Management Of Psychiatric Patients Research Articles

(193) Creating a Resident Elective in Psychiatric Management of Patients with Sickle Cell Disease: An Educational Case Report

(193) Creating a Resident Elective in Psychiatric Management of Patients with Sickle Cell Disease: An Educational Case Report

Evaluation of Nurses’ Skills about Management of Psychiatric Patients in Emergency Unit

Background: The emergency department (ED) is a health-care location where patients receive treatment for a range of diseases, including life-threatening crises, acute sickness and injury, and chronic-condition problems. Emergency departments (EDs) have the responsibility of providing safe emergency health care to everyone who require it in a compassionate and cost-effective manner Material and Method: A descriptive analytic design was conducted on Evaluation of Nurses’ Skills about Management of Psychiatric Patients in Emergency Unit in Babylon governorate for the period of (December 12th, 2021 to march 14th, 2022). The study instrument was designed to meet the objectives of the current study, which was consisting of two parts: the first part includes the demographical data for nurses; the second part includes the Skills management Scale 37 items (SPSD). Results: The results showed that nurses are young with age (27.89±6.291 year) in which 75.8% of them are seen with age group of 20-29 year. The analysis of skill in this study showed that nurses have fair level of skills as seen among 78.8% and 17.4% among nurse have poor level of skills and 3.8% among nurse have good level of skill. Conclusion: The study concluded that most nurses have a fair level of skills ' about the treatment of psychiatric disorders at emergency units. Keywords: Evaluation, of Nurses’ skills, Management, Psychiatric, Emergency Unit

Assessment of nurses’ knowledge about management of psychiatric patients in emergency unit

The Emergency Department is a fast-paced setting where nurses must deal with crucial situations such as psychologically disturbed patients. Nurses in emergency rooms are frequently presented with patients who exhibit physical symptoms associated with psychiatric disorder, which might impair nurses' ability to make an accurate diagnosis and manage their patients. A descriptive analytic design was conducted on measurement of the Nurses' Knowledge regarding management of psychiatric disorders at emergency units in Babylon governorate for the period of (December 12th, 2021 to march 14th, 2022). The study instrument was designed to meet the objectives of the current study, which was consisting of two parts: the first part includes the demographical data for nurses; the second part includes the knowledge management Scale 32 items (KMS). The results showed that nurses are young with age (27.89±6.291 year) in which 75.8% of them are seen with age group of 20-29 year. The study shows nurses have a good level of knowledge for items related to knowledge about the treatment of psychiatric disorders at emergency units as seen among 89.4%. The study concluded that most nurses have a good level of knowledge ' about the treatment of psychiatric disorders at emergency units.

Investigation of the effect of trazodone on spontaneous and acetylcholine-induced bladder detrusor smooth muscle contractions

Objective: The management of psychiatric patients is often complicated by medical comorbidities, complex pharmacological regimens, and side effects secondary to these regimens. In the current study, it was aimed to investigate the effects and mechanism of action of trazodone on rat bladder smooth muscle contractility in vitro. Method: Sixteen adult male Wistar albino rats were euthanized by the cervical dislocation method following ether anesthesia. Two muscle strips of 2 × 10 mm in size were prepared vertically from the bladder by opening a longitudinal incision from the neck of the bladder in the direction of the apex. The strips were tied properly and hung in the organ bath. All contraction amplitudes and frequencies were recorded. After a 45-min adaptation period, contractions were induced by applying 105 M acetylcholine (ACh) to all spontaneously contracting bladder strips. After 20 min, doses of trazodone (109 M vs 103 M) were given cumulatively. The resulting effects were recorded. Results: The groups were compared within themselves: a significant difference was found between the initial tensions in the group with ACh-induced contractions and the tensions after the administration of trazodone at 109, 108, 107, 106, 105, 104, and 103 M doses (p < 0.0001). In the group with spontaneous contractions, a significant difference was found between the initial tensions and the tensions after the administration of trazodone at 109, 108, 105, and 104 M doses (p < 0.0001). Conclusion: Results showed that trazodone had a significant inhibitory effect on bladder smooth muscle contractions in vitro, especially at concentrations of 104 and 103 M.

Psychiatric management of Patients in intensive care units.

Psychiatric management of Patients in intensive care units.

