Mental Hospital Research Articles

Exploring the Quality-of-Care Dynamics of Inpatient Psychosocial Rehabilitation in Community-Based Mental Health Services: A Comprehensive Analysis.

This study aims to investigate the intricacies of inpatient psychosocial rehabilitation by examining a community-based mental health inpatient rehabilitation service in Nova Scotia, Canada. It provides a comparative analysis with national standards using the Quality Indicator for Rehabilitative Care (QuIRC) and offers recommendations for improvement. The study will link findings to research on enhancing specific domains, focusing on strategies to address identified challenges and leverage opportunities to meet or exceed national benchmarks in promoting recovery and social inclusion. This study utilizes the QuIRC as a primary assessment tool to evaluate the quality of care in psychiatric and psychosocial rehabilitation care unit. The QuIRC assessment findings reveal crucial insights across several domains, including the living and therapeutic environment, treatments and interventions, self-management and autonomy, social interface, human rights, and recovery-based practices. The study identifies strengths and areas for improvement by comparing unit scores with national averages in Canada, offering a detailed examination of the quality of care provided in a community-based psychosocial rehabilitation service. Using the QuIRC identifies strengths and areas for improvement of current care provided, opening opportunities for positive change and improved quality of care. By highlighting the critical indicators of the quality of care and best practices derived from the QuIRC assessment, this study provides practical insights that can be directly applied by practitioners, policymakers, and stakeholders, fostering an understanding of essential elements that support effective mental health rehabilitation within community settings.

Study About the Stages of Recovery with Patients Hospitalized in Psychiatric Clinic According to Sociodemographic and Clinical Factors

Objective: This study aims to describe the stages of recovery and the effect of sociodemographic and clinical factors on the recovery stages of individuals with mental illness under inpatient treatment. Methods: 171 patients who received inpatient treatment between April 2021 and June 2021 were taken to the study. Data were collected by using the Introductory Information Form and the Stages of Recovery Instrument from participants. Results: According to the nurse, awareness was the highest level of the recovery stages and, according to the patient, growth was the highest level of the recovery stages. The average of the subscales of stages of recovery scale was found as 12.57±7.54 for moratorium, 19.26±5.84 for awareness, 19.22±6.40 for preparation, 19.52±7.03 for rebuilding and 20.03±7.73 for growth. Social support was found effective in all stages of recovery except moratorium stage; income level was found effective in preparation, rebuilding, and growth stages; diagnosis of the illness was found effective in the awareness stage; going to the Community Mental Health Center (CMHC) was found effective in preparation stage and child presence was found effective in rebuilding stage of recovery. Conclusion: Our findings are important for identifying the effects of situations that can be changed by intervention, such as level of social support, income level, and going to CMHC, on improvement, and for drawing attention to actions that legislators should take regarding to collaboration between mental health professionals and institutions.

Epistemic negotiations on a closed psychiatric ward

ABSTRACT On a closed psychiatric ward, conflict and disagreement may exist between patients and psychiatrists on how to interpret the patient’s condition. This forms a complexity for implementing contemporary ideals such as shared decision making, which would require a substantial degree of epistemic flexibility from both psychiatrists and patients. Recently, authors have argued that psychiatrists are pluralistic and pragmatic in their interpretation of the patient’s condition, implying a space for this flexibility in the clinical encounter. In this article we present an empirical study in which we aim to describe, understand, and explain this epistemic space and the dynamics between the psychiatrist’s and patient’s interpretation. We aim to explore and contextualize philosophical discussions through empirical research. We performed a qualitative inquiry on a closed psychiatric ward and found that both patients and psychiatrists were epistemically flexible, but epistemic negotiations were more complex and variegated than often presumed. We constructed an empirically grounded typology of different types of epistemic interaction, which shows that this interaction can only be properly understood if one acknowledges that it is shaped by different professional, societal and personal norms and values. We conclude by discussing the scope and limits of the epistemic space that we found.

