregulation in inpatient and residential settings. Interventions are summarized and categorized into individual- and systems-level interventions in addressing aggressive behaviors. Going forward, dysregulation will need to be operationalized in a standard way.

Patient Safety Related to Microbiological Contamination of the Environment of a Multi-Profile Clinical Hospital.

Nosocomial infections pose a serious burden for hospitals, patients, and the entire society. The aim of the study was to assess the microbiological cleanliness of the hospital environment through quantitative and qualitative analysis of microbiological contamination of air and surfaces in inpatient treatment facilities, based on the example of a large clinical hospital in Poland. Data were collected between 2012 and 2018 in premises of a large teaching hospital in Gdansk using the sedimentation method and the impact method using the Aerideal apparatus (Biomerieux). In the analyzed clinical center, the microbiological cleanliness tests in most of the hospital rooms in the analyzed period showed an acceptable number of saprophytic microorganisms. Of all the tested samples, 1159 (21.8%) were positive, indicating the presence of microorganisms in the tested sample. Species potentially pathogenic for hospital patients were identified, constituting 20.8% of all positive samples (4.6% of all samples). Significantly higher proportion of microorganisms potentially dangerous to patients were isolated from sanitary facilities. Due to the potentially pathogenic microorganisms detected in the tested samples, the authors suggest that in the analyzed hospital, the areas requiring a specific level of microbiological purity should be designated and described, with [specifically] defined cleaning and disinfection protocols.

Neural responses to negative events and subsequent persistence behavior differ in individuals recovering from opioid use disorder compared to controls

ABSTRACT Background: Negative emotion is associated with substance craving and use in individuals recovering from substance use disorders, including prescription opioid use disorder (POUD). Decisions to abandon or persist towards a goal after negative emotion-eliciting events, and neural responses that shape such decisions, may be important in maintaining recovery from POUD. Objectives: We examined differences in neural responses to negative events and subsequent persistence decisions in individuals recovering from POUD without a history of a substance use disorder. Methods: 20 individuals with POUD (POUD group: 4 females, abstinent 2–3 weeks after admission to an inpatient treatment facility post-detoxification, no other substance use disorder), and 20 individuals with no substance use history (control group: 6 females) completed a persistence-after-setbacks task during functional magnetic resonance imaging. Participants advanced along a path toward a reward; after encountering each negative event (i.e., progress-erasing setback), participants made decisions to persist or abandon the path. Persistence decision rates were compared between groups and blood-oxygen-level-dependent signal to negative events was analyzed within a striatum region of interest (ROI) as well as whole-brain. Results: The POUD group persisted less (t(38) = 2.293, p = .028, d = .725) and showed lower striatum (left ventral putamen) signal to negative events compared to the control group (p < .05, corrected for striatum ROI). Conclusions: In POUD, neural and behavioral responses to negative events differ from controls. These differences are a target for research to address whether POUD treatment increases persistence and striatum responses to negative events and improves recovery outcomes.

The Course of Borderline Psychopathology in Adolescents with Complex Mental Health Problems: An 18 Month Longitudinal Follow-up Study.

A persistent and significant barrier to the diagnosis and treatment of borderline personality disorder (BPD) in adolescents is clinician reluctance to label an adolescent with a stigmatized, intractable, treatment-resistant diagnosis. The goal of the current study was to evaluate this claim by examining the 18-month longitudinal course of borderline pathology in adolescents after discharge from inpatient treatment. 556 adolescent consecutive admissions (64.6% female; ages 12-17, M = 15.29, SD = 1.46) were assessed during admission to an inpatient treatment facility. They were followed up at discharge, 6months, 12months and 18months after discharge with validated self-and parent report measures of adolescent BPD features. Latent growth modeling was used to evaluate outcomes. BPD features showed a significant decline over the follow-up period with very large effect sizes (> .80) for both parent and adolescent self-report. Rates of change were steeper for adolescent report although adolescent report fell below clinical cut-off 6months later than parent-report. However, when internalizing and externalizing psychopathology were included in latent growth models, youth-reported BPD features did not show the same level of decline, while parent-reported BPD features maintained the same level of decline. The rate of decline between parents and adolescents was correlated, and baseline levels of BPD features were predictive of rate of change. This is the first study to show that adolescent borderline pathology follows a similar course after discharge from inpatient treatment previously demonstrated for adults. Like adult BPD, adolescent BPD appears to be not as intractable and treatment resistant as previously thought, mitigating against therapeutic nihilism.

