Previous Psychiatric Admissions Research Articles

Prevalence and associated factors of developmental coordination disorder in primary school children.

Developmental coordination disorder (DCD) is one of the most frequently observed movement disorders in childhood, yet data on its prevalence are still unclear. This two-stage epidemiological study aims to determine the prevalence of DCD in children between 6 and 10 years of age according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). In the first stage, the Developmental Coordination Disorder Questionnaire (DCDQ'07) were given to primary school students. In the second stage, clinicians conducted psychiatric interviews with children who had an indication of DCD or were suspected of having DCD according to the DCDQ'07 and their parents. The interviews utilized the DSM-5 diagnostic criteria for DCD and applied the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Adaptation (K-SADS-PL) and Wechsler Intelligence Scale for Children (WISC-R) to identify co-occurring disorders. In the first stage, 2,306 children were evaluated, and 205 were invited for a clinical interview. Of the 198 children interviewed, 49 met the diagnostic criteria for DCD. The prevalence of DCD in Türkiye was found to be 2.1%. High parental education level, a previous psychiatric admission of the child, mother's postpartum depressive symptoms, co-occurring disorders, and co-occurring attention deficit hyperactivity disorder (ADHD) were significantly more common among children with DCD. Potentially associated factors were evaluated by logistic regression analysis. The mother's education level, the presence of postpartum depressive symptoms, and co-occurring disorders in the child were found to be associated factors.

Readmission after discharge from a medium secure service between 1999 and 2017: A retrospective cohort study.

Previous research into outcomes after treatment in medium secure psychiatric hospitals has mostly relied on pre-millennium data. To examine patient and inpatient service-related factors associated with readmission within 2 years following discharge to the community or open conditions from conditions of medium security. A retrospective cohort study of 137 patients discharged either to the community or to open conditions from one 64-bed South Wales Regional Medium Secure Hospital Unit between July 1999 and November 2017 was completed using data from healthcare records to document demographics, diagnosis and nature of index offences together with researcher-completed ratings of inpatient progress using the Dangerousness Understanding Recovery and Urgency Manual (DUNDRUM) Programme Completion and DUNDRUM Recovery scales. Binary logistic regression analyses were used to identify independent associations between inpatient progress according to these measures and readmission. Forty-three patients (31%) were readmitted within 2years of discharge and 23 (17%) in breach of legal conditions on discharge. Most readmitted patients (n=29, 67%) returned directly to medium secure care. There were significant binary level associations between readmission and severity of the index offences (lower), number of adverse childhood experiences (higher), history of drug misuse (more likely) and number of previous psychiatric admissions (higher). Binary logistic regression confirmed that these relationships were not independent. No inpatient service-related variables, according to DUNDRUM scale scores, showed an independent association with readmission within 2years post-discharge. The proportion of medium security hospital patients who were readmitted within 2years of discharge aligns with estimates found in earlier national research using the same follow-up period. Since levels of inpatient progress bore little if any relationship to longer term outcomes, our findings highlight the need for investigating factors in the discharge environment that are linked to readmission. It is possible that readmission may indicate effective monitoring and responsive care to the changing needs of patients, but a better understanding of this is essential.

Electroconvulsive therapy in the maintenance phase of psychotic unipolar depression.

To determine whether the rates of readmissions and suicide vary in psychotic unipolar depression based on whether patients receive maintenance electroconvulsive therapy (M-ECT) following the initial series of ECT, and to examine if there is an age-dependent association. We used Swedish national registries to identify hospitalized patients with psychotic unipolar depression, treated 2008-2019 who received ECT during their hospital stay. The patients who received subsequent M-ECT within 14 days after discharge were compared with those who did not. The primary composite outcome was time to readmission due to a psychiatric disorder, suicide attempt, or suicide within 2 years from discharge. Data were analyzed using Cox regression adjusted for previous psychiatric admissions, age, sex, comorbidity, and pharmacological treatment. We also conducted a within-individual analysis using the sign-test, with patients having ≥1 hospital episode followed by M-ECT and ≥1 hospital episode without M-ECT. A total of 1873 patients were included, of which 130 received M-ECT. There was no statistically significant group difference regarding the primary outcome in the whole sample. However, when stratified by age, there was a significant difference in favor of M-ECT for patients >65 years (adjusted hazard ratio 0.55, 95% confidence interval 0.35-0.87). The within-individual analysis, including 46 patients, significantly favored M-ECT. M-ECT was not associated with a differential risk of the composite of readmission and suicide in psychotic depression. Among patients >65 years, M-ECT was significantly associated with a decreased risk of the outcome. The possibility of residual confounding cannot be excluded.

Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access

There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis. Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October-December 2021 and one year later (October-December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units. One year after full intervention implementation (October-December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October-December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P= 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88± 1.11, 95% CI [1.54, 2.30]). The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.

Organic affective disorder due to meningioma, case report

IntroductionBrain tumors can be associated with psychiatric symptoms in up to 50% of cases. The most frequent primary is meningioma and the clinic will depend on its location. Since surgical treatment does not always guarantee complete resolution of the condition, concomitant psychopharmacological treatment is usually recommended.ObjectivesTo review about organic mania and its differential diagnosis.MethodsWe carry out a literature review about organic affective disorder accompanied by a clinical description of one patient with organic mania.ResultsA 50-year-old woman admitted due to psychotic symptoms. She had a diagnosis of frontal and parietal meningioma treated with surgical treatment 10 years ago. In this context she had a diagnosis of Organic Affective Disorder and 3 previous psychiatric admissions due to affective or psychotic symptoms. Current episode consisted in dysphoria, magalomanic ideation, delusional ideation of harm and mystical-religious content, high speech pressure and insomnia with little awareness of the disease. Cranial magnetic resonance showed postoperative right frontal changes and stability in parietal meningioma, with no significant differences compared to the previous study. Diagnosis of Organic Affective Disorder is maintained and reintroduced treatment with aripiprazole withdrawaled by the patient weeks before. Because of adverse effects and persistence of the symptoms described, it was changed to olanzapine with good response and tolerability. The behavior was progressively adapted with improvement of the dysphoria and without psychotic symptoms at discharge.ConclusionsAffective symptons due to organic disorders such as brain tumors can be treated surgically and with psychopharmacological treatment.Disclosure of InterestNone Declared

What Are the Sociodemographic and Clinical Characteristics and Needs of Mothers Who Access Acute Postpartum Psychiatric Care and Have Children’s Social Care Involvement?

Mothers with severe postpartum psychiatric diagnoses are more likely to have children’s social care involvement with their infants, but little is known about the needs or experiences of this group of women. With input from a lived experience advisory group, we carried out secondary analysis of data collected from 278 mother-infant dyads where the mother accessed acute psychiatric care in England or Wales postnatally. We explored the characteristics, needs, and service use experiences of mother-infant dyads with (n = 99) and without (n = 179) children’s social care involvement. We found that mothers with social care involvement were often experiencing wider adversity and inequity across multiple areas of their lives. These mothers were also less satisfied with their mental health care and had more unmet needs after discharge from acute services. We built multivariable logistic regression models to examine factors associated with children’s social care involvement during the acute admission and one year later. We found that having social care involvement during an acute postpartum admission was associated with being deprived, reporting a maternal history of childhood trauma, experiencing domestic abuse, having a diagnosis of personality disorder or schizophrenia, and having a history of previous psychiatric admissions. At one-year follow-up, factors associated with children’s social care involvement included deprivation, experiencing childhood trauma, having been single at the time of the postpartum admission, and having been readmitted to acute psychiatric services following the postpartum admission. Our findings suggest that mothers with children’s social services involvement in the context of an acute postpartum psychiatric diagnosis may have high levels of support needs, but services may struggle to meet their needs fully. We argue that an increased focus on supporting mothers with histories of trauma, adversity, and deprivation, along with greater collaboration between mental health, children’s social care, and third sector services may help improve experiences and outcomes.