Short-term exposure to gaseous ambient pollution and hospital admissions for mental health among children and adolescents: A time-stratified case-crossover study

Little evidence has demonstrated the linkage of gaseous air pollution and hospitalization rates for mental diseases among children and adolescents in China. Based on a time-stratified case-crossover design among children and adolescents in nine cities, Sichuan, a conditional logistic regression and a concentration-response (C–R) curve model were applied to investigate mental disorders in relation to gaseous air pollutants exposure at lag 0-lag 7, and lag 01-lag 07. Hospitalization costs were calculated through the attributable risk method. With daily data from official environmental monitoring centers, individual daily mean ambient pollutants estimates were evaluated via Inverse Distance Weighted method. Daily hospitalized records for mental illness were collected from medical organization or/and institutions from January 2016 to December 2019. There were 11479 inpatients suffering depression, anxiety, and/or other mental disorders. In single- and cumulative-day-lag analyses, with each 10 μg/m3 increment of NO2, SO2, and O3, the greatest odds ratio (OR) for all-cause mental disorders were 1.114 (95% confidence interval [CI]: 1.067–1.164) (lag 0), 1.219 (95% CI: 1.040–1.430) (lag 4), and 1.039 (95% CI: 1.009–1.069) (lag 7), separately. Stronger associations were found in inpatients hospitalized in warm days in SO2 analysis. C–R curve showed that all-cause mental disorders hospitalizations were positively related to SO2 and O3 exposure at relative high levels. During study period, the total economic cost of hospitalization for all-cause mental disorders caused by NO2 pollution was 94.71 million CNY. These findings indicated that gaseous air pollutants exposure may increase the risk and economic burdens of mental disorders among children and adolescents.

Impact of socio-vocational rehabilitation on work productivity and social behavior of inpatients with chronic schizophrenia

Background: A large proportion of persons with schizophrenia are either abandoned by their family members in mental hospitals or do not have any family members to look after them. Therefore, almost 2/3rd of hospital beds are occupied by chronic schizophrenic patients. Very few beds are available for the treatment of acute mental patients who need urgent hospitalization. Aim: To assess the impact of a comprehensive socio-vocation rehabilitation package on the work productivity and social behavior of persons with chronic schizophrenia. Materials and Methods: Sixty chronic schizophrenic inpatients were included in the present study. Sociodemographic and clinical details were collected on a specially designed Performa for the study. Each patient was rated on a job-up-to-date form at baseline, 3 months, and 6 months after intervention. Data related to the vocational outcome were collected on the supervisor’s evaluation form at the end of the first month and then after every month till the end of 6 months after intervention. The patient’s social behavior was measured on the Social Behavior Schedule at baseline, 3 months, and 6 months after intervention. Results: Significant improvement was found in the area of vocational outcomes when a comparison was made from the 1st month to the 6th month. Marked improvement was also noticed in their social behaviors after social and vocational rehabilitation. Conclusion: The overall results suggest that chronic schizophrenic inpatients can be properly rehabilitated if opportunity is provided to them.

The effects of mindfulness-based techniques on self-rumination, cognitive reappraisal and expressive suppression among patients with major depression: a nursing perspective.

Patients with major depressive disorder (MDD) often struggle with adaptive strategies like self-reflection and cognitive reappraisal, relying instead on maladaptive ones like self-rumination and emotional suppression. Mindfulness-based techniques (MBTs) have been identified as a promising complementary psychological intervention for this population. To evaluate the effects of MBTs on mindful attention awareness, self-rumination, self-reflection, cognitive reappraisal and expressive suppression in patients with MDD between patients who receive MBTs and those who do not. This quasi-experimental research was carried out at the Psychiatric Outpatient Clinics. A representative sample of 120 patients with MDD were randomly recruited to either a study group (n = 60) or a control group (n = 60). The Mindful Attention Awareness Scale (MAAS), The Rumination-Reflection Questionnaire (RRQ) and The Emotion Regulation Questionnaire (ERQ) were utilised to collect data. After participation in MBTs, the study group had significantly greater improvements in the mean scores of MAAS, RRQ, Cognitive Reappraisal and Expressive Suppression compared to the control group (p < 0.001 each). The study recommends developing and implementing training programmes for nurses to equip them with the skills and knowledge to effectively deliver MBTs as part of patient care. Conducting longitudinal studies is necessary to assess the sustainability of these improvements.

