Patients In Psychiatric Hospital Research Articles

The potential consequences of informal interpreting practices for assessment of patients in a South African psychiatric hospital

In South Africa health care practitioners are commonly professionals who speak only one, or at most two, of the languages spoken by their patients. This provides for language provision challenges, since many patients are not proficient in English or Afrikaans and ad hoc and haphazard arrangements are made for interpreting by untrained personnel. As part of a larger study (conducted in 2010) in a public psychiatric hospital, we report here on the potential consequences for diagnostic assessments of 13 psychiatric evaluations mediated by ad hoc interpreters who were employed as health care workers and household aides. The psychiatric evaluations were recorded and transcribed verbatim. The first author checked for accuracy of transcription and translations, and the two members of the author team who are both senior African language academics rechecked transcription and translation. We used the typology developed by Vasquez and Javier (1991) to study interpreter errors (i.e. omissions, additions and substitutions). All errors were independently rated by a senior psychiatrist and a senior clinical psychologist to determine whether the errors were likely to have a bearing on clinical decisions concerning the patient and to rate whether errors deemed clinically significant contributed to making the patient appear more ill psychiatrically, or less ill. Of the 57 errors recorded, 46% were rated as likely to have an impact on the goal of the clinical session. Raters concurred that the clinically significant errors contributed towards potentially making the patient look more psychiatrically ill. Detailed analyses of evaluations demonstrate the complexity of informal interpreter positioning regarding issues of diagnosis and cultural factors in illness. Evaluations conducted where clinicians and interpreters are not trained in language and interpreting issues may create a distorted picture of the patients' mental health conditions.

Health Workers Perception on Constraints to Effective Administration of Quality Care to the Mentally Ill Patients

Mental health services which should have been fully mainstreamed into Primary health care with an approach to improve primary prevention and address the risk factors of mental illness have often been identified as one of the most neglected areas of the health services. This study examined the Perception of health workers on the constraints to effective administration of quality health care to the mentally ill patients in psychiatric hospital in Anambra State, Nigeria. Two research questions and two hypotheses guided the study. Related literatures were reviewed. By purpose based classification scheme, descriptive survey research design was used. The study population consisted of all the thirty (30) health workers met on duty during the period of data collection. The instrument used for data collection was self-developed, structured, validated and reliable questionnaire which was administered on a face-to-face basis to the respondents. Data collected were analyzed using chi-square (x 2 ) to test the hypotheses for results at 0.05 level of significance. The result revealed that the constraints as perceived by the health workers were found to be the same irrespective of their area of specialization and years of service at the institution. Based on the findings, it was concluded that there were significant relationship between the health worker's area of specialization and their perception of the constraints to administration of quality health care to the mentally ill patients. The length of service of the health workers also had significant relationship with their perception of constraints to administration of quality health care to the mentally ill patients. It was recommended that government should pay more attention to mental health by integration into Primary health care, recruit more mental health personnel and provide proper treatment facilities.

Effect of a Regional Dedicated Psychiatric Emergency Service on Boarding and Hospitalization of Psychiatric Patients in Area Emergency Departments

IntroductionMental health patients boarding for long hours, even days, in United States emergency departments (EDs) awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the “regional dedicated emergency psychiatric facility,” which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the “Alameda Model” on boarding times and hospitalization rates for psychiatric patients in area EDs.MethodsOver a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service.ResultsIn a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service.ConclusionThe results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding times for patients awaiting psychiatric care by over 80% versus comparable state ED averages. Additionally, the psychiatric emergency service can provide assessment and treatment that may stabilize over 75% of the crisis mental health population at this level of care, thus dramatically alleviating the demand for inpatient psychiatric beds. The improved, timely access to care, along with the savings from reduced boarding times and hospitalization costs, may well justify the costs of a regional psychiatric emergency service in appropriate systems.

Identification and management of adverse effects of antipsychotics in a tertiary care teaching hospital.