Exploring Agreement Between Adolescent Self-Reported PTSD Symptoms and Clinical Diagnoses on a Psychiatric Inpatient Unit

ABSTRACT A significant number of adolescents in the U.S. experience traumatic events, putting them at risk for developing Posttraumatic Stress Disorder (PTSD). Despite this risk, PTSD is not a commonly assigned diagnosis in psychiatric settings. The current study examined rates of psychiatrist-reported PTSD (PR-PTSD) diagnoses compared to probable PTSD diagnoses based on adolescent self-reported PTSD (SR-PTSD) symptoms on a psychiatric inpatient unit (n = 151, age 13–17). Self-report measures included questions on exposure to trauma and The Child PTSD Symptom Scale for DSM-5 (CPSS-5). Approximately 60% of participants met criteria for a “probable PTSD diagnosis” on the CPSS-5; however, only 10 out of 151 (6.6%) and 58 out of 151 (38.4%) were given PR-PTSD at admission and at discharge, respectively. Chi-square analyses indicated adolescents with SR-PTSD were more likely to have previous psychiatric admissions, χ2(1, N = 149) = 3.87, p = .049. There was also a significant association between SR-PTSD and suicide risk, χ2(3, N = 148) = 9.93, p = .019. Both the null and low suicide risk groups contributed the most to predicting SR-PTSD based on the standardized residuals being ±1.96. Additionally, SR-PTSD and insurance status were significantly associated, χ2(1, N = 147) = 4.48, p = .034. All of the cells equally contributed to the significance. When comparing diagnosis given at admission to SR-PTSD, agreement was poor (κ=.070, p = .043), and there was no agreement between diagnosis given at discharge and SR-PTSD (κ=.116, p = .074). Findings from the study highlight a discrepancy in SR-PTSD and PR-PTSD in adolescent psychiatric settings.

Long-term Outcome Following Electroconvulsive Therapy for Late-Life Depression: Five-Year Follow-up Data From the MODECT Study

Electroconvulsive therapy (ECT) is the most effective treatment for late-life depression (LLD). Research addressing long-term outcome following an acute course of ECT for LLD is limited. We aimed to describe relapse, cognitive impairment and survival 5 years after a treatment with ECT for severe LLD, and assess the association of clinical characteristics with all three outcome measures. This cohort study was part of the Mood Disorders in Elderly treated with ECT (MODECT) study, which included patients aged 55 years and older with major depressive disorder. Data regarding clinical course, cognitive impairment and mortality were collected 5 years after the index ECT course. We used multivariable Cox proportional hazards models and logistic regression models to assess the association of clinical characteristics with relapse and survival, and cognitive impairment, respectively. We studied 110 patients with a mean age of 72.9 years. 67.1% of patients who showed response at the end of the index ECT course relapsed, and the included clinical characteristics were not significantly associated with the risk of relapse. 38.8% of patients with available data showed cognitive impairment at five-year follow-up. 27.5% were deceased; higher age and a higher number of previous psychiatric admissions were significantly associated with increased risk of mortality. Five-year outcome after a course of ECT for severe LLD seems to be in line with long-term outcome following other acute treatments for severe LLD in terms of relapse, cognitive impairment and survival. Additional studies aimed at improving long-term outcome in severe LLD are warranted.

Factors associated with psychiatric admission and subsequent self-harm repetition: a cohort study of high-risk hospital-presenting self-harm

Background Individuals presenting to hospital with self-harm of high lethality or high suicidal intent are at high risk of subsequent suicide. Aim To examine factors associated with psychiatric admission and self-harm repetition following high-risk self-harm (HRSH). Method A cohort study of 324 consecutive HRSH patients was conducted across three urban hospitals (December 2014–February 2018). Information on self-harm repetition was extracted from the National Self-harm Registry Ireland. Logistic regression models examined predictors of psychiatric admission and self-harm repetition. Propensity score (PS) methods were used to address confounding. Results Forty percent of the cohort were admitted to a psychiatric inpatient setting. Factors associated with admission were living alone, depression, previous psychiatric admission, suicide note and uncommon self-harm methods. History of emotional, physical or sexual abuse was associated with not being admitted. Twelve-month self-harm repetition occurred in 17.3% of cases. Following inverse probability weighting according to the PS, psychiatric admission following HRSH was not associated with repetition. Predictors of repetition were recent self-harm history, young age (18–24 years) and previous psychiatric admission. Conclusion(s) Findings indicate that psychiatric admission following HRSH is not associated with repeated self-harm and reaffirms the consistent finding that history of self-harm and psychiatric treatment are strong predictors of repetition.

Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines.&#x0D; Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors.&#x0D; Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated.&#x0D; Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

Facilitated early discharge in Wandsworth

ObjectiveThere is limited research surrounding facilitated early discharge (FD) and Home Treatment Teams (HTTs). This study aimed to compare patients who received FD with patients who were discharged without FD to identify whether there were significant differences in terms of social demographics, illness characteristics, health outcome and treatment duration. Using this data we furthermore aimed to provide proposals to help advance the effectiveness of FD, as well as suggesting concepts of where future research should lie.Case reportA randomised sample of patients who received FD and patients who were discharged without FD was obtained from a South London Hospital. This was manually narrowed down to patients specifically treated by the Wandsworth Home Treatment Team (WHTT). Socio-demographic and clinical data were then attained from the patients’ electronic records to compare and statistically analyse between the two groups.DiscussionPatients who received FD from the WHTT were found to have significantly less previous psychiatric admissions compared to those who were discharged without FD (p = 0.032). All other variables were found to have no association with FD.ConclusionHaving a high number of previous psychiatric admissions seems to be an aspect that decreases the chance of being allocated FD. This variable can be seen as an indicator of severity of illness and a challenging social environment; it could therefore be valuable to take this variable into consideration when allocating FD. Furthermore, total treatment duration was found to not be significantly different for FD and non-FD patients, thus supporting the use of CRHTTs as an equivalent alternative for inpatient admission, however, national scale research should be conducted to strengthen and expand on these findings.

It might not be just an intellectual disability: Change of behavior masking the diagnosis of cancer in a psychiatry unit

IntroductionIntellectually disabled people are vulnerable to somatic and mental illnesses, often presenting behaviour changes. Moreover, difficulties in describing symptoms can limit their access to healthcare system and adequate treatment.ObjectivesThrough a case report, we aim to provide an overview on behaviour changes in people with intellectual disability (ID), emphasizing the screening for organic conditions.MethodsDescription of a clinical case and a qualitative review about the assessment of behaviour changes in persons with ID, using PubMed database.ResultsWe present a clinical case of a 57-year-old man with history of ID, alcohol and tobacco abuse and Epilepsy. He had previous acute psychiatric admissions due to behaviour disorganization and irritability. In January he was admitted with disorganized behaviour and caregiver exhaustion, and stabilized with Olanzapine 20mg/day. On the 28th day of hospitalization, he fell of his of bed and suffered a mild traumatic brain injury. Cerebral CT scan revealed two metastatic lesions in the brain. Further investigations found out primary neoplastic lung lesion and multiple metastasis. Afterwards, his relatives mentioned a heavy familiar history of cancer and that he had postural instability signs that they did not value.ConclusionsAlthough psychiatric disorders are common in patients with ID, we must always remind that behaviour changes can mask the presentation of an organic disease. Despite a long follow-up in Psychiatry, organic conditions should be considered when patients with ID present behaviour changes. Further studies are needed in the assessment of this particular population to provide proper medical, psychological and social care.

Population-attributable risk of adverse childhood experiences for high suicide risk, psychiatric admissions, and recurrent depression, in depressed outpatients

ABSTRACT Background: Population-attributable risk (PAR) may help estimate the potential contribution of adverse childhood experiences (ACEs) to serious clinical presentations of depression, characterized by suicidality, previous psychiatric admissions, and episode recurrence. Objective: To determine the PAR of ACEs for serious clinical presentations of depression (high suicide risk, previous psychiatric admissions, and recurrent depression) in outpatients with ICD-10 clinical depression. Method: Systematic chart review of 1,013 adults who were assessed and/or treated in a mental health clinic in Santiago, Chile for a major depressive episode. Data were collected on demographics and clinical characteristics of depression. Exposure to ACEs was determined with the Brief Physical and Sexual Abuse Questionnaire, assessing seven types of ACEs. Multivariable logistic regression analysis was used to assess the association between exposure to ACEs and suicidality, previous psychiatric admissions, and recurrence. Predicted probabilities were used for calculations of PAR. Results: Of the 1,001 study participants with complete data, 53.3% had recurrent depression, 13.5% had high suicide risk, and 5.0% had previous psychiatric admissions. Exposure to at least one ACE was recorded for 69.0% of the sample. Exposure to at least one ACE and specific types of ACEs (i.e. childhood sexual abuse and traumatic separation from caregiver) were associated with serious clinical presentations of depression. A dose-response relationship was observed between cumulative exposure to ACEs and the most serious clinical presentations of depression. ACEs were attributed to a significant proportion of disease: 61.6% of previous psychiatric admissions, 45.0% of high suicide risk, and 14.5% of recurrent depression. Conclusions: A substantial proportion of serious clinical presentations of depression among outpatients are associated with ACEs. Early detection of depressive episodes associated with ACEs, and tailored treatment for these patients, may potentially reduce the incidence of serious complications in this population.