Evaluating the Effectiveness of Safety Plans for Mitigating Suicide Risk in Two Samples of Psychiatrically Hospitalized Military Veterans

Although safety plans (SPs), following the Stanley–Brown Safety Planning Intervention protocol, are required for suicidal veterans receiving treatment in the Veterans Health Administration (VHA), prior studies have shown that they are frequently incomplete or are not sufficiently personalized to the unique circumstances of each patient. In two studies, we examined SP completeness, SP quality (i.e., degree to which the SP was clear, actionable, and personalized), and SP fidelity (i.e., sum of completeness and quality). We also examined which SP steps were associated with a reduced likelihood of future psychiatric rehospitalizations (Study 1) and suicide attempts (Study 2) following hospital discharge. Participants were veterans admitted to two VHA acute inpatient psychiatric units for suicide risk (Study 1: N = 78; Study 2: N = 132). SPs were coded by independent raters on completeness, quality, and fidelity; step scores (e.g., Step 1 quality) were summed to create whole-plan scores (e.g., SP quality). In Study 1, 52.5% of participants had an SP and, in Study 2, 93.1% of participants had an SP. In Study 1, whole plan scores were not associated with subsequent psychiatric hospitalization status, but higher Step 2 (internal coping) fidelity scores were associated with decreased likelihood of rehospitalization (AHR = 0.05, 95% CI [0.30, 0.84], p = .008). In Study 2, higher whole-plan quality (AHR = 0.79, 95% CI [0.66, 0.95], p = .012) and fidelity (AHR = 0.84, 95% CI [0.71, 0.99], p = .040) scores were associated with a decreased likelihood of future suicide attempt. Step 1 (warning signs) quality (HR = 0.48, 95% CI [0.30, 0.76], p = .002) and fidelity scores (AHR = 0.57, 95% CI [0.37, 0.90], p = .016) were associated with a decreased likelihood of future suicide attempt. The association of SP characteristics differs by outcome of interest, and fidelity of internal coping strategies may contribute to preventing rehospitalizations, whereas quality and fidelity of warning signs may help prevent future suicide attempts. Overall, results suggest that mandating SPs without training and implementation strategies to ensure quality is not enough.

Therapeutic Garden Design at Marzoeki Mahdi Hospital

Abstract Mental disorders is characterized by clinically significant disturbance in a person’s cognition, emotional regulation, or behavior. Dr. H. Marzoeki Mahdi Hospital (RSMM) is one of the mental hospitals that provides psychosocial rehabilitation services. Psychosocial rehabilitation consists of various activities to hone the patient’s ability so that they live independently. One of the activities is vocational and occupational therapy. The hospital garden is a necessity in the patient rehabilitation process so it needs to be designed to make it can be utilized optimally. The research objectives are to identify and analyze activities, user needs, potentials and constraints on the site; determine the design concept and create a therapeutic garden design for psychosocial rehabilitation at Marzoeki Mahdi Hospital. This research uses a descriptive method with stages such as preparation, research and analysis, concept and design. Data was collected through surveys, interviews, questionnaires and literature studies. The proposed design is a therapeutic garden to support psychosocial rehabilitation. The design concept applies one of patients rehabilitaion activities, namely socializing, which is depicted in a circular pattern and rehabilitation activities carried out repeatedly are depicted in a repetitive pattern. In addition, a symmetrical pattern is also applied which illustrates organized life and firmness. Based on this pattern, spaces are designed to support rehabilitation activities, namely the welcome area, active therapy area, passive therapy area and parking area.

Pediatric psychiatric inpatients' perspectives of aggression management: Discernment in the doorway.