Objective:Antipsychotics have revolutionized psychiatry by allowing significant numbers of patients in long-term hospital settings to be discharged and successfully maintained in the community. However, these medications are also associated with a range of adverse events ranging from mostly annoying to rarely dangerous. This study is carried out to identify the adverse drug reactions (ADRs) to antipsychotics and its management in psychiatric patients.Methods:Prospective interventional study was conducted in the psychiatric unit of a tertiary care hospital. Patients of any age and either sex prescribed with at least one antipsychotic were included and monitored for ADRs.Findings:Among the 517 patients receiving antipsychotics, a total of 289 ADRs were identified from 217 patients at an overall incidence rate of 41.97%. Sixty-seven different kinds of ADRs were observed in the study patients. Central and peripheral nervous system was the most commonly affected system organ class (n = 59) and weight gain (n = 30) was the most commonly observed ADR. Olanzapine was most commonly implicated in reported ADRs (n = 92) followed by risperidone (n = 59). Of the 289 ADRs, 80% required interventions including cessation of drug and/or specific/symptomatic/nonpharmacological treatment.Conclusion:This post marketing surveillance study provides a representative data of the ADR profile of the antipsychotics likely to be encountered in psychiatric patients in an Indian tertiary care hospital.

The prevalence of metabolic syndrome and its associated factors in long-term patients in a specialist psychiatric hospital in South Africa

The aims of this study were to determine the prevalence of metabolic disorders in long-term psychiatric patients, and the relationship between known risk factors and these metabolic disorders. All psychiatric in-patients ≥18 years, who had been admitted ≥six months were invited to participate. Eighty-four patients participated. They were interviewed, examined, measured and blood tests conducted to determine several demographic and clinical variables including age, gender, weight, blood pressure and fasting blood glucose. The prevalence of the metabolic disorders were: metabolic syndrome 32%, hypertension 32%, diabetes mellitus 8%, cholesterol dyslipidaemia 32%, triglyceride dyslipidaemia 29%, low density lipoprotein (LDL) dyslipidaemia 50%, overweight 37%, and obesity 24%. Black African and female patients were more likely to have metabolic syndrome. Female patients were more likely to have cholesterol dyslipidaemia and obesity. Hypertension was associated with age. Ninety-six percent of patients with dyslipidaemia were newly diagnosed during the study. Three out of the seven previously diagnosed diabetic patients had raised fasting blood glucose levels. The prevalence of metabolic syndrome falls towards the lower limits of the expected prevalence rate. Race and gender showed a moderate statistical association with metabolic syndrome. There is a lack of screening for dyslipidaemia in this setting. Diabetic patients should be referred to specialist diabetic clinics for better monitoring and control.

Oral health status and treatment needs among psychiatric inpatients in Rennes, France: a cross-sectional study

BackgroundSevere mental disorders have a chronic course associated with a high risk for co-morbid somatic illnesses and premature mortality and oral health is critical for overall systemic health. But general health care needs in this population are often neglected. Some studies have aimed at determining the oral health status of psychiatric in-patients but to date, no emphasis has been placed on oral health of psychiatric patients in France. The goal of this study was to assess the oral health and treatment needs of institutionalized patients in a large psychiatric hospital, where a dental service was available and free, to compare it with the average population, with psychiatric in-patients in other countries and to provide recommendations for psychiatrists and care-giving staff.MethodsThe dental status (DMFT), the oral hygiene (OHIS: Simplified Oral Hygiene Index), the saliva flow rate were recorded on a randomized patient sample. Demographic and medical data were retrieved from the institutional clinical files.ResultsAmong the 161 examined patients, 95 (59.0%) were men and 66 (41.0%) were women. The mean age was 46.9 ± 17.5 years. The majority was diagnosed schizophrenia (36.6%) or mood disorders (21.1%). The mean OHIS was 1.7 ± 1.1. Among the 147 patients who agreed to carry out the salivary examination, the average saliva flow rate was 0.3 g ± 0.3 g/min. Saliva flow under the average rest saliva flow (0.52 mg/min) was found for 80.3% of the patient. The mean DMFT was 15.8 ± 8.8 (D = 3.7 ± 4.4, M = 7.3 ± 9.4, F = 4.7 ± 4.9) and significantly increased with age (p < 0.001) and degree of disability (p = 0.003) (stepwise linear regression). Eighteen patients (11.2%) were edentulous.ConclusionsThe DMFT was similar to low income French population but psychiatric patients had almost 4 times more decayed teeth, slightly less missing teeth and 1.5 times less filled teeth. Oral health appeared to be better than in most other countries. But compared to general population, the still unmet dental and prosthetic needs indicated the major need of enhanced access to dental care and specific preventive programs.