Examining the time-varying association of negative affect and covariates with craving during treatment for prescription opioid dependence with two types of mixed models

Opioid use disorders are chronic and relapse is common. Both negative affect and craving have been suggested antecedents of relapse and have been shown to demonstrate within- and between-person variability, as well as association with each other. The present study extends previous research by examining the covariation of negative affect and craving both within-day and at the person-level during 12 days of treatment among opioid-dependent patients. Ecological momentary assessment (EMA) data were collected from 73 participants starting between 10 and 14 days after admission to an inpatient treatment facility. These data were analyzed using multivariate multilevel models and time-varying effect models. Results demonstrated strong association between negative affect and craving. Within-day, negative affect and craving were most associated in the early afternoon. At the person-level, association between negative affect and craving declined during the first week of data collection. Following this initial decline in association, negative affect and craving increasingly covaried during days 8–12 of data collection. To our knowledge, this is the first study to report a lagged increase in the association between negative affect and craving among patients during inpatient treatment for opioid dependence. Implications for research and treatment providers are discussed.

Lofexidine for acute opioid withdrawal: A clinical case series.

IntroductionMaintaining abstinence through the opioid withdrawal period is a substantial barrier to treatment for patients with opioid use disorder. The alpha-2 agonist lofexidine has demonstrated efficacy and safety in clinical trials, but pragmatic studies describing its use in clinical practice are lacking. This case series describes the use of lofexidine for opioid withdrawal symptoms in an inpatient addiction treatment facility.MethodsSeventeen patients receiving at least 1 dose of lofexidine during inpatient treatment for opioid withdrawal were included in this study. A retrospective chart review was conducted for clinical, subjective, and objective data. Adverse events, total daily dose, clinical opioid withdrawal scale (COWS) scores, vital signs, and reasons for early discontinuation of lofexidine are reported.ResultsPatients treated with lofexidine experienced mild withdrawal symptoms throughout treatment. Most patients (65%) experienced a decrease in their average daily COWS scores from intake to discharge. Two patients (12%) left treatment against medical advice, and 5 patients (29%) discontinued treatment prior to day 7 due to resolution of symptoms. Average daily blood pressure readings remained stable, and daily average heart rate decreased over time.DiscussionLofexidine can be successfully incorporated into a conventional withdrawal management protocol. The cost of lofexidine and its recent introduction to the market remain barriers to accessibility in the United States. Studies evaluating patient-reported outcomes as well as direct comparisons with other alpha-2 agonists are needed to inform optimal clinical use of lofexidine.

Scabies, Fleas, or Bedbugs? Investigation of Skin Rashes in an Inpatient Eating Disorders Treatment Facility Unit

<h3>Background</h3> We investigated a cluster of skin rashes on an inpatient adult and pediatric eating disorders treatment facility (EDTF) unit where group activities occur and include therapy dogs. <h3>Methods</h3> An epidemiological investigation was launched after scabies was diagnosed in patient A (occupying room X). An interprofessional team was engaged and included EDTF leaders, dermatology, environmental services, and infection prevention. Patient A was treated for scabies and persons with epidemiologic links were informed of possible exposure. Within two weeks, patient B (occupying room X) was evaluated by dermatology for a rash deemed inconsistent with scabies, but bed bug bites could not be excluded. Pest control professionals assessed room X for bed bugs, none were found. Four weeks later, a bed bug was visualized in room X (occupied by patient B). Pest control professionals confirmed presence of bed bugs and treated the room with high temperature heat. The investigation was expanded to persons with epidemiological links to patient B. <h3>Results</h3> 92 employees were informed of scabies exposure, no post exposure prophylaxis administered as none reported skin-to-skin contact. 55 patients had a concurrent inpatient stay with patient A. Of these, 9 had possible skin-to-skin contact and received prophylaxis. 25 were discharged and informed of possible exposure, none sought prophylaxis. Therapy dogs were examined, no fleas identified. Heat treatment cost was approximately $1000.00. There were no bedbugs identified outside room X and no additional patients with bed bug-related rashes. Investigative data supports source of bed bugs was outside the facility. Policies are under revision to restrict personal items, such as bedding, brought to EDTF. <h3>Conclusions</h3> This investigation illustrates challenges with identifying etiology of arthropod-related skin rashes in a special population and the need to reevaluate hypotheses as data unfolds over time. An interprofessional team supported timely implementation of control measures.

