IntroductionThe continuous exploration of new treatments in the field of psychopharmacology has brought a new light on psychedelics, raising the provocative question of how these drugs of abuse (DOA) may become useful in clinical practice. Psychedelics are included in the category of “psychoplastogens”, substances that are known for their effects of enhancing neuroplasticity in the nervous central system via the modulation of Brain-derived Neurotrophic Factor (BDNF) signaling. However, psychedelics were originally known as DOA; therefore, ascribing them to therapeutic use for patients with psychiatric disorders may seem largely counterintuitive.ObjectivesTo review the current data on the benefits and risks of psychoplastogens in patients with psychiatric disorders.MethodsA literature review was conducted in four electronic databases (PubMed, EMBASE, Cochrane, and Clarivate/Web of Science) and the US National Library of Medicine database for clinical trials (www.clinicaltrials.gov) to find clinical and preclinical sources published between January 2000 and September 2024. The keywords used were “psychoplastogens,” “neuroplastogens,” “neuroplasticity,” “psychoactive drugs,” “drugs in the pipeline,” and all the main psychiatric diagnosis categories. Both primary and secondary reports were allowed, but only those published in English were selected.ResultsKetamine and each of its stereoisomers, as well as psilocybin, are the most extensively explored drugs in this class, but also MDMA, DMT, psilocin (ELE-101), CYB003 (a psilocybin analog), and lisuride have received increased attention in the last decade. Such agents are investigated for indications such as treatment-resistant major depression, posttraumatic stress disorder, binge eating disorder, and substance use disorders. One important direction of research is the evaluation of psilocybin in patients with cancer-related depression and/or anxiety. Hallucinations and altered states of consciousness that may receive mystical interpretations are typical for high doses of psychedelics, raising questions about the use of these drugs in clinical populations with already severe mood, thought and perceptual disturbances. Safety and tolerability aspects are extremely important in deciding when, to whom, and how much psychoplastogens may be recommended for different psychiatric disorders. Creating psychoplastogens with less or no psychotomimetic activity is expected to increase the interest of clinicians in the use of such agents for patients with psychiatric disorders, especially in treatment-resistant cases.ConclusionsAlthough expected to be a paradigm-shifter in psychiatry, the exploration of psychoplastogens should consider not only the potential benefits, which require further and extensive studies, but also their adverse events. For this purpose, long-term studies are needed with both efficacy and tolerability outcomes carefully monitored.Disclosure of InterestNone Declared

IntroductionPregnancy and the immediate postpartum period are at high risk of decompensating or developing psychiatric disorders. Electroconvulsive therapy (ECT) is an effective treatment for severe and resistant mental disorders and could be a therapeutic option for psychiatric disorders during pregnancy.ObjectivesThe aim of our study was to investigate the safety and the efficacy of ECT in pregnant women through a systematic review.MethodsA systematic review was conducted. PubMed via Medline, Google Scholar and Semantic Scholar were used as search engines. The keywords used were (“Electroconvuslive therapy” or “ECT”) and (“pregnancy” or “pregnant”). Clinical trials, case reports and case series assessing the efficacy and safety of ECT during pregnancy, published from inception to December 2023 and written in English or Frensh were included.ResultsA total of 30 articles were included for the final analysis with a total of 96 cases. The mean age of patients was 30.1 years. ECT was mostly performed during the first trimester of pregnancy with 45.3% of patients. The main psychiatric diagnoses were major depressive disorder with 47.6% of patients, followed by bipolar disorder with 19.3%. The average number of sessions performed was 10.4 with a maximum of 22. A partial improvement or a total resolution of symptoms were noted in 78.6% of cases. Transient fetal arrhythmia (not requiring drug intervention) was the most common complication, occurring in 6.25% of cases (n=6). Fetal death or abortion were observed in 4.1% of cases (n=4).ConclusionsECT appears to be an effective treatment for severe psychiatric disorders in pregnant women. However, it needs to be performed as part of a multidisciplinary care team to reduce the risk of serious consequences for both the mother and the fetus.Disclosure of InterestNone Declared

Patient characterization and evaluation of gerontopsychiatric inpatient equivalent treatment (IEHT-G) in a large German city. Collection of sociodemographic and clinical data, as well as assessment of clinical severity (CGI), health and social functioning (HoNOS-D) and autonomous performance of activities of daily living (IADL) at the beginning and end of IEHT-G. 53 subjects (age: MW=74.81; 77.4% women) were analyzed. Main psychiatric diagnoses were affective disorders (n=25), schizophrenia and schizotypal disorders (n=20). 12 patients (22.64%) had a cognitive disorder. The CGI, HoNOS-D and IADL showed a significant improvement over the treatment period (paired t-test, p<0.001). In an urban gerontopsychiatric population, IEHT-G can be implemented well. Symptom severity, social functioning and autonomy improved significantly.