Descriptive analysis of the admission of minors into a psychiatric unit

IntroductionThe admission of minors into adult psychiatric units is a problem due to the lack of adequate resources and epidemiology data. ObjectiveThe aim of this study is to describe and analyse the sociodemographic and clinical characteristics of minors that were admitted into the Short-Stay Psychiatric Hospitalisation Unit of Caceres, Spain. Materials and methodsA retrospective, observational, and descriptive study was conducted on a sample of patients between 12 and 18 years-old admitted to the Psychiatric Unit. The study period was between 1 January 2014 and 31 December 2018. ResultsA total of 79 patients, with a mean age of 15.72 (±1.65) years, were included. Almost all of them (93.6%) had a personal psychiatric history. The most common diagnoses at discharge in males were disruptive, impulse-control and conduct disorders, and mood disorders in females. A history of substance consumption was present in 40.6%, and was more common in males, which led to a worse prognosis. The mean stay was 5.4 (±4.7) days. Prolongation of the mean stay was associated with a history of previous psychiatric admissions, the number of diagnoses at discharge, a greater number of drugs at discharge, and those that received long-acting injectable antipsychotic drugs (P < .005 in all cases). ConclusionsThe study identified the sociodemographic and clinical profile of the minor admitted to the Psychiatric Unit, and how the hospital stay was associated with previous psychiatric history, as well as diagnostic and clinical complexity.

Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder

Purpose Acute polymorphic psychotic disorder (APPD) without symptoms of schizophrenia is a serious psychiatric condition. APPD can be effectively treated with electroconvulsive therapy (ECT), but little is known about relapse prevention after ECT for APPD. Materials and methods This was a retrospective register-based study conducted with 97 patients with APPD (ICD-10 diagnosis F23.0). We estimated the rates of readmission and suicide, and the prognostic factors of these outcomes after ECT. We combined data from several national Swedish registers and used Cox’s regression analysis to identify demographic factors, disease characteristics, and relapse preventive treatments that predicted time to readmission or suicide (relapse). Data registered between 2011 and 2016 were used in the study. Results Twenty percent of cases relapsed within a year. Thereafter, relapse rate was low. Two cases died during follow-up, whereof one by suicide. Anxiolytic treatment, lamotrigine treatment, and having more than four previous psychiatric hospital admissions were associated with shorter time to relapse. The most robust of these associations was between anxiolytics and relapse risk. Conclusions The first year after discharge from APPD is the period associated with the highest risk of relapse. Having many previous admissions was associated to relapse risk after ECT for APPD. The associations between anxiolytics, lamotrigine, and relapse are uncertain and might be influenced by indication bias.

Descriptive analysis of the admission of minors into a psychiatric unit

The admission of minors into adult psychiatric units is a problem and is due to the lack of adequate resources and epidemiology data. The aim of this study is to describe and analyse the sociodemographic and clinical characteristics of minors that were admitted into the Short-Stay Psychiatric Hospitalisation Unit of Caceres, Spain. A retrospective, observational, and descriptive study was conducted on a sample of patients between 12 and 18 years-old admitted to the Psychiatric Unit. The study period was between January 1, 2014 and December 31, 2018. A total of 79 patients, with a mean age of 15.72 (±1.65) years, were included. Almost all of them (93.6%) had a personal psychiatric history. The most common diagnoses at discharge in males were disruptive, impulse-control and conduct disorders, and mood disorders in females. A history of substance consumption was present in 40.6%, and was more common in males, which led to a worse prognosis. The mean stay was 5.4 (±4.7) days. Prolongation of the mean stay was associated with a history of previous psychiatric admissions, the number of diagnoses at discharge, a greater number of drugs at discharge, and those that received long-acting injectable antipsychotic drugs (p<0.005 in all cases). The study identified the sociodemographic and clinical profile of the minor admitted to the Psychiatric Unit, and how the hospital stay was associated with previous psychiatric history, as well as diagnostic and clinical complexity.