Stability of admission diagnoses; data from a specialized in-patient treatment facility for dual diagnosis

Aim We investigated the stability of diagnoses during admission over an 11-year period in patients admitted to a highly specialized integrated dual diagnosis treatment facility in Denmark using diagnosis coded in patient charts. Materials and methods Admission and discharge diagnoses from patient files were examined for stability of primary diagnosis and association with year of admission, age, sex, and duration of admission, in 1570 patients from 2007 to 2017. Results A vast proportion (69.6%) of the patients retained their diagnosis during a 3-month admission. Stability was highest for schizophrenia spectrum diagnoses and lowest for unspecified diagnosis. Type of primary diagnosis, age, and length of admission was associated with lower likelihood of a stable primary diagnosis. Conclusions Long-term admission for psychiatric patients with substance use disorder (SUD) was significantly associated with stability of diagnosis. The finding calls for longer observation of dual diagnosis patients to ensure that relevant diagnosis is given, and consequently that the appropriate clinical treatment such as psychopharmacological as well as non-pharmacological intervention can be applied.

Untapped Therapeutic Potential: Using Sandtray in Substance Abuse Treatment Groups

ABSTRACT Substance use is a significant problem that plagues many individuals and families. Of the millions needing substance use related services, a fraction of those receive treatment in an inpatient treatment facility. Most of those facilities use evidence-based practices to treat these disorders. While research shows the benefits of verbal methodologies, adding a sensory-based, creative process to the treatment of substance use disorders (SUD) could have massive benefits due to the neurological and developmental changes that take place with trauma and substance abuse. Clinical illustrations of using sandtray therapy in SUD treatment groups are provided.

Factors associated with readmission in patients with eating disorders.

This study examined predictors of readmission to inpatient/residential settings in patients with eating disorders. We hypothesized that readmitted patients would report worse transitional care and continuity of care compared to those who were not readmitted. We conducted a cross-sectional, online survey of 80 individuals from the US who reported that they were diagnosed with an eating disorder requiring inpatient/residential treatment. Participants completed questionnaires on demographic and clinical characteristics, the Care Transition Model-15, and the Continuity of Care Questionnaire. We analyzed data using univariate statistics and a series of logistic regression models. Participants who reported better transitional care (adjusted OR (AOR) = 1.14; p < 0.001), continuity of care during their inpatient or residential stay, including greater transfer of information (AOR = 6.39, p = 0.002), relationships in the hospital (AOR = 6.83, p = 0.003), management of follow-up (AOR = 3.41, p = 0.02), management of communication (AOR = 8.74, p = 0.001), and management offorms (AOR = 9.61, p = 0.002), reported increased odds of being readmitted to an inpatient or residential treatment facility. Use of nasogastric (NG) tube feedings was significantly associated with being readmitted. Contrary to our hypotheses, we found that better transitional care and continuity of care were associated with higher odds of readmission. Level III, case-control analytic study.

"What's Going on With My Ears?": Some Reflections on Managing Uncertainty in the Audiology Consultation.