Influence of architectural features in child and adolescent psychiatric wards on coercive measure use has not been investigated so far. We aimed to assess the effect of altering the physical environment of an adolescent psychiatric inpatient unit on the proportion and frequency of adolescents experiencing mechanical coercive measures. In a naturalistic observational design, coercive measures were compared before and after an architectural intervention facilitated by rebuilding a child and adolescent psychiatric department in October 2020. Age, gender, length of stay, main psychiatric diagnosis and indices of coercion in n = 782 admissions to inpatient child and adolescent psychiatry from April 2019 to April 2022 were extracted. Group comparisons were performed using chi-squared tests for categorical and Mann-Whitney U-tests for numerical variables. After structural modernization which included amplifying space and with the newly introduced availability of seclusion rooms, significantly fewer patients were affected by mechanical restraint (8.1% vs. 13.7%, p = .013). Rate of seclusion increased to 5.0% (vs. 0%, p < .001). Rate of seclusion and/or restraint decreased from 13.7% to 11.8% (p = .425). The median cumulative duration of all coercive measures per affected case decreased significantly (2.8 vs. 5.4 h, p = .005), as well as its proportion to length of stay (0.8% vs. 2.8%, p = .006). Modernisation and restructuring of buildings hosting psychiatric departments can contribute to a reduction of coercive measures in child and adolescent psychiatric units.

Suicide is an important social and medical problem, particularly among children and adolescents. The aim of the study was to determine the association of the psychiatric diagnosis and selected psychosocial factors with the risk of suicide attempts among patients of an adolescent psychiatric unit. A retrospective analysis was performed on a database of consecutive N = 1311 patients aged 13–18 years of the adolescent psychiatric ward. A hierarchical logistic regression analysis was performed to assess the predictive value of the main psychiatric diagnosis, for factors selected from the database to determine their influence on the relative risk of a suicide attempt. Primary diagnoses of mood disorders and emotional and behavioral disorders were associated with an increased risk of a current admission after a suicidal attempt, a history of past suicidal attempts and non-suicidal self-harm (NSSI). History of NSSI was associated with a fourfold increase probability of a suicide attempt. Truancy, sexual abuse, heartbreak and frequent conflicts were related to a rise in suicidal attempt risk. Learning difficulties were found to be linked to increased probability of suicidal attempt, but only among women. The current study confirms that the primary diagnosis, NSSI and well-recognized psychosocial factors (including family- and school-related factors) may prove useful in the assessment of suicidal risk among adolescents admitted to a psychiatric ward.

BackgroundContinuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care.MethodsProspective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables.ResultsHigher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care.ConclusionOur results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients’ motives as well as methodological reasons for non-participation remain considerable potential sources for bias.Trial registrationThis prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.

Purpose: Loneliness among the elderly is a widespread phenomenon and is connected to various negative health outcomes. Nevertheless, loneliness among elderly inpatients, especially those with a psychiatric diagnosis, has hardly been examined. Our study assessed loneliness in elderly inpatients, identified predictors, and compared levels of loneliness between inpatients on psychiatric and somatic wards. Methods: N = 100 elderly inpatients of a somatic and psychiatric ward were included. Levels of loneliness were assessed, as were potential predictors such as depression, psychological resilience, severity of mental illness, well-being, daily functioning, and psychiatric diagnosis. Analyses of group differences and hierarchical multiple regression analysis were conducted. Results: 37% of all inpatients reported elevated levels of loneliness. Significant predictor variables were self-reported depressive symptoms, well-being, severity of mental illness, being single and living with a caregiver. Hierarchical multiple regression analysis revealed that the full model explained 58% of variance in loneliness. Psychiatric inpatients’ loneliness was significantly higher than loneliness in somatic inpatients. When analyzing group differences between inpatients with different main psychiatric diagnoses, highest levels were found in patients with an affective disorder, followed by those treated for organic mental disorder. Since the study took place during the COVID-19 pandemic, potential influence of different measurement points (lockdown vs. no lockdown) were analyzed: Differences in loneliness depending on the phase of the pandemic were non-significant. Conclusion: Elderly inpatients experience high levels of loneliness, especially those with a mental disorder. Interventions to reduce loneliness in this population should address predictors of loneliness, preferably through multiprofessional interventions.

