Patients In Psychiatric Units Research Articles

A comparison of inpatient suicides in Australian psychiatric and non-psychiatric hospital units between 2009 and 2018

Hospitalisation is designed to protect patients from harm; however, patients have been reported to take their own lives during hospital admissions. While a significant healthcare concern, few studies have analysed inpatient suicides in general and psychiatric hospital units. Understanding these deaths is important for informing future prevention initiatives. Here we investigate a national sample (n = 367) of inpatient suicides in general (24%, n = 87) and psychiatric (76%, n = 278) hospital units. Patient characteristics, suicide location, timing, and suicide methods were assessed and compared. Patients who died from suicide were mostly male and admitted into psychiatric units. General hospital patients were less likely to have a known history of mental illness or previous self-harm and were often admitted for mental illness-related presentations. Suicides frequently occurred outside of the hospital by hanging. Patients in psychiatric units were more likely to be on approved leave at their death, and general patients were more likely to have absconded. These results indicate the need to identify risk factors relevant to each setting and address broader system-level factors. Removing obvious ligature points, preventing absconding, and assessing patients before episodes of leave, could contribute to preventing inpatient suicides.

Staffing and patient-related factors affecting inpatient falls in a psychiatric hospital: a 5-year retrospective matched case\u2013control study

BackgroundThe frequency and severity of falls of psychiatric inpatients in Thailand have not been previously reported. Also, the risk factors of falls have been numerous and complicated. This study aimed to investigate the staffing factors and patient-related factors that increase the likelihood of falls among psychiatric inpatients.MethodsA five-year retrospective matched case–control study was conducted that selected cases of inpatients who fell and which were reported to the hospital risk management system. Subjects were compared to two control patients from the same hospital (1:2) by age (± 5 years), sex, and admission the same year. The total sample consisted of 240 patients. Univariate and multivariate conditional logistic regression was used to analyze the data.ResultsOf the eighty falls, 86.3% resulted in temporary harm and required intervention. The multivariate model showed that three patient-related factors were associated with increased inpatient falls: (1) having an acute psychotic condition (adjusted odds ratio (AOR) = 4.34; 95% CI 1.45, 13.05; p < 0.05), (2) polypharmacy with more than four types of medicines (AOR = 3.06; 95% CI 1.59, 5.88; p < 0.05), and (3) taking atypical psychiatric drugs (AOR = 2.74; 95% CI 1.35, 5.58; p < 0.05). Staffing for 26–50 patients in the wards was more protective for falls than with 25 or fewer patients (AOR = .17; 95% CI 0.04, 0.72; p < 0.05).ConclusionsThe risk factors found may help assess fall risk and manage the number of patients in psychiatric units. Drug dosage and drug interaction of antipsychotic drugs and cardiovascular agents with other medications and drug administration timing before falls are recommended for further investigation. Also, staff ratio per patient and the proportion of staff mix in psychiatric units need further study to establish adequate levels of surveillance to prevent inpatient falls.

Implementing evidence-based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research.

To produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence-based practices through participatory action research. The therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units. Participatory action research. Participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour. Nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence-based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated. This study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence-based practice enhanced participants' awareness of their clinical practice and allowed them to make changes and improvements. The process confirmed that the implementation of evidence-based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses' functions and competencies in current psychiatric units.

Substance Use Among Patients Admitted to Psychiatric Units in Harare, Zimbabwe

Mental and substance use disorders contribute significantly to the global burden of disease. Cross sectional studies done in various high and low income countries show a high prevalence of substance use among patients in psychiatric units. The last local study done to investigate prevalence of substance use among patients admitted to psychiatric units in Zimbabwe was published 19 years ago. Local surveillance information however suggested a change in patterns of substance use needing further investigation. This cross sectional study surveyed a sample of 322 patients admitted to two of the referral psychiatric units in Harare, Zimbabwe from November 2014 to March 2015. Data was collected using a socio-demographic questionnaire, WHO AUDIT and the DAST 10. Urine screening was carried out using on site qualitative immune-chromatographic cassettes. Case notes were reviewed for working diagnosis and details of substance use histories. Current use of alcohol ranged from 24% for illicit alcohol to 56% for beer. After alcohol, the most commonly used substances currently were tobacco products (47%), cannabis (39%) and cough syrups (22%). Thirty eight percent of patients had an alcohol use disorder (WHO score greater than 8) and 34% had a drug use disorder (DAST 10 score greater than 3). Fifty four percent of patients who consented to a urine tests had a positive urine screen for cannabinoids. Forty percent of the patients had a substance related primary diagnosis however 20% of participants had no entry on substance use in their case notes and the substance use histories documented were poorly detailed. There is a high burden of substance related psychiatric conditions in psychiatric units in Zimbabwe with emergence of psychoactive substances (cough syrups and illicit alcoholic beverages) that had not been previously reported on. Funding: None. Declaration of Interest: None. Ethical Approval: Ethical approval to conduct the study was sought from the Institutional Research Boards for the hospitals as well as the Medical Research council of Zimbabwe. Written informed consent was sought from all participants or their relatives/caregivers prior to interviews and urine sampling. The interviews were conducted in a private consultation room to maintain confidentiality.