The impact of implementing a psychiatric emergency hotline on the reduction of acute hospitalizations in a Swiss tertiary hospital

BackgroundInpatient treatment is not the most beneficial treatment setting for many patients with psychiatric disorders and overcrowding is a recurrent problem for psychiatric hospitals. Therefore, it is important to develop strategies to limit avoidable inpatient treatment. This study sought to evaluate the impact of an emergency hotline that was developed to better manage psychiatric patients, particularly for identifying those requiring a hospital admission.MethodsThis pre-post intervention quality improvement study compared changes in the management of psychiatric patients’ admission before and after the introduction of an emergency hotline where a specialist in psychiatry examines all inpatient referral from private practitioners.Main outcomes were the change in proportion of hospital admissions after referral from a private practitioner before and within 3 months after the intervention. Secondary outcomes were the average length of hospital stay, proportion of non-voluntary admission, the time required for triage and the impact of the intervention on treatments’ costs. Fisher’s Exact test was used to test the primary hypothesis of difference in the proportion of hospitalized patients before and after introduction of the emergency hotline. Secondary outcomes were tested with Student’s t-test for continuous variables and Fishers’s Exact test for proportions.ResultsAmong 45 admission requests from private practitioners during the 3 months after introduction of the new emergency hotline, 25 (55.6%) were accepted as inpatient treatment, while 20 (44%) were redirected to more appropriate outpatient treatments. There was a highly significant difference from the baseline period during which all 34 requests were accepted (44% vs 100%, p < 0.001). In addition, for the patients hospitalized after the introduction of the emergency hotline there was a trend-level reduction of the average length of stay (9.32 days vs 17.35 days).ConclusionImplementation of an emergency hotline manage by a specialist in psychiatry for admissions to acute psychiatric wards is feasible and simple to use. Importantly, it allows to significantly decrease the proportion of hospitalizations. Additional studies are needed to assess the generalizability of these exploratory results to other health care settings.

Awareness, knowledge, and practice of healthcare providers toward the appropriate management of psychiatric patients presenting to an emergency department in Taif city, Saudi Arabia

Awareness, knowledge, and practice of healthcare providers toward the appropriate management of psychiatric patients presenting to an emergency department in Taif city, Saudi Arabia

Therapeutic drug monitoring and pharmacogenetics of antipsychotics and antidepressants in real life settings: A 5-year single centre experience

Objectives Exposure and clinical response to CNS drugs are largely variable. AGNP guidelines suggest therapy individualisation with therapeutic drug monitoring of plasma concentrations and pharmacogenetic testing. We present the retrospective analysis of the last 5 years’ data collected in real life settings as indirect evidence of the applications of the AGNP guidelines in the routine clinical management of psychiatric patients requiring pharmacologic treatments. Methods Plasma concentrations were quantified using a liquid chromatography/tandem mass spectrometry method. Genomic DNA was isolated using an automatic DNA extraction system. All genotypes were determined by Real-Time PCR. Results We collected a total of 4582 requests for TDM and 212 requests for pharmacogenetic analysis. A wide distribution in the trough concentrations was observed for most drugs indicating a high interpatient variability. Nearly 45% of the samples had trough levels below the minimum effective drug concentrations set by the AGNP guidelines; only 8% of the samples had high concentrations. For pharmacogenetics analysis, among antipsychotics, clozapine, haloperidol and aripiprazole were the most requested (78%); while for antidepressants SSRIs were the most frequently prescribed. Conclusions These data suggest that physicians are becoming more confident with the laboratory pharmacologic tools to optimise treatments and/or that the pharmacological treatment of patients with psychiatric disorders is becoming more challenging. TDM and PGx might significantly contribute to the rational selection of the best drug and best dose in individual cases.

A Pilot Study of Plasma Antipsychotic Drugs Concentrations of First Episode Patients with Psychosis From Epirus - Greece

Background: This contribution is a study on plasma antipsychotics concentrations of first episode outpatients with psychosis (FEPs), under antipsychotic treatment; it aims to attract attention to the importance of the drug-driven management of psychiatric patients for improving adherence and clinical efficacy. Methods: The plasma antipsychotic concentrations were determined retrospectively (after the completion of selection of all samples) and therefore, they were not used to monitor patients’ response to pharmacotherapy. A total of 120 plasma samples from 35 psychiatric patients were collected and tested for antipsychotics. The concentrations of eight antipsychotic drugs (amisulpride, aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone and paliperidone) and seven of their metabolites were determined. Results: Overall, 74% of the samples had therapeutic antipsychotic levels, 19% had subtherapeutic concentrations, while supra-therapeutic concentrations were measured for clozapine (7%). Therapeutic drug concentrations were recorded in 54% of plasma samples from patients being under olanzapine medication and in all patients under long-acting injectables. Sub-therapeutic levels were either attributed to non-adherence, or they reflected residual levels due to medication changes. Supra-therapeutic levels were recorded for clozapine and were not followed by adverse effects. Conclusion: This is the first study on antipsychotic plasma levels conducted in Greece. Our results show the importance of performing measurement of plasma antipsychotics levels, at appropriate time intervals, for improving adherence, clinical decision making and thus clinical efficacy. Especially for FEPs, such approach could contribute to early detection of treatment limitations and improve outcome.