Compared with the general population, people with severe mental disorders have significantly worse physical health and a higher mortality rate, which is partially due to the adoption of unhealthy lifestyle behaviors, such as heavy smoking, use of alcohol or illicit drugs, unbalanced diet, and physical inactivity. These unhealthy behaviors may also play a significant role in the personal and functional recovery of patients with severe mental disorders, although this relationship has been rarely investigated in methodologically robust studies. In this paper, we aim to: a) describe the levels of physical activity and recovery style in a sample of patients with severe mental disorders; b) identify the clinical, social, and illness-related factors that predict the likelihood of patients performing physical activity. The global sample consists of 401 patients, with a main psychiatric diagnosis of bipolar disorder (43.4%, N = 174), psychosis spectrum disorder (29.7%; N = 119), or major depression (26.9%; N = 118). 29.4% (N = 119) of patients reported performing physical activity regularly, most frequently walking (52.1%, N = 62), going to the gym (21.8%, N = 26), and running (10.9%, N = 13). Only 15 patients (3.7%) performed at least 75 min of vigorous physical activity per week. 46.8% of patients adopted sealing over as a recovery style and 37.9% used a mixed style toward integration. Recovery style is influenced by gender (p < 0.05) and age (p < 0.05). The probability to practice regular physical activity is higher in patients with metabolic syndrome (Odds Ratio - OR: 2.1; Confidence Interval - CI 95%: 1.2–3.5; p < 0.050), and significantly lower in those with higher levels of anxiety/depressive symptoms (OR: 0.877; CI 95%: 0.771–0.998; p < 0.01). Globally, patients with severe mental disorders report low levels of physical activities, which are associated with poor recovery styles. Psychoeducational interventions aimed at increasing patients' motivation to adopt healthy lifestyle behaviors and modifying recovery styles may improve the physical health of people with severe mental disorders thus reducing the mortality rates.

A growth in the number of patients admitted to forensic psychiatric services has been reported worldwide. At the same time, an increase in the length of hospital stay of these patients was observed. To identify the factors that influence the length of hospital stay in a Romanian forensic psychiatric sample, as well as to compare the socio-demographic, clinical and criminological features of the "long stay" and "shorter stay" patients. This was a retrospective, cross-sectional study that included all patients admitted to Săpoca Psychiatry and Safety Measures Hospital according to article 110 of the Penal code (n=650) over a period of 11 years (2008-2018). Long stay was considered as a period of hospitalization greater than 5 years. The average length of hospital stay in the sample was 3.20 years. Approximately one quarter (n=154) of the patients were classified as "long stay". The variables that were significantly associated with length of stay included the main psychiatric diagnosis, social support, the severity of the offence and the perpetration of violence. Overall, our findings are in line with observations made by researchers from other countries. Our study highlights the need for further, more detailed research on the patients admitted to forensic psychiatric units in Romania.

Psychotropic polypharmacy among elderly patients is problematic due to their multiple comorbidities. This study investigated psychotropic polypharmacy among elderly patients discharged from a Malaysian university hospital and its associated factors. Discharges of patients aged 65 years or above from the psychiatric wards from 2010 to 2019 were reviewed. Sociodemographic data, length of stay (LOS), psychiatric and other diagnoses, and psychotropic prescription upon discharge were extracted from electronic databases. Multiple logistic regression was conducted with age, gender, race, marital status, main psychiatric diagnosis, LOS, and the number of medical comorbidities as independent variables, and polypharmacy (&gt;2 psychotropics) as the dependent variable. There were 354 discharges in this period. The mean age was 72.4 years (SD=5.9 years); 63.0% were female and 39.8% were Malays. Most were married (84.2%). The commonest category of psychiatric diagnosis was mood disorders (54.5%). A total of 76.8% of the discharges involved one or more medical comorbidities. The median number of psychotropics was two, with 38.1% prescribed three or more psychotropics. In the multiple regression model, female gender, Malay race, and being married were significantly associated with psychotropic polypharmacy. Sociocultural factors may contribute to psychotropic polypharmacy among elderly patients. Such factors require further investigations to elucidate their roles.