Factors associated with suicide method among psychiatric patients in a general hospital in Korea

This study aims to highlight the factors associated with suicide method among psychiatric patients in a general hospital in Korea. In a sample of 467 suicides by patients who had received mental health care in a general hospital in Korea, the relationship between suicide method and time of death as well as clinical characteristics, including psychiatric adiagnosis, was examined using multinomial logistic regression analysis. Compared with the general population, psychiatric patients, regardless of disorder, committed suicide by jumping from heights more often than by hanging (OR=2.35–8.64). In particular, patients with psychotic disorders and female patients were more likely to use jumping from a height than hanging to kill themselves (OR=2.98 and 1.83, respectively). Patients were more likely to use suicide methods other than hanging (e.g., OR=6.7 for jumping, 5.3 for drowning, and 2.7 for self-poisoning) between midnight and dawn. Possible suicide-prevention strategies suggested by this study include limiting access to or fencing off tall structures in close proximity to psychiatric institutions and residential care homes. At night, limiting access to or instituting heightened supervision of tall structures is specifically indicated.

Dictionary construction and identification of possible adverse drug events in Danish clinical narrative text

ObjectiveDrugs have tremendous potential to cure and relieve disease, but the risk of unintended effects is always present. Healthcare providers increasingly record data in electronic patient records (EPRs), in which we aim to identify possible adverse events (AEs) and, specifically, possible adverse drug events (ADEs).Materials and methodsBased on the undesirable effects section from the summary of product characteristics (SPC) of 7446 drugs, we have built a Danish ADE dictionary. Starting from this dictionary we have developed a pipeline for identifying possible ADEs in unstructured clinical narrative text. We use a named entity recognition (NER) tagger to identify dictionary matches in the text and post-coordination rules to construct ADE compound terms. Finally, we apply post-processing rules and filters to handle, for example, negations and sentences about subjects other than the patient. Moreover, this method allows synonyms to be identified and anatomical location descriptions can be merged to allow appropriate grouping of effects in the same location.ResultsThe method identified 1 970 731 (35 477 unique) possible ADEs in a large corpus of 6011 psychiatric hospital patient records. Validation was performed through manual inspection of possible ADEs, resulting in precision of 89% and recall of 75%.DiscussionThe presented dictionary-building method could be used to construct other ADE dictionaries. The complication of compound words in Germanic languages was addressed. Additionally, the synonym and anatomical location collapse improve the method.ConclusionsThe developed dictionary and method can be used to identify possible ADEs in Danish clinical narratives.

Informal and involuntary mental patients in England and Wales: A comparison in the light of Rabone

Informal and involuntary (compulsorily detained) patients are the two broad categories of patients in psychiatric hospitals today. In Rabone v Pennine Care NHS Trust the Supreme Court made, among other things, a distinction between the two types of patients. This article contributes to the literature by adding to that distinction. It looks at the evolution of the term, 'informal patient', gives an account of Rabone case and then deals with the comparison between the two types of patients.

The effects of an adherence therapy approach in a secure forensic hospital: a randomised controlled trial

Objective To examine the effects of an ‘adherence therapy’ approach on medication compliance and attitudes towards medication in forensic psychiatric inpatients. Method Forty-eight patients in a statewide forensic psychiatric hospital were randomly assigned to receive either eight sessions of adherence therapy (n = 24) or eight sessions of standard health education (n = 24). Outcome measures, collected before and after treatment, included medication adherence, psychopathology, drug attitudes and treatment engagement. Results An analysis of covariance revealed that the experimental group demonstrated significantly more positive attitudes towards medication than the control group following treatment. T-tests showed a significant 35% point increase in the experimental group’s compliance ratings from baseline to post-treatment. Finally, chi-square analyses demonstrated that doctors were less concerned about the future medication adherence of patients from the experimental group who were discharged within three months of receiving treatment. Conclusion Further trials of adherence therapy with forensic populations are warranted.