Purpose Feedback sessions after audiology consultations predominantly involve information counseling or patient education, where the patient is informed about their hearing status and possible management options. Effective communication is vital to ensure that information about the hearing impairment, recommendations, and/or management options is appropriately provided and understood by patients and that patient needs and expectations from the session are met. This research note reports on an exploratory study that sought to describe communication in follow-up audiological consultations within a context where ototoxicity monitoring is routine practice. Method Six interactions between patients and audiologists were video-recorded at an in-patient treatment facility for drug-resistant tuberculosis in Johannesburg and analyzed using a sociolinguistic approach. Semistructured interviews were also conducted with participants and analyzed using content analysis. Results These interactions differed considerably to other audiology consultations we have analyzed in terms of aspects such as the length of the interaction and the type of information given to patients. We observed a substantial amount of mitigative, vague, and exaggerated language in these interactions. Conclusions In this research note, we offer some reflections on this data set using a lens of uncertainty management theory and explore factors within the broader context that may contribute to the interactional features observed in the current study. Overall findings suggest the need for clinicians to be trained to embrace and address uncertainty rather than avoid it within challenging clinical encounters.

Methamphetamine, Amphetamine, and MDMA Use and Emergency Department Recidivism.

Emergency department (ED) recidivism and the use of amphetamine and associated derivatives such as methamphetamine and MDMA (MAE), are intersecting public health concerns. This study aims to determine the frequency of ED recidivism of patients who use MAE and associated factors. The study was a retrospective 6-year electronic medical record review of patients with MAE-positive toxicology screens and single and multiple ED visits in the span of 12months. There were 7844 ED visits by 5568 MAE-positive patients. Average age was 42±13years. The majority were male (65%), white (46%), tobacco smokers (55%), and in the psychiatric discharge diagnostic-related group (41%), followed by blunt trauma (20%). Admission rate was 35%, with another 17% transferred to inpatient psychiatric treatment facilities. Occasional (2-5 visits/year), heavy (6-11 visits/year), and super users (≥12 visits/year) altogether accounted for 20% of patients and 43% of visits. Heavy and super users combined represented 2% of patients and 10% of visits, with significant differences for race/ethnicity, health insurance, tobacco smoking, and psychiatric/cardiovascular/trauma discharge diagnostic-related groups. Heavy and super users were less likely to be admitted and more likely to be discharged to an inpatient psychiatric treatment facility. Regression analysis revealed racial/ethnic differences, female gender, and tobacco smoking to be associated with super and heavy use. Heavy users were more likely to have cardiovascular-related discharge diagnoses. The prevalence of ED recidivism in patients who use MAE is similar to published ranges for general ED users. Significant differences in demographics, discharge diagnoses, insurance, smoking, and disposition exist between nonfrequent and frequent ED users.

Pediatric Nonsuicidal Self-Injury: A Call to Action for Inpatient Staff Training.

The rising prevalence of nonsuicidal self-injury (NSSI) in pediatric populations along with the recent inclusion of NSSI as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have increased the focus on the assessment and treatment of NSSI among youth. Despite the frequent occurrence of NSSI in inpatient psychiatric treatment settings, there are no empirically based assessment protocols to guide clinical staff. This article presents findings from a needs assessment conducted with staff at a state-run child and adolescent inpatient treatment facility. The purpose was to assess the need for formalized NSSI training among staff. A questionnaire was developed to evaluate whether staff had received formal training in NSSI assessment and treatment as well as typical practice responses to patients engaging in NSSI behaviors. The questionnaire also evaluated staff comfort and confidence in their knowledge and skills concerning the assessment and treatment of NSSI among children and adolescents. Respondents were 126 clinical staff, most of whom were nursing staff. Only a minority of staff reported having received formal NSSI training, and a third of respondents indicated that they do not typically assess for NSSI at all. Although a substantial percentage of clinical staff self-reported comfort and confidence with assessing and treating NSSI, fewer than 10% demonstrated accurate skill. Formal training in NSSI is associated with positive outcomes for both patients and staff in general healthcare settings. These findings suggest that similar training for staff on pediatric inpatient psychiatric units will likely foster comfort, confidence, and accuracy, thereby improving outcomes for children and adolescents engaging in NSSI behaviors.

