Acute Psychiatric Wards Research Articles

Co-produced Positive Psychotherapy for Acute Psychiatric Ward Patients and Staff: an Evaluation of Feasibility and Acceptability

Aim: To investigate feasibility and acceptability of positive psychotherapy for acute psychiatric ward patients and staff, when delivered by non-psychology clinical staff, and co-produced with staff with lived experience. Method: Group or individual strengths-based positive psychotherapy was led by an activity coordinator and co-facilitated by a peer support worker with lived experience of mental health problems. It was delivered for acute ward patients and staff. Feasibility was measured by completion of session components and percentage of participants able to identify a strength, plan a strength-based activity, and activity completion. Acceptability was measured by comparing pre- and post-session mood, and with helpfulness ratings and narrative feedback. Results: Participants (n = 22) included 12 patients and 10 staff members. Participants were mainly female and of white or mixed ethnicity. Most patients had a psychotic disorder. Staff were nurses and healthcare assistants. The most identified strengths were self-regulation, social intelligence and perseverance. Typical activities included activity-scheduling, sleep hygiene, walking, gardening and cooking. High completion rates for components and activities indicated feasibility. Lack of adverse effect on mood, high helpfulness ratings, and positive feedback indicated acceptability. Conclusion: This evaluation indicates that non-psychology staff can deliver psychological interventions, that interventions can be co-produced with staff with lived experience, and that patient and staff participants can collaborate on these interventions. This shows how psychological interventions on acute wards can be inclusive, positively impact on ward culture, and be more widely delivered to support patients and staff.

High Scores on the Montgomery-Åsberg Depression Rating Scale and Psychotic Symptoms Predict Suicide: A Prospective Cohort Study of Psychiatric Acute Ward Patients.

Objective: To investigate the role of depression severity in suicide risk by studying the predictive value of psychotic symptoms and depression scale scores, controlled for suicidal behavior and gender.Methods: We conducted a prospective cohort study of consecutive psychiatric acute ward admissions between 2005 and 2014 from a Norwegian catchment area. Inclusion criteria were an ICD-10 diagnosis of unipolar or bipolar depression with a current depressive episode (n = 1,846); depression severity was measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). Patients were assessed for suicidal ideation/planning, self-harm, and recent suicide attempts on admission. Mean follow-up time was 5.5 years (minimum/maximum: 0/10.6 years). We used Cox regression analyses and Kaplan-Meier analyses to explore potential predictors and time to suicide.Results: During the follow-up period, 46 patients died by suicide, 30 (65%) of these within the year following admission. Psychotic depression (P = .014), admission MADRS score (P = .006), suicide attempts (P = .021), and male sex (P = .043) significantly predicted suicide. Suicidal ideation and self-harm did not predict suicide. The cumulative suicide risk in psychotic depression was 1.7% after 12 weeks and 3.0% after 52 weeks.Conclusions: Depression severity as measured with the MADRS or a diagnosis of psychotic depression independently predicted suicide. More suicides may be prevented by implementing intensive treatment and post-discharge follow-up for patients who present to psychiatric acute wards with severe depressive episodes and recent suicide attempts, regardless of self-reported suicidal ideation, suicide plans, and self-harm.

Open Doors by Fair Means: a quasi-experimental controlled study on the effects of an open-door policy on acute psychiatric wards