Aggressive behavior is common on psychiatric inpatient units. Seclusion and restraint interventions to manage patients' aggressive behavior may have the consequence of being traumatizing for patients. Pediatric psychiatric patients' perspective on the use of seclusion and restraint interventions is not present in the literature. This hermeneutic nursing research study asked the question, "How might we understand children's experiences of seclusion and restraints on an inpatient psychiatric unit?" Four past pediatric psychiatric inpatients shared their hospitalization experiences that occurred within the previous year when they were 10 years old. The texts of the research interviews were compared to Attachment Theory for a deeper understanding of the meaning of the message. Participants commonly described experiences with seclusion and restraints as feeling trapped and alone in a dark room. They recommended the nurses step into the room with them to help them heal. Interpretively, the rooms on inpatient units could be considered as actual and metaphorical spaces of possible harm or healing. The participant's voices expand understanding of nurse's use of discernment at the doorway of a patient room to ensure the most therapeutic care is provided to the patient in these spaces through a secure nurse-patient relationship.

Risk of corrected QT interval prolongation in patients receiving antipsychotics.

Antipsychotic (AP) use has been associated to QT interval prolongation on the surface electrocardiogram (ECG). Our study aimed to determine the incidence of corrected QT (QTc) interval prolongation among patients admitted to a psychiatric hospitalization unit requiring AP treatment and to assess the relationship between administered dose and QTc interval changes. We enrolled 179 patients admitted to the Hospital Psiquiátrico Departamental Universitario del Valle in Cali, Colombia. ECGs were conducted upon admission, and again at 3 and 7 days postadmission. The QT interval was measured, and QTc interval correction was performed using Bazzet's formula. QTc interval prolongation at time points B or C was observed in 9.5% of patients. Clozapine was the most common AP associated with QTc interval prolongation (20.59%), followed by olanzapine (15.38%). The relative risk of QT interval prolongation with clozapine compared to haloperidol was 4.17 (95% confidence interval, 1.14-15.17, P = 0.02). AP use upon hospital admission was linked to early (within 3 days) QTc interval prolongation. Clozapine and olanzapine were associated with a greater increase in QTc interval compared to haloperidol, indicating a need for rigorous electrocardiographic monitoring with their use.

Socialization and Workshop of Coding Based on ICD-10 and ICD-9 Cm Regulations at Mental Hospital Prof Hb Saanin Padang

Socialization and Workshop of Coding Based on ICD-10 and ICD-9 Cm Regulations at Mental Hospital Prof Hb Saanin Padang

Exploring Patients Service Experience of Psychiatric Intensive Care Unit (PICU) Admissions

Background: A psychiatric intensive care unit (PICU) is a tertiary mental health service that provides short-term care for patients who present with highly challenging behaviours during their psychiatric admission and require close supervision and observation due to their elevated risk of self-harm and harm towards others. A key feature of a PICU is its high level of staffing and more secured facilities. The main purpose of a PICU admission is to optimise management of patients who pose a risk to themselves and others whilst benefiting from a low-stimulus environment. However, the body of knowledge that sub serves the perspective of patients’ ‘service experience’ regarding PICU admissions remains relatively unexplored. Objective: The purpose of this study is to explore patients’ service experience of PICU admissions with the hope that this will help improve service delivery on these wards/units. Methods: The study employed a descriptive qualitative research approach. Data for this study was collected using a semi-structured questionnaire over a six-month period. The study participants involved psychiatric patients admitted to PICU under the Irish Mental Health Act of 2001 legislation from other approved centres in Ireland. Results: Six themes emerged from participants’ responses namely, communication and therapeutic engagement, unit environment, recreational and activity therapies, privacy and confidentiality, access to information as well as general experience of care and service provision in PICU. The results provide moderately less evidence for the engagement of PICU patients in recreational activities during the period of admission in PICU. Additionally, there was significantly inadequate pre-discharge debriefing for patients prior to discharge from PICU. Lastly, a greater proportion of the study participants were satisfied with PICU services and expressed their willingness to recommend PICU to individuals who may benefit from PICU services. Conclusion: Understanding the experiences of this patient population and their perspectives on PICU services is crucial to informing and developing concrete strategies for clinical practice in acute psychiatric settings. Therefore, therapeutic programs and more flexible activities are required to facilitate easy access by patients that will enhance or positively shape their experiences of PICU and other acute psychiatric services.