The Therapeutic Value of Recording in Music Therapy for Adult Clients in a Concurrent Disorders Inpatient Treatment Facility

While recording has traditionally been viewed as a practical, adjunctive role of the music therapist, here the authors examine the skillful use of recording devices and software as fertile ground for the development of therapeutic programs with tangible benefits for adult cli­ents in a concurrent disorders recovery setting. The integration and layering of musical composition with musical performance, digital technologies, and production, invite rich and engaging conversations about therapeutic goals, processes, and outcomes. Using methods of action research inquiry, the authors discuss how their interactions with clients through recording have yielded new insights into therapist roles and identities as well as expressions of music therapy. The case for therapy-oriented recording is outlined and a description of the authors’ research setting and data collection methods identified before a literature review on the use of recording in music therapy is provided. The authors then distinguish four types of therapeutic recording illustrated by case examples from work with clients. Their writing culminates with a discussion of challenges and benefits associated with therapeutic recording. The authors conclude that recording offers critical and rewarding yet often unrecognized opportunities for music therapists to be innovators in their field.

Limited changes in activities of daily life performance ability among people with schizophrenia at clinical settings and the factors moderating the changes

BackgroundImpaired community functioning and functional ability are common among people with schizophrenia spectrum disorders (SSD). However, changes occurring in activities of daily life (ADL) ability through interventions provided at clinical settings have not been systematically examined in this population. MethodsWe retrospectively collated and analysed changes in ADL ability between admissions and discharges, measured utilising the Assessment of Motor and Process Skills (AMPS), among 72 people with SSD at a public inpatient treatment and rehabilitation facility in Western Australia. Clinical and demographic factors moderating the changes were also determined. ResultsThe standardised AMPS motor (p = 0.0088) and process scores (p < 0.0001) improved significantly between admission and discharge. However, overall, the improvements were of small to moderate magnitude, and >60% of participants did not experience significant or meaningful changes. Furthermore, mild to moderate impairment in the AMPS standardised motor (−1.3 SD), and process (−1.6 SD) ability was present at discharge. A logistic regression analysis revealed that low admission AMPS scores and duration of illness of more than five years predicted improvement of the AMPS motor score by discharge, but only the former predicted changes in the process scores. Other demographic, clinical, and treatment-related variables did not affect the outcome of the AMPS scores. ConclusionsImpairment of ADL ability is recalcitrant in schizophrenia. The improvement was modest and occurred only in a proportion of participants. However, promisingly, chronic illness, low baseline ADL ability, treatment with clozapine and presence of treatment-resistant schizophrenia did not have an adverse effect on the outcome.

The Oldest Addiction Treatment Institution on the Historical Territory of Slovakia: The Istebné nad Oravou Treatment Facility (1937–1949)

BACKGROUND: There is a continuous tradition of institutional impatient addiction treatment in what is now the Czech Republic which dates back to 1948, when the “Apolinar Model” began to be developed by Jaroslav Skála and his colleagues. Before the advent of this treatment approach, there was only one inpatient facility providing addiction treatment on the historical territory of Slovakia, the institution in Istebné nad Oravou (1937–1949). AIMS: To explore the modern history of anti-alcohol activities developed in the first half of the 20th century in Slovakia and the origin, operation, and dissolution of the first specialised inpatient addiction treatment facility. METHODS: Qualitative content analysis of available historical documents was used to collect the data. The documents were categorised according to their relevance to the focus of the research, taking into account the site under consideration, the time and place of its establishment, and the roles of the people involved. RESULTS AND CONCLUSION: The establishment of the first institutional treatment facility on the historic territory of Slovakia was marked by some specific features ensuing from the relative lack of interest in dealing with addictionrelated issues on the part of society. This was reflected in the circumstances of its origin, funding, and occupancy, in operational reductions following the proclamation of the independent Slovak State (1939), and in the gradual dissolution of the facility in 1949. In spite of all this, the Istebné nad Oravou facility was a significant milestone in institutional addiction treatment in Slovakia.