Sociability and attachment as distinct domains of the interpersonal relationships factor of the BASIS-24

The Behavior and Symptom Identification Scale (BASIS-24) was administered to 1972 patients in a private psychiatric hospital specializing in intensive treatment of several weeks’ duration. The study was designed to investigate the factor structure in a large inpatient population with a high burden of psychiatric illness. While largely replicating previous factor analyses, the study unexpectedly yielded two factors from the items comprising the interpersonal relationships factor, which were interpreted as assessing sociability and attachment. These two new factors showed differential relationships with other measures of interpersonal functioning (Inventory of Interpersonal Problems) and attachment (Relationship Questionnaire), and both factors were sensitive to improvement over the course of intensive inpatient treatment. These results suggest that different treatment interventions might be employed to target these two separable domains of potentially problematic interpersonal functioning.

An examination of discharge against medical advice from brain injury inpatient rehabilitation

Objective: Discharges against medical advice (DAMA) have been considered predictors of adverse outcomes for patients in acute care and psychiatric hospitals. However, little is known about the profile of patients who discharge AMA admitted to rehabilitation hospitals. The aims of this study were to provide a profile of patients who received inpatient rehabilitation services following a traumatic brain injury (TBI) who discharged AMA and to compare this group with the regular discharge group.Research design: Retrospective cohort study.Methods: Hospital discharge data from two national administrative databases were reviewed for the years 2001–2006.Results: The databases yielded 1559 cases of TBI (average length of stay = 51 days). Of these, 31 (2.0%) had recorded DAMA events: one in 50 patients left rehabilitation against medical advice. Compared to regular discharge (n = 1247), DAMA was significantly associated with unemployment, intentional injury, higher motor functions at admission and shorter length of stay. Known factors for DAMA in acute hospitals, such as male sex, young age and substance abuse history, were not significant.Conclusion: Careful screening and assessment of patients who discharge AMA could enable better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.

Continuing clozapine with granulocyte colony-stimulating factor in patients with neutropenia.

The current guidelines dictate that clozapine should be stopped following the emergence of neutropenia. Various alternative approaches have been tried in the past, among them one rarely used alternative being to continue treatment with clozapine with coprescription of granulocyte colony-stimulating factor (G-CSF). In this case series we aim to describe the treatment and progress of a number of patients in a secure psychiatric hospital in the UK. These patients were restarted on clozapine in combination with G-CSF, in spite of previous neutropenia associated with clozapine treatment. We hope that this case series will raise the profile of a potentially effective alternative to discontinuing clozapine after neutropenia.

Malariotherapy at Mont Park: the earliest surviving movie of psychiatric treatment in Australia

A movie on malariotherapy for neurosyphilis made at Mont Park and filmed by Reg Ellery in 1926 is believed to be the oldest surviving movie of psychiatric treatment in Australia. The objective is to review the movie and discuss the background and context of the film, which shows the conditions of patients in a psychiatric hospital in the 1920s. Movie film is a guide to a psychiatric past that is rapidly being forgotten. The Ellery movie is an incentive to collect surviving footage before it is too late.

Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

BackgroundWe compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway.MethodAll acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP). Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian) with univariate and multivariate statistics.ResultsRussian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted.ConclusionAcutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”). Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian.

1144 – Crimes and mental elderly patients in psychiatric hospital of Razi in tunisia