Strengthening Youth Emotional and Behavioral Well-Being Through Community-Academic Partnership: The EMPOWER Project.

The onset of mental health issues frequently starts during adolescence, where one third of adolescents who are 14 years and younger receive a mental health diagnosis. The state of youth mental health is a major public health concern. The EMPOWER project was developed during the COVID-19 pandemic to address youth mental health. The EMPOWER project is a partnership between two after-school programs and an academic mental health hospital in Toronto, Canada, that aims to bolster youth mental well-being. In this Practice Note, we share our community-based participatory research process of how we built the EMPOWER partnership and highlight our lessons learned so far. Through EMPOWER, we aim to codesign, deliver, and evaluate a scalable, evidence-based, and community-informed youth mental wellness curriculum that will be implemented in after-school programs.

Inpatient’s, therapist’s and staff’s expectations regarding treatment and their effects on placebo response in the psychiatric ward – results from an add-on oxytocin RCT

ObjectivesPatient’s and therapist’s expectations are considered an important factor influencing placebo response in experimental and therapeutic settings. Nevertheless, the placebo effects of common neurological facilitators that promote treatment efficacy have not been explored. In the present study we examined the estimations of patients, therapists, and staff members, regarding their treatment type and assessed their influence on the facilitating effects of oxytocin.MethodsPatients (N = 87) were randomized and double-blindly allocated to receive either oxytocin or placebo, twice daily for a period of four weeks, as part of a larger randomized, double-blind, placebo-controlled trial. Patient’s, therapist’s and staff’s expectations were assessed based on their estimation of treatment type (agent or placebo). Multilevel modeling and univariate and multivariate regression analysis were performed to assess the effects of patient’s, therapist’s, and staff’s estimations on treatment outcome beyond the effects of treatment type.ResultsStaff’s, therapist’s, and patient’s estimations were significantly associated with treatment outcomes. Nevertheless, only therapist’s and patient’s estimations significantly predicted improvement beyond actual administration, with therapist’s and patient’s estimations associated with improvement in trait anxiety (STAI-T, B=-1.80, p < .05, and B=-2.02, p < .05, respectively); therapist’s estimations were associated with improvement in general distress (OQ-45, B=-3.71, p < .05), and patient’s estimations were associated with symptom relief (HSCL-11, B=-0.13, p < .05). Overall, patient’s estimations had a higher relative contribution to treatment success, with standardized coefficients across scales ranging from − 0.06 to -0.26.ConclusionsThe neurobiological factors that promote treatment success are also influenced by patient’s and therapist’s expectations. Future studies should consider these effects when examining their impact in inpatient settings.

Relationship of sociodemographic and clinical characteristics to mechanical restraint used in a psychiatric hospital in Spain.