BackgroundPsychiatric wards treating involuntarily admitted patients are traditionally locked to prevent absconding. However, on the basis of observational evidence, the necessity for locked units in psychiatric hospitals has increasingly been questioned. Updated Mental Health Laws in several Federal States of Germany legitimate involuntary commitment without generally locked doors.MethodsWe examined the effects of an open-door policy in a quasi-experimental, prospective design. For the first time, at each of two locations, two identical wards serving as control and intervention could be compared. After a baseline period of three months, one ward at each location started the 12 month intervention period with the implementation of an open-door policy, while the respective control ward, as before, used open doors only facultatively. Primary outcomes were average opening times of the four wards between 8 a.m. and 8 p.m., and the number of involuntary treatment days with the doors open. Secondary outcomes were adverse events including aggressive incidents, absconding, suicide attempts and coercive measures.ResultsOverall, door-opening times increased significantly at both sites´ intervention wards. The number of adverse events did not increase during intervention period. Frequencies of coercive measures decreased in Friedrichshafen and remained unchanged in Tuebingen. In case of the intervention ward in Friedrichshafen, doors were open in up to 91% of all involuntary treatment days, whereas in the control ward, this was only the case in 67% of all involuntary treatment days (p < .001). In case of the intervention ward in Tuebingen, 45% of involuntary treatment days had open doors, compared to 30% in the control ward (p < .001).ConclusionsIt is possible to manage psychiatric wards with open doors without taking inappropriate risks. The extent to which open-door policies are achievable is be dependent on staffing and patient characteristics. Further research is necessary to explore the role of staff attitudes.Trial registrationOur trial "Open Doors by Fair Means" is retrospectively registered with DRKS (DRKS00015154) on Sept. 10th 2018 and displayed on the public web site. It is searchable via its meta-registry (http://apps.who.int/trialsearch/).

The changes of parental functioning of the patients with bipolar disorder and major depression since discharging from hospital: A longitudinal study.

This study examined the changes in patients' parental functioning and the associated factors, including manic, depressive symptoms and social support from before discharge to 6 months post-discharge. For parents with bipolar disorder and major depression, parenting is a recovery factor for patients, but little research examines the dynamic parental functioning from acute hospitalisation to a remission stage. A longitudinal design was used. The STROBE Checklist were used in presenting this research. Participants were inpatients with bipolar disorder or major depression (n=33) recruited within one week before discharge from the acute psychiatric ward in Taiwan. Data on parental functioning was collected four times: before discharge (T1), the 1st (T2), the 3rd (T3) and the 6th (T4) months of post-discharge. Baseline parental functioning before admitting to the acute word was retrospectively assessed at T0. The questionnaires included positive and negative domains of parenting practice, hypomanic/manic symptoms, depressive symptoms and social support. Generalised estimating equations were applied for data analysis. The negative parenting domains (poor monitoring, inconsistent discipline) decreased during hospitalisation but increased at one month post-discharge, except corporal punishment at 3-months discharge. The positive parenting domains (parental involvement and nurturance/responsiveness) did not recovery to baseline. While clinical symptoms remained stable during 6 months post-discharge, social support decreased at 3 and 6 months post-discharge. Higher depressive symptoms and low social support were associated with positive parenting domains but not related to negative parenting domains. Manic symptoms were not associated with positive or negative parenting domains. Positive parenting domains did not fully return to the usual situation during 6 months post-discharge. Parenting functioning recovery program targeting at the impacts of depressive symptoms on the parenting functioning and insufficient social support is needed from hospitalisation to post-discharge.

Impact of a pharmacist in extended role on an acute mental health ward

Specialist mental health pharmacist roles are recognised in providing medicines optimisation for people with mental health disorders. Here, the authors describe an initiative that examined whether a pharmacist could fulfil the role of an ‘extended role practitioner’ on an acute psychiatric ward, so releasing consultant psychiatrist clinical time. The study considers how extended roles such as advanced clinical practitioner can be utilised and service provision redesigned around new patient‐facing roles.

Recruiting and retaining participants in three randomised controlled trials of psychological interventions conducted on acute psychiatric wards: top ten tips for success.

It is essential to conduct randomised controlled trials of psychological interventions on acute psychiatric wards to build a robust evidence base for clinical practice. This paper aims to share strategies from three different in-patient trials that successfully recruited and retained participants, to disseminate good practice for the conduct of future trials in this challenging and complex clinical setting. We present strategies from three in-patient trials of psychological interventions: TULIPS (Talk, Understand, Listen for Inpatient Settings), amBITION (Brief Talking Therapies on Wards) and INSITE (Inpatient Suicide Intervention and Therapy Evaluation). All studies recruited participants from acute in-patient wards, initiated therapy within the in-patient setting and followed up on participants post-discharge. We summarise our recommendations for good practice in the form of ten top tips for success, based on our collective experience of conducting trials on psychiatric wards. Key themes relate to the importance of relationships between the research team and clinical staff; good stakeholder involvement and getting early buy-in from the team; and adapting to the particular demands of the clinical setting. Sharing good practice recommendations can help reduce research waste arising from poor recruitment and/or retention in future in-patient clinical trials.

