Care Of Psychiatric Patients Research Articles

Members Report Uptick in Plans’ Claims Denials, Scrutiny, and Hassles

Members Report Uptick in Plans’ Claims Denials, Scrutiny, and Hassles

Investigating causes of increased morbidity and mortality within psychiatric patients - Somatic comorbidities of inpatients in a german psychiatric community hospital

IntroductionThe co-occurrence of mental illness and somatic comorbidities is a major cause of increased morbidity and mortality within psychiatric patients, compared to the general population. This may be caused by an unhealthy lifestyle, side effects of psychotropic drugs and systematic barriers in healthcare provision. The underlying mechanisms remain under-investigated.ObjectivesWe systematically investigated relevant barriers and risk factors to the utilization of primary care among severe mentally ill outpatients.MethodsIn a cross-sectional analysis, the psychiatric as well as somatic diagnoses of inpatients of a German psychiatric community hospital were identified. Furthermore, somatic and psychiatric medication, blood values (HBA1C) and sociodemographic data of the patients were analyzed. The frequencies of the somatic diagnoses were presented according to psychiatric diagnoses. By a Chi-Square goodness-of-Fit Test the distribution of somatic diagnoses and drug classes were verified according to the total cohort as well as for each psychiatric diagnosis and in respect to sex.ResultsOur results provide an overview of common comorbidities with regard to the psychiatric diagnosis. The medication, in relation to the recorded somatic comorbidities, as well as the blood values, allow a conclusion to be drawn about the extent and success of the treatment.ConclusionsFor the first time, real-life data on the somatic diagnoses and treatment of patients with a severe mental illness in a German hospital is presented. Our results will be used to create low-threshold interventions for the most relevant somatic comorbidities and to improve primary care of psychiatric patients through linking the care systems.DisclosureNo significant relationships.

Association of Psychiatric Services Referral and Attendance Following Treatment for Deliberate Self-harm With Prospective Mortality in Norwegian Patients

Psychiatric care following somatic treatment for deliberate self-harm (DSH) is pivotal in patients' lives both in the short and long term, but evidence to guide such care is limited. To examine follow-up psychiatric care for patients treated for DSH (ie, intentional self-injury or self-poisoning, irrespective of motivation) at hospital emergency departments and to assess the association of psychiatric referral and treatment attendance with risk of subsequent mortality in these patients. Retrospective data from several Norwegian registries were interlinked to follow up a national cohort of all patients with hospital-treated DSH for up to 11 years from 2008 through 2018. Data were analyzed from March to October 2021. Socioeconomic characteristics, psychiatric history, and clinical features of DSH. Referral to psychiatric services, attendance in psychiatric treatment, and prospective mortality were the 3-stage outcomes during follow-up. Logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were used to examine associations between exposures and outcomes. The study identified 43 153 patients (24 286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years) involving 69 569 DSH episodes. Of these patients, 6762 (15.7%) were referred to psychiatric services after somatic treatment for DSH, and 22 008 patients (51.0%) attended psychiatric treatment within 3 months of discharge following somatic treatment for DSH. Prior psychiatric history and psychiatric disorders comorbid with DSH were associated with both referral to and attendance in psychiatric care. During follow-up, 7041 patients died by suicide (n = 911) or other causes (n = 6130). While suicide risk was associated with male sex, age 35 to 64 years, and particularly prior and coexisting psychopathologies, other-cause mortality was associated with age 65 years and older and socioeconomic disadvantage. Patients with psychiatric referrals generally had an increased risk of suicide, but the risk was particularly high among patients who received a referral but did not subsequently attend psychiatric treatment (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed association was more pronounced during the first years of follow-up and in patients aged 10 to 34 years or 35 to 64 years and those with a clear intent of self-harm. This national cohort study found an association between psychiatric care attendance following treatment for DSH and prospective mortality, highlighting the importance of patient engagement in psychiatric treatment.