Soigner sans contention physique, quels enjeux psychiques ? De la contention à la contenance

AimsVia a brief history of mechanical restraint and its current use in psychiatry, we discuss its implications, its negative impact and the scope for and the consequences of non-restraint in clinical practice. MethodsWe conducted a literature review to analyze mechanical restraint use in Europe and also made use of clinical experience in a psychiatric hospital in Marseille, France. ResultsThe use of mechanical restraint is controversial and its therapeutic benefits remain unsubstantiated. Research suggests that the most efficient strategies to avoid physical restraint include a better working environment, better staff training, improved staff-to-patient ratio, and implementation of an open-door policy. DiscussionDespite a gradual reduction in the use of mechanical restraint in psychiatry in the 1960s, as reforms progressed in Europe and particularly in France, psychiatric departments today have to cope with new security issues. In this context, coercive physical measures and isolation strategies have increased. There are even “recommendations” about limiting the use of restraint, so as to avoid aggravating situations. This is a paradoxical situation, since it supports a practice whose deleterious effects are recognized. ConclusionsThe increasing use of physical restraint in the management of psychiatric patients is not attributable solely to security and legal considerations. The phenomenon can also be interpreted as an evolution of psychiatry from a practice based on a relationship and talking therapy to a more objective practice, where subjectivity and the spoken word seem to be ignored.

Impact of an educational intervention in enhancing nurses’ knowledge towards psychiatric patients’ ethical and legal rights

Background and objective: The management of psychiatric patients and the law of ethic already exists. Therefore, nursing ethics are necessary for psychiatric nurses since they are involved in providing services that impact human life. The aim was to evaluate the effectiveness of an educational program in enhancing nurses’ knowledge regarding their responsibilities toward psychiatric patients’ ethical and legal rights.Methods: A quasi experimental study design with one group pre/post was used with 30 nurses recruited conveniently from Psychiatric Hospital Jeddah, Saudi Arabia. Nurses were questioned using 5 short answer questions, 11 multiple choice questions and the Structured Knowledge Questionnaire developed by Kumar, Mehta, and Kalra (2011).Results: A total of 30 nurses were recruited, with their age ranging between 25-54 years old; the majority (59.4%) were married, while 78.1% neither have psychiatric nursing experiences nor did they study ethics during their undergraduate years. The total mean score of pre-knowledge questionnaire was 27.2 ± 2.97 compared to 30.2 ± 2.40 in post assessment, with a significant difference between pre and post assessment. On the other hand, the total mean percentage of nurse’s theoretical background in pre assessment was 25% compared with 29% with no significant difference between pre and post interventions.Conclusions: Nurses’ knowledge was inadequate regarding ethical and legal rights. The current study findings evidenced the effectiveness of the educational intervention in changing the nurses’ knowledge significantly. Therefore, it is a necessity to ensure that nurses working in psychiatric hospitals have the necessary expertise regarding the legal and ethical issues involved with caring for psychiatric patients, to decrease the effects of malpractices and negligence in psychiatric nursing practice.

Perception on Psychiatric Care Received by Patients Admitted Following Deliberate Self Harm to Three Hospitals in Galle District

Deliberate Self-harm (DSH) adds a significant burden to the health care system in Sri Lanka. Delivering appropriate psychiatric care is crucial to minimize further risk. The objective of this study was to describe perception on psychiatric care received by patients who are admitted following DSH to selected hospitals in Galle District. Sample was taken from a large study which was intended to describe psychiatric management of patients admitted following DSH to 3 tertiary care hospitals in the Southern province of Sri Lanka. Only a sub-sample of 60 patients was taken for the analysis and it was further supplemented with a qualitative component. An interviewer-administered questionnaire (IAQ) was used and a series of in-depth interviews were also conducted. Descriptive statistics were calculated and qualitative data was analyzed separately. As per the results, only 22 (36.7%) were referred to the psychiatry unit and the rest were discharged only after managing their medical problems. A majority (68.2%) told that they were not informed about the need and importance of psychiatric referral. But a larger proportion mentioned that it was good (54.5%) and it brought some relief to them (81.8%). Only a few acknowledged that it helped them to solve their problems (22.7%) and only a very few (13.6%) told that they were embarrassed because of referring to the psychiatry unit. Out of those who had psychiatric referral, only 59.0% were requested to attend for clinic follow up. But only 41.6% intended to come. Upon inquiring about their overall perception about psychiatric referral, almost all gave positive remarks. However, results of this study can be used a baseline and further studies are needed to confirm burden issue related to the health care system in Sri Lanka. KEYWORDS – Deliberate Self Harm, Psychiatric Care