Admitted to treatment without diagnosis: The status of known diagnoses in US addictions treatment centres

BackgroundDiagnostic and treatment gaps exist for those with substance use disorders (SUD). SUD diagnostics in treatment have been critically under-investigated. We investigated known diagnoses in US addiction treatment centres receiving state or federal funding. MethodsCross-sectional risk factor analysis of variables associated with known diagnoses in US inpatient and outpatient treatment facilities receiving public funding from 2000 to 2014 (N = 8,692,362). ResultsOf all clients, 59.68% had unknown diagnoses. However, 14 states reported zero diagnostic data, representing the majority of unknown diagnoses. Of the reporting states (n = 4,161,021), 16.05% had unknown diagnoses. Those with known diagnoses were represented by four subcategories of SUD (73.22%), No Diagnosis (0.81%), Alcohol Intoxication (1.36%), and Mental Health (8.57%). Uninsured status was one meaningful association and was less likely to have a known diagnosis. Insurance status, referral source, service setting, and wait to admission significantly predicted known diagnosis (p < 0.0001). ConclusionsA large proportion of admissions are missing diagnoses. Many states do not report any diagnostics. Variables predictive of a known diagnosis highlight administrative inconsistencies. Policies requiring SUD diagnosis documentation can improve assessment of treatment appropriateness and level of care, programme evaluation, and inform the funding allocation for relevant treatment efforts.

Sharing wisdom II: Integrated care in partnership – Designing youth mental health services in Queensland, Australia

An extended inpatient treatment facility for adolescents with severe and complex mental illness in Queensland, Australia closed in January 2014. Following the closure of the centre, three former patients died by suspected suicide, which led to widespread community concern about the processes and support offered to patients around the closure. In 2015, the Queensland Government of Australia established a Commission of Inquiry into the closure of the facility with a final report provided to Government in 2016 recommending the development of new youth mental health facilities and acknowledging the marked lack of consumer and carer consultation throughout the closure process. Consequently, the Queensland Department of Health through the Division of Clinical Excellence’s Mental Health Alcohol and Other Drugs Branch, along with the Queensland Department of Education, Health Consumers Queensland the peak organisation representing the interests of health consumers and carers in Queensland and the Destravis Group a strategic building consulting firm, joined in partnership to co-design an integrated mental health service system for young people. Commencing with the development of a model of service and continuing to the finalisation of building designs, this approach has put young people, their families and their carers at the centre of the design process, in direct contrast to the closure of the previous facility. The partnership has led to an unprecedented level of participation and inclusion of people with a lived experience of mental health services, and an unparalleled approach to integrating expertise from the clinical, education, user and design perspectives, building an integrated methodology from the ground up. It has enabled people with lived experience to become true co-creators in the development of new services, by building relationships of trust and respect. This interactive workshop prepared and delivered by consumers, carers and the project team including Destravis, building consultants, aims to share the principles utilised and the practical activities that continue to facilitate collaborative co-creation in the development of new youth mental health services. Through a combination of group work and discussion, the workshop will consider the innovative approach taken, lessons learned, and issues for sustainability when developing new services in collaboration with consumers and carers. In addition, the workshop will also explore how these co-design lessons can be transferred to the development of health services in other settings. The workshop is suitable for clinicians, administrators, consumers, carers, policymakers, academics, architects, and health building designers. This workshop session discussion will include four brief oral poster presentations relating to co-design of mental health services internationally.

Court Finds Substance Users Can Be Jailed For Relapsing While on Probation

Court Finds Substance Users Can Be Jailed For Relapsing While on Probation

What scares patients to get admitted in a psychiatry ward? An exploratory study

Background: There has been very little focus on understanding the experiences of people suffering from mental illness during their treatment in the outpatient and inpatient treatment facilities. Majority of the decisions regarding their treatment are taken by the mental health professionals in consultation with the caregivers, and the patient remains a passive recipient of the services. It is commonly seen that patients refuse admission in the psychiatry ward even when clinical needs warrant admission. Aim: The aim of the current study was to explore the perception of patients regarding admission in the psychiatry ward and the fears associated with indoor treatment facility. Methodology: A semistructured interview schedule was administered to 110 patients undergoing treatment from outpatient services to study their attitude toward treatment in psychiatry ward. Results: A large number of patients perceived psychiatry ward as a hostile place with unfriendly atmosphere and dark and unsupportive environment. However, the patients who had been admitted in the past found it less scary and appreciated good and friendly behavior of the staff in the ward. Conclusion: Negative perception of inpatient treatment and psychiatry wards is still highly prevalent among the patients. With growing focus on reducing stigma about psychiatric illnesses, dispelling the myths related to treatment in wards is the need of the hour.