Detained Persons Incarcerated for the First Time and Needing Acute Psychiatric Care: Sociodemographic and Clinical Characteristics.

Among detained persons, those incarcerated for the first time (FTI: first time incarceration) are known to present long-standing psychological vulnerability but also suffer significant deterioration of their mental health during the first year following imprisonment. Whether the patterns of psychiatric morbidity differ in FTI cases compared to cases with repeated and long term incarceration (RLTI) is still a matter of debate. We examined the sociodemographic and clinical differences between a subgroup of FTI vs. one of RLTI in a series of 139 randomly selected detained persons admitted to an acute psychiatric ward located in the central prison of Geneva, Switzerland. Fisher exact, unpaired Student t and Mann-Whitney U tests were used to explore sociodemographic (age, gender, marital status, religion, knowledge of French, education) and clinical (psychiatric outpatient care, suicidal behavior, psychiatric diagnosis) differences between the two groups. Subsequently, univariate and multiple logistic regression models were used to detect the variables associated with FTI. The proportion of women was significantly higher in the FTI compared to the RLTI group. FTI cases were also more frequently separated or divorced, with less frequent religious affiliation. 16.9% of FTI cases but only 1.3% of RLTI cases had a clinical diagnosis of depression. In multiple regression models, female sex and lower religious affiliation rate were associated with FTI status. Among diagnostic categories, depression was strongly related to FTI status both in univariate and multivariable models. Importantly, this was not the case for adjustment disorders, previous history of psychiatric care and suicidal behavior. Our observations support the assumption that FTI cases with lower affective support, less religious investment and without psychiatric care prior to imprisonment are particularly vulnerable to depressive illness.

Evidence-based Shared-Decision-Making Assistant (SDM-assistant) for choosing antipsychotics: protocol of a cluster-randomized trial in hospitalized patients with schizophrenia

BackgroundChoosing an antipsychotic medication is an important medical decision in the treatment of schizophrenia. This decision requires risk-benefit assessments of antipsychotics, and thus, shared-decision making between physician and patients is strongly encouraged. Although the efficacy and side-effect profiles of antipsychotics are well-established, there is no clear framework for the communication of the evidence between physicians and patients. For this reason, we developed an evidence-based shared-decision making assistant (SDM-assistant) that presents high-quality evidence from network meta-analysis on the efficacy and side-effect profile of antipsychotics and can be used as a basis for shared-decision making between physicians and patients when selecting antipsychotic medications.MethodsThe planned matched-pair cluster-randomised trial will be conducted in acute psychiatric wards (n = 14 wards planned) and will include adult inpatients with schizophrenia or schizophrenia-like disorders (N = 252 participants planned). On the intervention wards, patients and their treating physicians will use the SDM-assistant, whenever a decision on choosing an antipsychotic is warranted. On the control wards, antipsychotics will be chosen according to treatment-as-usual. The primary outcome will be patients’ perceived involvement in the decision-making during the inpatient stay as measured with the SDM-Q-9. We will also assess therapeutic alliance, symptom severity, side-effects, treatment satisfaction, adherence, quality of life, functioning and rehospitalizations as secondary outcomes. Outcomes could be analysed at discharge and at follow-up after three months from discharge. The analysis will be conducted per-protocol using mixed-effects linear regression models for continuous outcomes and logistic regression models using generalised estimating equations for dichotomous outcomes. Barriers and facilitators in the implementation of the intervention will also be examined using a qualitative content analysis.DiscussionThis is the first trial to examine a decision assistant specifically designed to facilitate shared-decision making for choosing antipsychotic medications, i.e., SDM-assistant, in acutely ill inpatients with schizophrenia. If the intervention can be successfully implemented, SDM-assistant could advance evidence-based medicine in schizophrenia by putting medical evidence on antipsychotics into the context of patient preferences and values. This could subsequently lead to a higher involvement of the patients in decision-making and better therapy decisions.Trial registrationGerman Clinical Trials Register (ID: DRKS00027316, registration date 26.01.2022).