Painful insight vs. usable insight in schizophrenia. Do they have different influences on suicidal behavior?

BackgroundSuicidal behavior is highly prevalent in schizophrenia. Among the risk factors, insight has been little studied and has yielded contradictory results. In addition, it has been studied neglecting relevant psychological aspects, such as beliefs about illness and coping styles. MethodWe assessed 133 outpatients diagnosed with schizophrenia according to ICD-10 criteria. Evaluation included sociodemographic, general clinical, psychopathological, psychological and suicidal behavior variables. ResultsNeither insight nor insight coupled with negative beliefs and/or coping styles were associated with suicidal behavior. Nevertheless, insight coupled with negative beliefs and/or coping styles was associated with greater hopelessness and depression, internalized stigma, worse control over illness and greater global severity as compared to insight coupled with positive beliefs and coping styles. Suicide attempt and suicidal ideation groups showed greater depression and hopelessness, worse global beliefs and worse control over illness, higher socio-economic level, and greater number of previous psychiatric admissions compared to the non-suicidal group. ConclusionsInsight coupled with negative beliefs and/or coping style was not associated with suicidal behavior. Nevertheless, it was associated with greater depression and hopelessness, both of which are firmly established risk factors for suicide in schizophrenia. Prospective studies with long-term follow-up and large samples are needed to clarify this issue. Clinicians should assess these psychological features associated with insight, both in patients with insight and in those with poor insight when promoting it.

Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: a retrospective, medical record-based analysis

BackgroundPsychiatric readmissions negatively impact patients and their families while increasing healthcare costs. This study aimed at investigating factors associated with psychiatric readmissions within 30 days and 1 year of the index admissions and exploring the possibilities of monitoring and improving psychiatric care quality in China.MethodsData on index admission, subsequent admission(s), clinical and hospital-related factors were extracted in the inpatient medical record database covering 10 secondary and tertiary psychiatric hospitals in Beijing, China. Logistic regressions were used to examine the associations between 30-day and 1-year readmissions plus frequent readmissions (≥3 times/year), and clinical variables as well as hospital characteristics.ResultsThe 30-day and 1-year psychiatric readmission rates were 16.69% (1289/7724) and 33.79% (2492/7374) respectively. 746/2492 patients (29.34%) were readmitted 3 times or more within a year (frequent readmissions). Factors significantly associated with the risk of both 30-day and 1-year readmission were residing in an urban area, having medical comorbidities, previous psychiatric admission(s), length of stay > 60 days in the index admission and being treated in tertiary hospitals (p < 0.001). Male patients were more likely to have frequent readmissions (OR 1.30, 95%CI 1.04–1.64). Receiving electroconvulsive therapy (ECT) was significantly associated with a lower risk of 30-day readmission (OR 0.72, 95%CI 0.56–0.91) and frequent readmissions (OR 0.60, 95%CI 0.40–0.91).ConclusionMore than 30% of the psychiatric inpatients were readmitted within 1 year. Urban residents, those with medical comorbidities and previous psychiatric admission(s) or a longer length of stay were more likely to be readmitted, and men are more likely to be frequently readmitted. ECT treatment may reduce the likelihood of 30-day readmission and frequent admissions. Targeted interventions should be designed and piloted to effectively monitor and reduce psychiatric readmissions.

Longitudinal examination of youth readmission to mental health inpatient units.