Coercive measures have been applied in mental health fields throughout history, denying people with mental illness the ability to decide, even though there is increasing evidence that these measures bring few benefits to these individuals. The objective of this study was to analyse the sociodemographic and clinical characteristics most likely associated with the use of mechanical restraints (MRs) in psychiatric hospital settings. This was a descriptive, comparative and analytical cross-sectional study in people with mental disorders who were hospitalized in two hospitals in the Autonomous Valencian Community (Spain). We included a total of 91 participants who completed the Scale to Assess Unawareness of Mental Disorder (SUMD), Positive and Negative Syndrome Scale (PANSS), Barrat's Impulsiveness Scale and the Hamilton Anxiety Scale. The results we collected indicated that the patients most likely to be mechanically restrained were younger people with less awareness of their symptoms and disease, previous admissions to a psychiatric hospital and cohabitation with parents and/or family. In addition, having been admitted involuntarily, previously having had MRs applied, presenting more positive psychotic symptoms and habitual caffeine consumption all predicted the use of MRs. The variables that were able to predict MR were involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Evaluation of the sociodemographic and clinical characteristics of patients can help health professionals, especially nurses, to recognize patients who are at risk of requiring MR. This allows mental health practitioners to take these factors into account during interventions or when implementing programmes designed to reduce the use of coercive measures in psychiatric hospital settings. What problem did the study address? Coercive measures have been applied in mental health fields throughout history, with no benefits to these patients. What were the main findings? There are studies that relate some variables to MR in psychiatric settings, but we have been able to find variables capable of predicting MR such as involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Where and on whom will the research have an impact? The findings of this study allow for the reduction of MRs in psychiatric units. The sociodemographic and clinical characteristics found to be related to MR will help professionals identify when a patient is admitted in order to use specific interventions aimed at preventing the use of MRs during admission. This is the first study to indicate a relationship between caffeine consumption and the use of MRs. Further studies will be necessary to verify if controlled caffeine supplementation during admission to psychiatric units could become an additional strategy contributing to preventing the application of MR specifically in individuals who habitually consume coffee or caffeine-containing beverages daily. We have adhered to relevant EQUATOR guidelines using the STROBE reporting method. No patient or public contribution.

Conceptual Framework for the Psychosocial Management of Depression in Adolescents in the North West Province, South Africa

Background A conceptual framework is imperative in the understanding of the psychosocial management of depression in adolescents, owing to the ability to effectively present and demonstrate the linking of concepts for an in-depth understanding of the phenomenon. Objectives This study aims To develop and validate a conceptual framework for the psychosocial management of depression in adolescents in the North West Province, South Africa. Methods A qualitative, exploratory, descriptive, contextual research design was followed in two phases: the empirical phase (phase 1) and the development of a conceptual framework phase (phase 2). Phase 1 consisted of two steps: firstly, a systematic review (referred to as step 1), followed by qualitative, exploratory, descriptive, and contextual research (referred to as step 2). The outcomes from the empirical phase served as the foundation for developing a conceptual framework for the psychosocial management of depression in adolescents, North West Province, South Africa. In Phase 2, the development of this conceptual framework was guided by addressing the six crucial questions introduced by Dickoff et al. (1968) regarding Practical Orientation and validated by Chinn and Kramer’s five criteria questions. Results The conceptual framework focused on mental health practitioners, immediate and extended family members of adolescents, social workers, psychologists and peer groups of adolescents, adolescents diagnosed with depression, mental health institutions, homes of adolescents, schools, religious institutions, and communities. Conclusion The conceptual framework for the psychosocial management of depression in adolescents provides comprehensive insights capable of enhancing the recovery process for adolescents dealing with depression. Implementing this conceptual framework has the potential to enhance professional practice, elevate the quality of care provided, and contribute to expanding the body of knowledge within the field of mental health.

Mood disorders in adolescents admitted to psychiatric units – risk factors

Mood disorders in adolescents admitted to psychiatric units – risk factors

Association between preferred language and use of mental health services among home care recipients with schizophrenia spectrum and other psychotic disorders: A retrospective cohort study in Ontario, Canada, 2010 to 2015