The Reorganization of a Psychiatric Unit During COVID-19: A Reflection for Psychiatric Hospital Design.

Objective:The COVID-19 pandemic has impacted healthcare systems worldwide. Although this disease has primarily impacted general medicine intensive care units, other areas of healthcare including psychiatry were modified in response to corona measures to decrease the transmission of the disease. Reflecting on the modifications to the environment provides an opportunity to design psychiatric environments for future pandemics or other demands for healthcare.Background:The therapeutic environment of psychiatric wards was modified in Friesland, the Netherlands, in response to COVID-19. During this time, an interdisciplinary team met consistently to contribute to the preliminary design of a new psychiatric hospital.Methods:During the first 18 months of the pandemic, clinical reflections were made to describe the impact of COVID-19 on the psychiatric care environment. Architects have created a preliminary design of a new psychiatric hospital based on these reflections, monthly collaborative design discussions based on virtual mock-ups and evidence-based design based on theoretical concepts and research.Results and conclusions:This theoretical and reflective study describes how an inpatient psychiatric environment was restructured to manage infection during COVID-19. The therapeutic environment of the psychiatric ward and patient care changed drastically during COVID-19. The number of patients accessing care decreased, patient autonomy was restricted, and the function of designated behavioral support spaces changed to manage the risk of infection. However, these challenging times have provided an opportunity to reflect on theories and consider the design of new hospital environments that can be adapted in response to future pandemics or be restructured for different care functions.

Psychodynamic Lessons for Modern Cancer Care: The Role of Institutional Transference in the Psychiatric Care of Cancer Patients

Psychodynamic Lessons for Modern Cancer Care: The Role of Institutional Transference in the Psychiatric Care of Cancer Patients

International Medical Graduates in the United States Psychiatry Workforce.

ObjectiveThis study describes the supply, distribution, and characteristics of international medical graduate (IMG) psychiatrists who provide services in the USA.MethodsCross-sectional study design, using descriptive statistics based on combined data from the American Medical Association (2020 Physician Masterfile) and the Educational Commission for Foreign Medical Graduates.ResultsInternational medical graduates continue to make significant contributions to the US physician workforce. As a group, they represent 29% of active psychiatrists in the USA, compared to 23% in all other medical specialties. Many IMG psychiatrists were US citizens who obtained their medical degrees outside the USA or Canada, often in the Caribbean. In some states (i.e., Florida, New Jersey), over 40% of active psychiatrists are IMGs. Over 30% of IMG psychiatrists graduated from medical schools in India and Pakistan.ConclusionsThis study provides an overview of the psychiatric workforce in the USA, quantifying the specific contribution of IMGs. Several factors, including immigration policies, continued expansion of US medical schools, and the number of available residency positions, could impact the flow of IMGs to the US. Longitudinal studies are needed to better understand the implications for workforce composition and distribution, and their potential impact on the care of psychiatric patients.

Surgical Care of Patients Experiencing Homelessness: A Scoping Review Using a Phases of Care Conceptual Framework.

Homelessness is a growing concern across the world, particularly as individuals experiencing homelessness age and face an increasing burden of chronic health conditions. Although substantial research has focused on the medical and psychiatric care of patients experiencing homelessness, literature about the surgical care of these patients is sparse. Our objective was to review the literature to identify areas of concern unique to patients experiencing homelessness with surgical disease. A scoping review was conducted using a comprehensive database for studies from 1990 to September 1, 2020. Studies that included patients who were unhoused and discussed surgical care were included. The inclusion criteria were designed to identify evidence that directly affected surgical care, systems management, and policy making. Findings were organized within a Phases of Surgical Care framework: preoperative care, intraoperative care, postoperative care, and global use. Our search strategy yielded 553 unique studies, of which 23 met inclusion criteria. Most studies were performed at public and/or safety-net hospitals or via administrative datasets, and surgical specialties that were represented included orthopedic, cardiac, plastic surgery trauma, and vascular surgery. Using the Surgical Phases of Care framework, we identified studies that described the impact of housing status in pre- and postoperative phases as well as global use. There was limited identification of barriers to surgical and anesthetic best practices in the intraoperative phase. More than half of studies (52.2%) lacked a clear definition of homelessness. Thus, there is a marked gap in the surgical literature regarding the impact of housing status on optimal surgical care, with the largest area for improvement in the intraoperative phase of surgical and anesthetic decision making. Consistent use of clear definitions of homelessness is lacking. To promote improved care, a standardized approach to recording housing status is needed, and studies must explore vulnerabilities in surgical care unique to this population.