Objective: To ascertain the social determinant, associated factors, and suicidal risk of university students who were psychiatric outpatients at a university hospital in southern Thailand, 6 months following the copycat suicide crisis among Thai university students in 2019. Methods: This time-series cross-sectional study was conducted 6 months after the crisis of copycat suicides among Thai university students. Psychiatric outpatients who were university students and accessed the service at the Prince of Songkla University Hospital in September 2019 were recruited, and their clinical data were collected, including the Thai version of suicide screening test (8Q score) through the hospital database system. R software was then used to conduct descriptive data and logistic regression analyses. Results: Of the 42 university students, the majority (92.9%) were Thai, Buddhist (85.7%), and female (61.9%). The main psychiatric diagnoses among them were depressive disorders (59.5%). Only physical comorbidities (10.5%) were significantly less than 6 months prior according to statistics (10.5/5) (P = .029). Most university students were at a lower risk of suicide (31.0%) with an insignificantly decreased mean score (6.5 [0-12.5]) and median (interquartile range) of suicide risk (10.1 ± 13.1) within 6 months (P=.25). Moreover, no factors were found associated with suicidal risk among university students, 6 months following the crisis of mimic suicide in March 2019. Conclusion: Suicidal ideation among Thai university students decreased over 6 months following the copycat suicides in March 2019 and was not statistically significant. Thus, the effect of imitative suicidal behaviors may not have considerably reduced in 6 months. Moreover, no associated factors of suicidal ideation were found 6 months following the copycat suicides nationwide. Cite this article as: Jatchavala C, Wiwattanaworaset P. A study on suicidality from a university hospital: Six following the crisis of copycat suicide among Thai university students in 2019. Neuropsychiatr Invest. 2021;59(1):14-20.

Background:Mental disability is a common condition but is considered as an invisibledisability. The disability certificate in psychiatry remains underexplored.Some reasons are issues of confidentiality, stigma, lack of awareness in thepublic, and the hesitancy in the mental health professionals. We aim toprovide a brief profile of patients with mental illness issued disabilitycertificates from a psychiatric unit over a five-year period(2013–2017).Methods:Our retrospective study is based on the data available from the copies of theissued disability certificates from a psychiatric unit that functions in amultispecialty tertiary care teaching government hospital in Southern India.Patients undergoing treatment in psychiatry apply for a disabilitycertificate to the medical superintendent of the hospital. Each applicantundergoes a detailed workup to ascertain the diagnosis, and the mentaldisability is assessed using Indian Disability Evaluation and AssessmentScale (IDEAS). Those with intellectual developmental disorder (IDD) areassessed by a clinical psychologist for quantifying intelligence quotient,based on which the disability certificate is issued. Data were extracted andanalyzed using SPSS. Descriptive statistics were used.Results:Over five years, 258 disability certificates were issued. A total of 218 werefor mental illness and 40 were for IDD. Schizophrenia was the commonestprimary diagnosis. There was no gender predominance, nor the influence ofgender on different domains of IDEAS except on work domain dysfunction dueto mental illness. The validity period was not mentioned in 81% of theissued certificates for mental illness.Conclusions:This descriptive study found a lower number of certificates issued from thepsychiatric unit. Schizophrenia remains the main psychiatric diagnosis forwhich a disability certificate was issued. We did not assess the utilizationpattern of the issued certificates.