Functional status and its associated factors in Nigerian adults with serious mental illnesses

Patients with serious mental illness may be less likely to achieve functional goals than the general population. Assessment of the functional impact of the illness is useful to determine severity of illness, evaluate remission, and achieve optimal treatment success. The aims of this study are to determine and compare the prevalence of low functional status among outpatients with major axis 1 psychiatric disorders, assess the risk factors for low functional status, and determine the proportion of the variance in low functional status explained by low self-esteem and non-adherence to medication. A descriptive cross-sectional study was conducted among 308 outpatients of the psychiatric unit of a tertiary hospital. The Global Assessment of Functions (GAF), Morisky Medication Adherence Scale (MMAS-8) and the Rosenberg’s Self-esteem Scale were used to collect data, which were analyzed using version 20 of SPSS. Level of statistical significance was set at 5% (P< 0.05). The overall prevalence of low functional status was 40.6%. Patients with schizophrenia had the highest prevalence of low functional status (53.4%). Educational attainment, employment status, self-esteem, medication adherence, and comorbidity had significant association with functional status. Poor medication adherence had the largest relative contribution (35.4%) to the variance in functional status, while self-esteem had an insignificant relative contribution of 3.4%. An appreciable proportion of the patients in this study had low functional status with more schizophrenic patients having impairment than patients with mood disorders. Poor medication adherence, among other variables, contributes significantly to low functional status. Physicians should give as much attention to functional recovery as they give to symptom resolution in the management of psychiatric patients. Keywords: Functional capacity; Psychiatric patient; Correlates; Benin-City

Management of psychiatric patients before deinstitutionalization: an inquiry into the years 1907-1913 in Pisa

Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness. We focused on the early years of this structure’s activities considering all admissions from 24th April 1907 to 31st January 1913. We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student’s t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers. Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a “sieve-institution” to prevent asylum overcrowding from treatable, non-chronic conditions. These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.

Epitranscriptomic blood biomarkers to manage psychiatric disorders

Major depressive and bipolar disorders are leading causes of disability worldwide yet, many people remain undiagnosed or misdiagnosed or ineffectively treated. Diagnosis relies on the clinical assessment of symptoms and currently, there is no molecular diagnostic test available. Identifying and validating blood biomarkers could provide a more accurate and objective means of diagnosis. Genetic and epigenetic events are involved in psychiatric aetiology, among them RNA editing modifications have been associated with inflammation and neuropsychiatric disorders. Adenosine to inosine RNA editing constitutes a physiological cellular process that translates environmental cues by regulating protein function at the synaptic level in health and disease. RNA editing is post-transcriptional process that leads to functional diversity of proteins. These marks form the molecular interface between the genome and the environment. Of particular interest is the RNA editing modification that occurs on the phosphodiesterase 8A gene located on chromosome 15q25.3, a genomic region that has recurrently been associated with early onset of major depressive disorder. ALCEDIAG???s test, EDITDIAG, identifies in blood specific signatures through the RNA editing modifications of patients in different pathological conditions such as a cohort of hepatitis C infected patients, treated with interferon alpha and ribavirin were followed during 16 weeks. This treatment is well known to trigger depression in 50% of patients. RNA editing modifications were measured each two weeks as well as clinical evaluations of depression (MINI). An algorithm was identified which allows to discriminate patients with depression from others with a high specificity and sensitivity; a cohort of depressed patients (n=163) was compared to controls (n=69). A specific RNA editing signature was identified in depressed patients. The test shows that RNA editing related blood biomarkers allow to stratify patients, characterizes psychiatric conditions and follows up the disease/treatment modifications along time. This test paves the way for a better management of psychiatric patients. Recent Publications 1. Weissmann D, Underwood M, Salvetat N, Cavarec L and Vincent L (2016) Region specific alterations of A-to-I RNA editin of serotonin 2c receptor in cortex of suicides with major depression. Translational Psychiatry 6(8):e878. 2. Van Der Laan S, Salvetat N, Weissmann D and Molina F (2017) Emerging RNA editing biomarkers will foster drug development. Drug Discovery Today 22(7):1056-1063. 3. Cavarec L, Vincent L, Le Borgne C, Plusquellec C and Ollivier N (2013) In Vitro screening for drug-induced depression and/or suicidal adverse effects: a new toxicogenomic assay based on CE-SSCP analysis of HTR2C mRNA editing in SHSY5Y cells. Neurotox Res. 23(1):49-62. 4. Cambon K, Dos-Santos Coura R, Groc L, Carbon A and Weissmann D (2010) Aggressive behavior during social interaction in mice is controlled by the modulation of tyrosine hydroxylase expression in the prefrontal cortex. Neuroscience 171(3):840-51.