Surface acting is related to emotional exhaustion among staff members working in high secure forensic psychiatric care

ABSTRACT The concept of ‘emotional labour’ has been suggested as a useful framework for studying the relationship between emotionally demanding work and well being of health-care staff. The framework distinguishes ‘surface acting’ from ‘deep acting’ and suggests a predominant reliance on surface acting as a risk for emotional exhaustion. The relationship between emotional demands and emotional exhaustion among staff members working in high secure forensic psychiatric care (n = 131) was studied using the framework of emotional labour. Surface acting was found to partly mediate the relationship between emotional demands and emotional exhaustion. Experiencing the relationship with the manager as supportive contributed negatively to the prediction of emotional exhaustion. Workplace support did not moderate the relationship between emotional labour and emotional exhaustion. Although staff members working on wards in the direct care of forensic psychiatric patients tend to use both deep and surface acting during their work, our study results also show that deep acting and surface acting are differently related to emotional exhaustion. The framework of emotional labour indeed showed to be a useful paradigm within this population. Therefore, suggestions are made to pay attention to emotional labour strategies in future research and practice.

Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study.

Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.

Work incapacity and psychiatric patient care following attempted suicide - a cohort study of 65 097 Swedish twins.

Research is scarce on the role of familial factors and previous psychiatric care on the association between suicide attempt and future work incapacity as well as deterioration in mental health. We aimed to investigate the associations between suicide attempt and sickness absence, disability pension and psychiatric patient care and to study the influence of previous psychiatric care and familial factors (genetics and shared environment) on the associations. The study included 65 097 twins living in Sweden on 31st of December 2006, aged 19-60 years. The twins were followed 2007-2013 regarding sickness absence, disability pension, inpatient care or specialized outpatient care for a mental diagnosis. Cox regression models were performed for the whole sample, and conditional models for discordant twin pairs. The analyses were also stratified by psychiatric care before 2007. We found that suicide attempt predicted sickness absence, disability pension, and future mental diagnosis among the whole sample. The discordant twin pair analyses showed that the association between suicide attempt and sickness absence or disability pension was influenced by familial factors. Stratified analyses of individuals with or without psychiatric care before 2007 showed that previous psychiatric care had some impact on the associations. A suicide attempt is a risk factor for work incapacity and psychiatric patient care. Familial factors and previous psychiatric care play a role in the associations between attempting suicide and work incapacity as well as psychiatric patient care. These factors are important when developing measures preventing work incapacity among those with a suicide attempt.

Mental Illness and Addiction: Lessons from the County Hospital Inpatient Psychiatric Ward

There is often a stark difference in how people interpret their first exposures to physical illness versus mental illness and addiction medicine. Many times, there is a tendency to sympathize with physical illness but separate ourselves from mental illness and addiction. I’ve slowly learned to see myself in each of my patients, regardless of diagnosis. In this experience article, I describe what it is like to interact with and care for psychiatric patients and how my thoughts on their care changed during my inpatient psychiatric rotation.

Buffering effect of in-patient psychiatric care on the link between fear of covid-19 and mental health consequences.