Every patient’s right to have a single room

All patients should have a single room in hospitals – and not only in acute care (news November 16). Many patients in psychiatric units are still being nursed in rooms of four or more. This is unacceptable. Privacy should be available for all patients.

Catatonia: A Clinician's Guide to Diagnosis and Treatment By Max Fink &amp; Michael Alan Taylor, Cambridge: Cambridge University Press. 2003. 256 pp. $50 (hb). ISBN 0 521 82226 2

![Figure][1] Catatonia – although regarded by many as merely of historical interest – is still instantly recognisable, and is associated with many different neurological and psychiatric disorders. It can be found in as many as one in ten acutely ill patients in psychiatric units.

The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly.

This retrospective study examined the quality of drug prescriptions in two units in Yorkshire. Separate results are given for prescriptions written for patients suffering from dementia and from functional psychiatric illness (such as depression, anxiety and psychosis).

The quality of psychotropic drug prescribing in patients in psychiatric units for the elderly

The quality of written prescriptions has not been examined in a psychiatric setting. The aim of this study was to examine the quality of drug prescribing by medical staff for elderly patients hospitalized with dementia in comparison with the quality of prescribing for elderly patients hospitalized for functional psychiatric illness (depression, anxiety and psychosis). We studied a cohort of 112 elderly psychiatric inpatients in two hospitals over a seven-year period. A standardized assessment sheet was used to assess 320 prescriptions of psychotropic drugs, using medical notes and drug charts. Patients with dementia and functional illness were defined by ICD-9 or ICD-10 criteria. Severity of illness was measured by the presence or absence of symptoms in six discrete symptom clusters. Two raters examined prescription quality. Twenty percent of prescriptions for patients with dementia were illegible, significantly higher than in functional illness. In both groups, among prescriptions of regular medication, one third contained missing information on either, dose, intended frequency, or, indications for use. Among prescriptions for as-required medication, two-thirds of prescriptions contained this missing information. Prescriptions were legible and free of all errors in only 20 of 112 cases (18%). Quality of as-required medication prescribing was inferior to the prescription of regular medication, particularly for dementia patients. In addition, prescribing for patients with dementia carried significantly more errors in notation of dose than prescribing for patients with functional illness. We conclude that errors are common in prescribing for elderly psychiatric patients, particularly for as-required medication and for patients with dementia.

Repetitively violent patients in psychiatric units.

Violent incidents in inpatient psychiatric settings were examined among a group of repeatedly violent patients to better understand the clinical and occupational health significance of repeated violence. Data on violent incidents were collected prospectively over seven months in five psychiatric units in Sydney, Australia. Recidivist patients--those responsible for more than 20 incidents of violence or aggression--and nonrecidivist violent patients were compared in terms of the nature of the incidents, warning signs, and staff responses to violence. Of the 174 patients involved in violent incidents, 20 (12 percent) were recidivists. These patients accounted for 69 percent of the 752 violent incidents identified. Recidivists were significantly older than nonrecidivist patients. Compared with nonrecidivists, the men recidivists were more likely to have an organic brain syndrome, and the women recidivists were more likely to have a personality disorder. When a recidivist patient was violent, staff members' response was significantly less likely to include institutional mechanisms for dealing with violence, such as contacting occupational health and safety officers, completing injury notification forms, and notifying police. Violence occurred among recidivists despite their giving more warning signs than nonrecidivists, suggesting that recidivists' threats were not taken seriously by staff, perhaps reflecting demoralization in the face of repeated violence. Even though this study focused only on serious incidents and defined recidivism narrowly, it found that recidivism of violence and aggression among psychiatric patients was a serious problem. The relative lack of response by staff members to the violent acts of recidivist patients is of concern.

Patient overcrowding in psychiatric hospital units: Effects on seclusion and restraint

The effects of environmental crowding on the behavior of persons in institutional and noninstitutional setting have been studied extensively, but much less frequently with psychiatric patients. The relationship of violent patient behavior, as measured by incidents of seclusion and/or restraint, and population density, as measured by the average census of patients in psychiatric units, was determined in this retrospective study. The results demonstrate a significant and strong positive relationship between number of seclusion and/or restrain incidents and overcapacity.

Guidelines on the clinical management of suicidal patients in psychiatric units

Views differ as to whether it is feasible – or indeed desirable – to agree on a Code of Practice with respect to the clinical management of suicidal patients in psychiatric units (Morgan, 1988). At Fulbourn Hospital (Gardner, 1988) we have developed some guidelines which might, if suitably modified, be used elsewhere; they are appended below.

Separation experiences and other emotional traumata in childhood, and their relationship to subsequent adolescent breakdown.

This paper forms part of an M.D. Thesis presented at the University of Cambridge. One hundred adolescents and their parents were interviewed to ascertain details of their early history. Fifty were obtained from adolescent patients in psychiatric units in Newcastle-upon-Tyne, and were compared with fifty matched individuals who had no psychiatric history, obtained from other departments in the hospital. A comparison of these two groups showed a significantly higher incidence of separation experiences in the childhood of the patient group than in the control group. This was also true of other traumatic events occurring in childhood. These factors also related adversely to prognosis in a two year follow-up of the patient group.