Protocol for the management of psychiatric patients with psychomotor agitation

BackgroundPsychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode.MethodsSpanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement.ResultsThe protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in the least invasive and coercive manner, ensuring their own safety and that of others around them.ConclusionEstablishing specialized teams in agitation and providing them with continued training on the identification of agitation, patient management and therapeutic alternatives might reduce the burden of PMA for both the patient and the healthcare system.

Disposition Decisions for Psychiatric Patients Presenting to the Emergency Department

Purpose of Review Disposition decisions of psychiatric patients in the emergency department are challenging in hospitals without rapid access to psychiatric professionals. There is a movement towards more outpatient management of psychiatric patients in response to inpatient bed shortages and more appropriate use of resources. If there were a good modality of risk assessment for suicidal patients, then it would be possible that the ER physician could discharge more patients home following evaluation. These options would allow for better throughout and less cost incurred by the patient and healthcare system.

Charges and convictions of psychiatrists for the violent behavior of the patient: psychiatric-forensic remarks

Purpose of the present study is to point-out a number of psychiatric-forensic remarks about the management of violent behavior against the person (VBP) amongst psychiatric patients. The study is the authors' personal contribution based on clinical and forensic experience as experts in the management of psychiatric patients with VBP. Twelve psychiatric-forensic remarks have been highlighted in the present study: 1) VBP is a multifactorial event; 2) the risk of VBP against the person may change rapidly over time in quantity and quality; 3) there are no methods for reliable prediction of VBP in a single clinical-case; 4) there are no medications with an indication of "heal" the VBP; 5) there are no therapeutic measures that neutralize always, quickly and without recurrences VBP; 6) there exist clinical hypotheses to assess VBP; 7) there exist principles of victimology to assess VBP; 8) there are emotional reactions that can affect the evaluation and clinical and forensic management of VBP; 9) the responsibility of the psychiatrist has to be evaluated at the moment of the events; 10) the responsibility of the psychiatrist must be contextualized in the single clinical-case; 11) there is the need to clarify the individual professional responsibility of psychiatrists who treated a patient; 12) there is the need to clarify the criteria for the definition of the guarantee role. The above-mentioned twelve psychiatric-forensic remarks have implications in the assessment and management of psychiatric patients with violent behavior. They may constitute a basis for further discussion aiming to obtain consensus amongst psychiatrists about good clinical practice and forensic implication in the management of psychiatric patients with VBP and to avoid charges and convictions.

Physical Restraint: A Historical Review and Current Practice

The use of physical restraint in the management of psychiatric patients has a history dating back at least 300 years, with its origins in society finding a quid pro quo legal justification for taking action against unruly citizens. It became increasingly obvious through the years that such practices were violations of patients' civil rights. The consumer movement in mental health in the 1960s and patients' rights cases involving the 14th amendment to the US Constitution that soon followed changed the views and policies related to the use of physical restraint in psychiatric patients. This article discusses current practices and strategies to minimize the use of physical restraint. [ Psychiatr Ann . 2017;47(1):52–55.]

Psychopathy in women: Prediction of criminality and violence in UK and USA psychiatric patients resident in the community

Psychopathy is an important clinical construct often used in the assessment and management of psychiatric patients and offenders. This, in part, is due to the strong association between psychopathy, crime, and particularly violent crime. However, there are few studies of these associations in women. These relationships were examined using information from two large databases. The Partnerships in Care database contains data from a sample of forensic psychiatric patients (154 women and 777 men) in the UK that were discharged from secure psychiatric units. Follow-up was via official conviction data within the next 2 years. The MacArthur study examined violence and aggression in a sample of civil psychiatric patients (367 women and 496 men) in the USA following discharge from an acute psychiatric hospital. Follow-up was via a mixture of self-report, informant report and official records. Psychopathy in both samples was measured via the PCL:SV prior to discharge. Psychopathy was a good predictor of target events for the women in both samples and for all time intervals used. No significant gender differences in the PCL:SV’s predictive efficacy were found. The results provide a strong evidence-base for the use of psychopathy in women when considering future community behaviour and reoffending.