Background& aimesPsychiatric admissions during the covid-19 pandemic were limited, overlooking their possible benefit. This study focused on assessing the effect of the fear of covid on the mental health and well-being of inpatients as opposed to outpatients.MethodsDuring the first lockdown, forty-four inpatients and day care patients (inpatient group) and 74 outpatients (outpatient group) were recruited after an informed consent procedure. Fear of the infection was assessed using the Fear of COVID-19 (FCV–19S); severity of mental health symptomatology was evaluated with the outcome questionnaire-45 (OQ-45); wellbeing was assessed with the Psychological well-being scale (PWB).OutcomesThere was no difference between the inpatient group and outpatient group in their fear of COVID-19 levels.FCV-19 predicted changes in the outpatient OQ total score (B ​= ​2.21, p ​< 0.001), OQ interpersonal relation subscale (B ​= ​0.34, p ​= 0.01), PWB total score (B ​= ​−0.05, p ​< 0.001), PWB environmental mastery subscale (B ​= ​−0.07, p ​< 0.001) and PWB positive relation subscale (B ​= ​−0.05, p ​< 0.001), but not in the inpatient group.ConclusionsMental health and wellbeing of the outpatient group, which had less therapeutic contact than the inpatient group, correlated with the fear of covid, supporting the hypothesis that intensive psychiatric therapy had a protective effect on the mental health consequences of “fear of covid”.

Analysis of Factors Influencing Telemedicine-Based Psychiatric Extended Care and Care of Psychiatric Patients.

The aim of this paper is to understand the current situation of the care burden of patients with mental illness in remission and the factors affecting it in order to provide a scientific basis for targeted interventions. This paper reviews the concept of telemedicine, the application of telemedicine in home hospice care, and the remaining problems and improvement strategies of telemedicine in home hospice care, with the aim of providing a reference for the application of telemedicine in home hospice care in China. The Zarit Burden Scale, Family Care Scale, and Social Functioning Scale were used to conduct one-to-one interviews with 201 schizophrenic patients in remission and their primary caregivers in Hubei Province. Among them, 66, 72, and 25 cases (32.8%, 35.9%, and 12.4%) had mild, moderate, and severe burdens, respectively. Caregivers' family care and patients' social functioning were generally poor. The results of multiple linear regression analysis showed that caregiver age, caregiver education, caregiver family care, patient medical costs, and patient social functioning were factors influencing the burden of care for patients with schizophrenia in remission (P < 0.05). The government, mental health centers, and families should understand the level of caregiving burden of patients with schizophrenia in remission and the factors influencing it and provide targeted measures to reduce the caregiving burden.

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Introduction:The study was done to find out the pathways of care in patients with depressive disorders before reaching psychiatric treatment in a tertiary care Medical College Hospital. Previous studies suggest, only a limited proportion of patients with psychiatric disorders including depression attend the healthcare facilities, and that too when the condition becomes severe. Treatment from unqualified practitioners and faith healers is reported to be a common practice, leading to delay in proper treatment. Highly literate states in India like Kerala, may be have a difference in this.Aim:To study pathways to care of psychiatric patients, and the associated factors based upon the duration of untreated illness, the duration between onset of symptoms and presentation to any mental health professional, total duration of illness, the duration between onset of symptoms and psychiatric consultation, expenses spent before reaching psychiatric care, number of carers seen before consulting psychiatrist, sociodemographic factors and the diagnosis.Methods:A cross-sectional study was conducted to understand the pathway of care adopted by patients with depression attending outpatient departments in tertiary care Psychiatry centers in a rural district of Kerala. The subjects were selected from a semi-structured interview schedule. Severity of depression assessed by Hamilton Rating Scale for Depression. The data was analyzed using SPSS v22 software.Results:Awaiting.Conclusion:Kerala being the leading state in India in literacy rate and composite Health Index scores, might have a pattern on its own in health-seeking behavior. Speedier access to psychiatric care will lead to faster remission, cure and decreased relapses and disability.