Background Home treatment (HT) has been proposed as a patient-centred alternative to acute mental inpatient care although evidence of patient-reported outcomes has remained limited. Aims The aim of this study was to examine patient experiences and satisfaction with HT. Methods This retrospective mixed-methods study included telephone interviews of 159 patients receiving HT between 2016 and 2019. Associations between patients’ characteristics and global satisfaction (ZUF-8 scale) were assessed. Differences between HT patients and inpatients were tested on a propensity score -matched inpatient sample. Qualitative analyses were conducted using thematic analysis. Results Global satisfaction with HT was slightly higher than in the inpatient sample (p = 0.019). There was no relationship between satisfaction and patients’ characteristics, such as gender, age, main psychiatric diagnosis, and treatment duration, but satisfaction was higher for patients who perceived HT as their only treatment option. Participants particularly appreciated the person-centred care and practical support whereas staff continuity and medical treatment were main sources of dissatisfaction. Conclusion The results indicate that HT seems to be a more patient-centred alternative to inpatient treatment and might close a gap in the psychiatric care of patients who preferred not to use inpatient services but needed higher treatment intensity than outpatient treatment.

Background: Sleep problems are particularly frequent in psychiatric disorders, but their bidirectional intersection is poorly clarified. An especial link between substance use and sleep seems to exist. While dual disorder patients are certainly at higher risk of experiencing sleep problems, very limited research is available today. Methods: Forty-seven dual disorder hospitalized patients were included in this first study. A complete psychiatric evaluation was performed, and sleep habits, patterns and potential disorders were evaluated with specific sleep scales, as well as anxiety. Results: The global prevalence of insomnia symptoms was considerably higher compared with the general population. Different abuse patterns as a function of concurrent psychiatric diagnosis were found, with no significant gender differences. The association between the investigated sleep parameters and any specific substance of abuse was minor. The addict behavior started in more than half of the patients prior to the main psychiatric diagnosis and close to the beginning of sleep problems. Men had a higher prevalence of insomnia symptoms, together with a higher incidence of anxiety. Overall, subjective daytime functioning was not altered as a consequence of poor sleep. Conclusion: Dual disorder patients face significant sleep disturbances, with low sleep quality. The role of sleep in addiction and dual disorders deserves greater research.

Background: In Germany, people suffering from severe mental illness who have committed serious offenses and have considerably reduced or suspended criminal responsibility can be detained and treated in forensic psychiatric hospitals. In the German federal state of Baden-Wuerttemberg, all psychiatric hospitals including forensic psychiatric hospitals are obliged to record data on every coercive intervention and to submit them to a central registry. The objective of this study was to determine key measures for the use of seclusion and restraint and to compare them with data from the same registry on the use of coercion in general inpatient mental health care.Methods: Data on the main psychiatric diagnosis according to ICD-10, type and duration of each coercive measure and number of treated cases according to diagnoses, and cumulated number of days of treatment from all 8 forensic facilities in the state of Baden-Wuerttemberg covering a catchment area with about 11 million inhabitants were collected at the treated-case-level for 3 years.Results: 22.6% of the cases treated in 2017 in forensic psychiatric hospitals were subjected to seclusion, and 3.8% were subjected to mechanical restraint. The mean cumulated duration of seclusion episodes per affected case was 343.9 h and the mean cumulated duration of restraint episodes was 261.7 h. 13.2% of the treated cases were subjected to room confinement with a mean cumulated duration of 539.1 h per affected case. Involuntary medication was applied in 1.9% of the cases. In general psychiatry, 2.9% of the treated cases were subjected to seclusion, and 4.7% were subjected to mechanical restraint. The mean cumulated duration per affected case amounted to 32.2 h for seclusion episodes and to 37.6 h for restraint episodes. Involuntary medication was applied in 0.6% of cases.Conclusion: Compared to general psychiatry, mechanical restraint is used in forensic psychiatry substantially less frequently and seclusion substantially more frequently. Room confinement is used only in forensic psychiatric hospitals. Use of involuntary medication is rare. On the one hand, recorded involuntary medication comprises only clear actions against the patient's expressed will as defined by law. Psychological pressure to take medication to avoid other forms of coercion and to achieve higher levels of freedom within the facility is not recorded. On the other hand, the low numbers of clear involuntary medication probably reflect the high legal threshold for such interventions, and, consequently, efforts by staff to motivate voluntary acceptance. The long duration of freedom-restricting coercive measures in forensic psychiatry probably reflects the selection of patients at high risk of violence.