Significant barriers exist for youth in obtaining mental health services. These barriers are exacerbated by growing demand, attributed partially to children and adolescents who have repeat hospital admissions. The purpose of this study was to identify demographic, socioeconomic and clinical predictors of readmission to inpatient psychiatric services in New Brunswick, Canada. Key demographic, support and clinical predictors of readmission were identified. The New Brunswick Discharge Abstract Database (DAD) was used to compile a cohort of all children and adolescents ages 3-19years with psychiatric hospital admissions between 1 April 2003 and 31 March 2014 (N=3825). Primary analyses consisted of Kaplan-Meier survival methods with log-rank tests to assess time-to-readmission variability, and Cox regression to identify significant predictors of readmission. In total, 27.8% of admitted children and adolescents experienced at least one readmission within the 10-year period, with 57.3% readmitted to hospital within 90days following discharge. Bivariate results indicated that male, upper-middle socioeconomic status (SES) youths aged 11-15years from nonrural communities were most likely to be readmitted. Notable predictors of increased readmission likelihood were older age, being male, higher SES, referral to care by medical practitioner, discharge to another health facility, psychosis, and previous psychiatric admission. A significant portion of the variance in readmission was accounted for by youth demographic characteristics (i.e. age, SES, geographic location) and various support structures, including referrals to inpatient care and aftercare support services. Readmission to inpatient psychiatric care among youth is affected by a number of multifaceted risk factors across individual, environmental and clinical domains. This study used provincial population-scale longitudinal administrative data to demonstrate the influence of various individual and demographic factors on likelihood of readmission, which is notably absent from the majority of studies that make use of smaller, short-term data samples. Ensuring that multiple factors outside of the clinical context are considered when examining readmission among youth may contribute to a more thorough understanding of youth hospitalization patterns.

MALTEPE BÖLGESİNDEKİ BİR AİLE SAĞLIĞI MERKEZİNE BAŞVURAN BİREYLERİN RUHSAL SAĞLIK DÜZEYLERİNİN DEĞERLENDİRİLMESİ

Bu çalışmada, Maltepe bölgesindeki bir Aile Sağlığı Merkezine (ASM) başvuran bireylerin sosyodemogfrafik özelliklerine göre ruhsal durumlarının değerlendirilmesi amaçlanmıştır. Tanımlayıcı tipte bir çalışmadır. Maltepe Bölgesindeki bir ASM’ye Şubat-Mart 2019 tarihleri arasında başvuran ve araştırmaya katılmayı kabul eden 18 yaş üzeri tüm bireyler (217 kişi) çalışmaya dahil edilmiştir. Veriler gözlem altında katılımcılar tarafından doldurulan sosyodemografik özelliklere yönelik soru formu ve Kısa Semptom Envanteri (KSE) ile toplandı. Veriler analizinde Ki kare, Mann-Whitney U ve Kruskal Wallis testleri kullanılmıştır. İstatiksel olarak p<0.05 anlamlı kabul edilmiştir. Çalışmanın etik kurul onayı alınmıştır. Katılımcıların %68,2 (n= 148) kadın olup, katılımcıların yaş ortalaması 34,38 (sd: 13,31)’tür. Katılımcıların %40,1’ini (n=87) bekâr, %49,8’ini (n=106) çalışmayan ve %81,6’sını (n=177) herhangi bir psikiyatrik başvuruda bulunmamış bireyler oluşturmaktadır. Bekâr bireylerde olumsuz benlik durumunun; çalışmayan bireylerde hastalık ciddiyeti indeksi, anksiyete ve hostilite durumunun; kadınlarda, daha önce psikiyatrik bir başvurusu olanlarda ve eğitim seviyesi daha düşük olan bireylerde somatizasyon durumunun daha sık görüldüğü saptanmıştır (p<0,05). Katılımcıların sosyodemografik özellikleri ile depresyon durumları arasında anlamlı bir ilişkiye ulaşılamamıştır. Katılımcıların yaşı ile anksiyete, olumsuz benlik ve hostilite puanları arasında istatiksel açıdan anlamlı düzeyde (p<0,05) negatif yönde zayif korelasyon saptanmıştır. Literatürle uyumlu olarak araştırmamızda çalışmayan bireylerin toplumdaki diğer bireylere göre ortalama anksiyete ve hostilite puanları istatistiksel olarak anlamlı düzeyde daha yüksek çıkmıştır. Araştırmaya göre medeni durum olumsuz benlik algısında, çalışma durumu hastalık ciddiyet indeksi, anksiyete ve hostilite durumunda ve eğitim düzeyi, yalnız yaşama durumu ve daha önceki psikiyatrik başvuru durumu, cinsiyet değişkenleri ise somatizasyon durumunda etkili faktörlerdir. Elde edilen sonuçlar özellikle kadınlara, bekârlara ve çalışmayan bireylere yönelik hizmetlerin yoğunlaştırılmasında yardımcı olacaktır.