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Background:Psychotic disorders carry a substantial burden on public health. There is divergence between high burden of mental illness and comparatively low likelihood of obtaining treatment. Hence, concept of pathway to care is being studied where the help seeking behaviour of patient and family; subsequent accessibility to health care services are evaluated.Aim:To find out pathways of help-seeking behaviour and to assess the association of socio-demographic, clinical and health care service factors with pathway of care of patients with psychotic spectrum disorders.Methodology:A cross sectional study was conducted on patients presenting to psychiatry OPD, KIMS, Hubballi diagnosed with schizophrenia and other psychotic spectrum disorders (as per ICD 10, F20-29). A semi-structured proforma was used to obtain socio-demographic, clinical details of the patient based on WHO encounter form.Results:A total of 60 cases of first episode psychosis were assessed. Mean age of the patients was 33.87±10.94 years. Majority of them were females, belonged to rural background and were married. Mean duration of psychotic illness was 7.5 months. Majority of them 55% had first contact with a faith healer. Only 18.3% had their first contact to a psychiatrist. On an average, the first contact ever was initiated after 2 months of illness onset.Conclusion:Referral to psychiatric services is often delayed leading to increased duration of untreated psychosis and burden of care. The service providers and policy makers’ needs to be sensitised about appropriate and accessible psychiatric services, providing easy and favourable pathway of care for psychiatric patients.

Profile of patients attending telepsychiatry unit and its usability and satisfaction during pandemic in South India - A retrospective study

Background: The COVID-19 pandemic is an unexpected event that has led to a drastic shift in the practice of medicine around the world. Currently, not many studies are available in India regarding the role of telepsychiatry and no study has been done to assess the usability and satisfaction scores of patients who undergo a telepsychiatric consultation. Aim: The aim of the study is to find the profile of patients attending the telepsychiatry Unit and its usability and satisfaction during the pandemic in South India. Setting and Design: The study was conducted on patients attending telepsychiatric consultation from a period of March 25, 2020, to September 2020. Materials and Methods: A retrospective chart analysis of patients attending telepsychiatry consultation from March 25, 2020, to September 2020 was made. Patients who underwent video consultation were asked to fill out the telehealth usability questionnaire scale through Google Forms. The usability of the telehealth system was assessed using a Likert Scale and scoring was done. Statistical Analysis: Descriptive statistics were used to characterize the study population. Statistical significance was set at P < 0.05. The design and findings of this study were written in accordance with SQUIRE 2.0 guidelines. Results: Twenty-two percent of the study population had consultation for more than fourtimes. Around 78% of the study population had online consultation for less than four times. More than 74% of the study population had video consultation and 26% of the study population had audio consultation. The total average Telehealth Usability Questionaire score was 5.3. The usefulness score summary was found to have a low score of 5.2 ± 0.6, whereas the satisfaction scale summary was found to have the highest score of 5.3 + 0.9. Conclusion: Profile of patients who attend a telepsychiatry unit during the crisis and their satisfaction helped us to know the pros and cons of online consultation and the ways to improve telemedicine in regard to psychiatric patient care. Our study shows that majority are satisfied with telepsychiatric consultation.

A Prehospital Emergency Psychiatric Unit in an Ambulance Care Service from the Perspective of Prehospital Emergency Nurses: A Qualitative Study.

The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend cases with suspected mental illness. A pilot project, Psychiatric Emergency Response Team (PAP), was carried out in which a prehospital emergency nurse (PEN) was accompanied by a psychiatric specialist nurse in the assessment of individuals with mental illness. The aim of the present study was to evaluate a prehospital emergency psychiatric unit from the perspective of PENs. A qualitative method using content analysis was applied. Seven senior PENs who had worked for 1 year in a prehospital psychiatric ambulance unit were interviewed individually. The analysis resulted in one main theme, “Transition from limited care and insufficient competence to improved and adequate care for psychiatric patients in ambulance care”. This emerged from six subcategories: inter-professional development, access to patient records, the ambulance vehicle, non-conveyed patients, cooperation with the police and meetings with patients and next of kin. In conclusion, these results suggest that in ambulance care in general, there is a lack of knowledge and skills about mental illnesses and initial care options. The PAP concept opened new avenues for the care of patients with mental illness, which the PENs described very positively as being helpful and valuable.