PurposeThis study (a) assessed quality of life (QoL) in a patient sample with severe mental illness in an integrated psychiatric care (IC) programme in selected regions in Germany, (b) compared QoL among diagnostic groups and (c) identified socio-demographic, psychiatric anamnestic and clinical characteristics associated with QoL.MethodsThis cross-sectional study included severely mentally ill outpatients with substantial impairments in social functioning. Separate dimensions of QoL were assessed with the World Health Organisation’s generic 26-item quality of life (WHOQOL-BREF) instrument. Descriptive analyses and analyses of variance (ANOVAs) were conducted for the overall sample as well as for diagnostic group.ResultsA total of 953 patients fully completed the WHOQOL-BREF questionnaire. QoL in this sample was lower than in the general population (mean 34.1; 95% confidence interval (CI) 32.8 to 35.5), with the lowest QoL in unipolar depression patients (mean 30.5; 95% CI 28.9 to 32.2) and the highest in dementia patients (mean 53.0; 95% CI 47.5 to 58.5). Main psychiatric diagnosis, living situation (alone, partner/relatives, assisted), number of disease episodes, source of income, age and clinical global impression (CGI) scores were identified as potential predictors of QoL, but explained only a small part of the variation.ConclusionAspects of health care that increase QoL despite the presence of a mental disorder are essential for severely mentally ill patients, as complete freedom from the disorder cannot be expected. QoL as a patient-centred outcome should be used as only one component among the recovery measures evaluating treatment outcomes in mental health care.

Psychiatric comorbidities are frequent in patients admitted in general hospital and are associated with greater lengths of stay (LOS). Early consultation-liaison psychiatry (CLP) interventions may reduce the LOS but previous studies were underpowered to allow subgroup analyses and have generally not considered the severity of the condition for which patients were admitted ('disease severity'). To investigate the association between the timing of CLP interventions and LOS in a general hospital. We retrospectively included 4500 consecutive patients admitted in non-psychiatric wards of a university hospital between 2008 and 2016 who had a first CLP intervention. We used general linear models to examine the association between the referral time, defined as log(days before the consultation)/log(LOS), and log(LOS), adjusting for age, gender, year of admission, place of residence, main psychiatric diagnosis, admission to the intensive care unit (ICU), main physical condition and disease severity. Referral time was associated with log(LOS) (β = 0.31; P <0.001), notably for older patients (β = 0.43; P <0.001) and those admitted to the ICU (β = 0.50; P <0.001), but not for those with psychotic disorders (β = -0.20; P = 0.10). The association was confirmed when considering the expected LOS for each patient. For instance, for an expected LOS of 10 days, a CLP intervention on day 3 compared with day 6 was associated with a reduction of the actual LOS of 2.4 days. Earlier CLP interventions were associated with a clinically significant shorter LOS in a large population even after adjusting for disease severity. Early CLP interventions may have benefits for both patients and health-related costs.

BackgroundIt is unclear whether benzodiazepines increase the risk of suicide. The aim of this study was to test the hypothesis that benzodiazepines are associated with an increased risk of suicide, by comparing psychopharmacological interventions between psychiatric patients who committed suicide and a group of matched controls.MethodsThe case group comprised 154 psychiatric patients (101 men, 53 women; age range: 13–96 years) who had committed suicide in Örebro County, Sweden. Control psychiatric patients matched by age, sex, and main psychiatric diagnosis were selected for each case. Binary logistic regression was used to calculate odds ratios in unadjusted and adjusted models.ResultsBenzodiazepine prescriptions were more common among cases than controls (65/154 [42.2%] versus 43/154 [27.9%], p = 0.009, odds ratio: 1.89 [95% CI: 1.17–3.03]). This association remained significant in a model adjusted for previous suicide attempts and somatic hospitalizations (odds ratio: 1.83 [95% CI: 1.06–3.14]). No statistically significant differences were seen between the groups in the use of any other subtype of psychopharmaceutical agent.ConclusionsThese data indicate that benzodiazepine use may increase the risk of suicide. However, this study is limited by the potential for indication bias.

The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors. The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single- and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates. The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree. Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.

BackgroundThe study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC.MethodsHospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing.ResultsOne hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPU-admission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10–6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations.ConclusionDifferent medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.