Language is an important demographic factor that may impact patients’ interactions with the healthcare system. This may become more apparent for individuals with a mental illness. The objective of this study was to evaluate whether individual language was associated with the use of inpatient and outpatient psychiatric services among home care recipients with schizophrenia spectrum and other psychotic disorders. We conducted a population-based retrospective cohort study using health administrative data. The study population included all individuals aged 18–105 with schizophrenia spectrum and other psychotic disorders, identified via a validated algorithm, who were receiving home care in Ontario, Canada between January 1, 2010 and December 31, 2015. Home care data was used to identify patients’ primary language, categorized as Anglophone, Francophone, or Allophone. Mental health service use was evaluated over a one-year period following their first home care assessment in the study period and included the rate of outpatient psychiatrist visits and mental health-related emergency department (ED) visits and hospitalizations. Multivariable regression evaluated the association between primary language and mental health service use. The cohort consisted of 9,436 patients (85.8% Anglophones, 3.3% Francophones, 11.0% Allophones). Mental health service use was low among all linguistic groups during the one-year study period, with 53.4% with no outpatient psychiatrist visits and 83.3% and 83.0% with no mental health-related hospitalizations or ED visits, respectively. Francophones had a higher rate of mental health-related hospitalizations compared to Anglophones (adjusted relative risk = 1.36, 95% confidence interval 1.02–1.80), with no differences in hospitalization rates between Allophones and Anglophones. Language was not associated with the rate of outpatient psychiatrist visits or mental health-related ED visits. Mental health service use among homecare patients with schizophrenia spectrum and other psychotic disorders was low. While Francophones had a higher hospitalization rate than Anglophones, language was otherwise not associated with mental health service use.

Psychoeducation group facilitation training for nurses: A quality improvement project.

According to the 2020-2021 National Survey of Children's Health, 23.3% of children and adolescents met criteria for one or more mental, emotional, developmental, or behavioral problems. However, the prevalence of depression, anxiety, and post traumatic stress disorder have risen dramatically since the COVID-19 pandemic, leading to an increase in suicidal ideations, completed suicides, and pediatric psychiatric hospitalizations. There is a critical need for high quality mental healthcare treatments, including psychoeducation. Inpatient psychiatric nurses are well positioned to lead psychoeducation groups, but few receive training. Nurses at a designated inpatient pediatric psychiatric unit expressed discomfort in facilitating psychoeducation groups. This is a one-group prepost and follow-up quality improvement study designed to improve the quality of psychoeducation group facilitation skills provided by nurses at a child and adolescent inpatient psychiatric unit. A convenience sample of nurses (N = 16) participated. Baseline (T1), post-test (T2), and follow-up (T3) data were collected regarding nurses' self-efficacy, evidence based-practice attitudes, and knowledge of psychoeducation group facilitation. Nurses received 45 min of psychoeducation group facilitation education and 15 min of skills simulation. The nurses' knowledge, self-efficacy, and attitudes toward evidence-based practice when facilitating psychoeducation groups increased significantly from the baseline to the post-test, which was sustained from the post-test to the follow-up period. Study findings indicate the importance of supporting nurses in their role of psychoeducation group facilitation through education and program structure. Further research is needed to assess longer term sustainability and efficacy in leading psychoeducation groups.

Characterizing research domain criteria symptoms among psychiatric inpatients using large language models

We sought to characterize the ability of large language models to estimate NIMH Research Domain Criteria dimensions from narrative clinical notes of adult psychiatric inpatients, deriving estimate of overall burden of symptoms in each domain. We extracted consecutive admissions to a psychiatric inpatient unit between December 23, 2009 and September 27, 2015 from the electronic health records of a large academic medical center. Admission and discharge notes were scored with a HIPAA-compliant instance of a large language model (gpt-4–1106-preview). To examine convergent validity, the resulting estimates were correlated with those derived using an earlier method; for predictive validity, they were examined for association with length of hospitalization and probability of readmission. The cohort included 3619 individuals, 1779 female (49 %), 1840 male (51 %) with mean age 44 (SD=16.6). We identified modest correlations between LLM-derived RDoC scores and a previously validated scoring method, with Kendall’s tau between from.07 for arousal and 0.27 for positive and cognitive domains (p < .001 for all of these). For admission notes, greater scores on cognitive, sensorimotor, negative, and social domains were significantly associated with longer length of hospitalization in linear regression models including sociodemographic features (p < .01 for all of these); positive valence was associated with shorter hospitalization (p < .001). For discharge notes, social, arousal, and positive valence were associated with likelihood of readmission within 180 days in adjusted logistic regression models (p < .05 for social and arousal, p < .001 for positive valence). Overall, LLM-derived estimates of RDoC psychopathology demonstrated promising convergent and predictive validity, suggesting this approach may make real-world application of the RDoC framework more feasible.