Phenomenology of the COVID-19 Pandemic Experience in Patients Suffering from Chronic Schizophrenia-A Qualitative Analysis.

Many studies have shown that the COVID-19 pandemic can have a great influence on mental health. However, there is still not enough research to fully understand how people suffering from schizophrenia experience crisis situations such as a pandemic. This qualitative study aims to explore this subject. Ten outpatients suffering from schizophrenia were interviewed in a semi-structured format using an interview designed by the authors for the purpose of this study. The interviews were transcribed, and a conventional qualitative content analysis was conducted. The general themes identified in the content analysis were organized into four categories: first reactions to information about the pandemic; subjective assessment of the pandemic’s impact on patients’ mental health; patients’ attitudes towards the temporary limitations and lockdowns; psychiatric treatment and psychotherapy during the pandemic. A variety of different experiences were observed, but the general conclusion arising from the study suggests that the majority of the interviewed patients coped quite well with the pandemic and that the observed reactions were similar to the reactions of other groups described in the literature. The study also confirmed the importance of the continuity of psychiatric care for patients with schizophrenia.

Improving services for those who serve: A private practice initiative to improve psychiatric care for first responder and military patients.

Professional isolation and limited opportunities for multidisciplinary collaborations are well-recognised challenges for psychiatrists in private practice. This narrative paper describes the development of a private practice group to assist first responders (FRs) and military patients located in Adelaide, South Australia. The aims included both peer review, and interdisciplinary communication and collaboration. Relevant personnel in the ambulance, police and fire services, military and veterans' groups, and the compensation system, participated in monthly meetings. Lack of timely access to psychiatric care for FR and military patients was identified as a problem and an expedited referral service was established. The Closing the Gap Group was established in 2017. The terminology refers to the gap between treating psychiatrists and the complex organisations that manage the workplace context for FR/military patients. This initiative provides a template for private practice innovations to improve psychiatrists' skills and knowledge, along with better engagement and understanding between private psychiatrists and relevant community organisations.

The comparative study of quality of life among working women and homemakers taking care of psychiatric patients presenting in a tertiary care hospital, Patna

Background: In India, women are twice more likely to become caregivers than men. The quality of life (QOL) is the ability level to which an individual is healthy and able to enjoy life. Aims and Objective: To assess and compare QOL among homemaker women and working women giving care to patients suffering from psychiatric illnesses. Materials and Methods: This hospital-based, cross-sectional study was conducted on the caregivers who were recruited from out-door patient department of Psychiatry department of Patna Medical College and Hospital, Patna from January 1, 2021, to June 31, 2021. Women who were 30–55 years old, working or homemakers, and who were taking care of psychiatric patients diagnosed with Schizophrenia and Bipolar affective disorder of either sex. Caregivers were first degree relatives of patients. The estimated sample size was 140 (Group 1=70 homemaker women and Group 2=70 working women). Sociodemographic data were recorded using Sociodemographic Performa 1 and QOL was assessed using World Health Organization (WHO)-QoL-BREF. Results: WHO-QOL domain mean score for physical, psychological, social, and environmental of Group 1 was 12.42, 11.60, 12.24, 12.62 whereas 14.46, 13.28, 11.28, and 12.28 of Group 2 with statistically significant difference (P&lt;0.05). Conclusion: In physical and psychological domain of QoL, working women scores were better than homemakers. QOL in working women caregivers was better than homemakers’ caregivers in social and environmental domains but statistically non-significant.