Few scientific studies have been devoted to the study of crime among the mentally ill elderly, however, all the studies agree on the importance of recognizing risk factors associated with passage to forensic action in elderly patients. The objectives of our work are to clarify the sociodemographic, clinical and forensic characteristic of mental elderly patients who commit forensic acts. Our work has focused on all patients older than 60 years hospitalized under the mode of office between 1995 and 2012 in the service of forensic Razi hospital according to article 29 of the law n° 92–83 of the third of August 1992 as amended by the law 2004-40 of 3 May 2004, following a non-legal place due to insanity within the meaning of the 38 article of the Tunisian Penal Code. Our study included 25 patients, their ages ranged between 60 and 90 years. They mostly had a low socio-economic level (64%), a low educational level (48%) and a marital status of married (64%). All patients had a neuropsychiatric disease: schizophrenia and other psychotic disorders in 48% of cases, dementia and Delirium nonspecific in 32% of cases, mood disorder in 16% of cases and mental retardation in 4% of cases. The medico-legal act was murder or attempted murder in 40% of cases, sexual crimes in 16% of cases, aggression against property in 16%, violence against people in 8% of cases and different offenses in the remaining cases.

P236: Effect of a prevention campaign on the prevalence of infections among patients in Belgian psychiatric hospitals: a dynamic prospective cohort study (2001-2010)

Results The overall infection, resp. infected patients prevalence was 18.9% and 16.5%. The three most frequent infections were 1) skin or soft tissue (38.7%), 2) lower (22.5%) and 3) upper respiratory tract infections (11.4%). The prevalence of antibiotics’ use was 2,7%. The implementation of a hand hygiene campaign resulted in significant decreased prevalence of infected patients: 17.7% (95% CI: 17.1-18.3) before versus 15.1% (95% CI: 14.415.7) in the 4-years after the implementation. Antibiotics’ use among infected patients diminished from 17.5% to 14.0% (p<0.001). Conclusion These results are suggestive for a statistically and clinically significant effect of hand hygiene campaigns. Per 1000 patients/year, 37 infections and 26 infected patients have potentially been avoided.

Building the basis for appropriate therapy.

Speech and language therapy may not seem a priority treatment for patients in a secure psychiatric hospital, nor one commonly undertaken by care assistants.

Cause-Specific Mortality of Psychiatric Inpatients and Outpatients in a General Hospital in Korea

This study aimed to examine the cause-specific excess mortality of psychiatric patients in a general hospital in Korea. Between January 1995 and December 2006, 29 986 patients presented to the outpatient clinic of a general hospital in Seoul, Korea, or were admitted to that hospital for psychiatric disorders. Their cause-specific mortality risk was compared with that of age-matched patients from the general Korean population. The mortality risk of psychiatric patients was 1.6 times higher than that of the general population. Inpatients, younger adults, and patients with alcohol use disorders or schizophrenia had the highest standardized mortality rates (SMRs). Alcohol use disorder was associated with extremely high SMRs of more than 20 for hematological disease and digestive system disease. Effective preventive measures are required to reduce the excess mortality of psychiatric patients, particularly alcohol-dependent patients and younger patients who have been admitted for general psychiatric care.

P-1095 - Use of intravenous clomipramine in psychiatric patients in a general hospital

Background Clomipramine is a tricyclic antidepressant with potent serotonin reuptake blockade. It is one of a few antidepressant medications available in the intravenous form and is the only one available in Tan Tock Seng Hospital (TTSH), Singapore. Studies have provided evidence that intravenous clomipramine is useful in the treatment of major depression and obsessive-compulsive disorders. Other possible indications include post-traumatic stress disorder and anxiety disorder. Methods of delivering intravenous clomipramine varied in the literature, with starting doses ranging from 25 mg per day to 150 mg per day and final dosages ranging from 150 mg per day to 250 mg per day, either via pulse loading or gradual loading. Objectives The study aimed to analyze the demographics, indications for treatment, dosage and frequency of administration, complications of treatment and co-morbid psychiatric conditions of patients who were treated with intravenous clomipramine in TTSH over the period from January 2007 to December 2011. Methods A retrospective study was performed on all inpatients admitted under the Department of Psychological Medicine in TTSH who were treated with intravenous clomipramine over the specified period. Results The common indications for treatment include mood and anxiety disorders. The dosage given per day ranged from 25 mg to 150 mg. No mortality or severe adverse events resulted from the treatment. Conclusions The use of intravenous clomipramine may provide clinicians with a safe, fast-acting and efficacious therapy modality for acute management of several psychiatric disorders. Further large-scale studies will be useful in providing evidence to support its clinical use in psychiatry.