Patients With Psychotic Disorders Are More Likely to Refuse Vaccination: An Audit of Vaccine Acceptability on Acute Adult Psychiatric Wards

AimsThis audit is looking at COVID-19 vaccine uptake in an acute adult psychiatric setting as part of the national drive to minimize COVID-19 infection. The aims of this audit are to identify: the number of patients that have been offered vaccination in a ward setting; the acceptability of the vaccination and the reasons for non-acceptance of vaccine.MethodsA total of 339 patients were admitted to acute adult psychiatric wards (Male, Female, PICU) at Highbury Hospital, Nottingham between February to August 2021. Data on the following parameters: demographics (age, sex, ethnicity), section status, HoNOS cluster, admission length and vaccine data (offered, accepted, received) using the RIO system and Health Informatics.ResultsOut of 339 patients, 31% (n = 105) had received or planned to receive the first dose of vaccine prior to admission. 43% (n = 100) of 234 patients who hadn't received vaccine were offered. Out of the patients who were offered vaccine, 59% (n = 59) accepted. 92% (n = 55) of patients who accepted vaccine, received vaccine. Those offered vaccination had an average length of stay of 117 days whilst those not offered had a shorter average length of stay of 81 days.For patients who were offered vaccine, those who were sectioned and in psychotic clusters refused vaccine compared to non-psychotic and informal patients. Deprivation, gender, age, admission length had no statistical significance in vaccine uptake for patients who were offered.Patients listed the following reasons for refusing the vaccine: media distrust; vaccine not effective; already had COVID-19; doesn't want it; believes vaccine made by consultant; doesn't want bad reaction; “Scientists and politicians are liars”; “I am fine and don't need it"; “Don't trust it and don't like needles”; “Don't want to be part of the game”; “Have had covid twice and, if I get it, I'd prefer my body to fight it”.ConclusionOur current vaccine acceptance rate of 59% is lower than those found nationally (80%) and in a medium secure psychiatric hospital (77%). The trust policy recommends all eligible patients should be offered the vaccine; our offer rate is lower than this standard. The low offer rate may be explained by vaccines being offered in rounds leading to patients possibly being missed. Our acceptance rate could be enhanced by improving our vaccination care plans for formally admitted psychotic patients.

Healthcare professionals’ encountering Experience of the Youths with Non-suicidal Self-injury in Acute Psychiatric Ward

Introduction Non-suicidal Self-Injury (NSSI) refers to causing damage on body tissue without attending to death. It is mostly presented among the youths and not approved by the society. Studies nowadays have explored the perspectives, feelings or experience of the youths or healthcare professionals. However, negative feelings and misunderstandings toward each other remain from both sides.ObjectivesThe aim was to explore the encountering experience of the youths with NSSI and the healthcare professionals during the same hospitalization in a psychiatric acute ward.MethodsQualitative study was employed by using narrative approach. In-depth interview was conducted for the youths with NSSI and their primary nurse and resident from a medical center in southern Taiwan.Results Narratives from the patients and healthcare professionals showed that the youths seemed to be comfortable as encountering with the healthcare professionals’ caring. In contrast, the healthcare professionals’ struggles had been hidden inside and remained uneasy and unsolved. Two extreme experiences have been reported by the youths with NSSI: felt satisfied and understood about being cared vs. felt numbness and not been understood. Four kinds of experience were identified as: struggling on caring them, feeling confused and helpless, keeping a safe distance, and having contradicted values.Conclusions This study found that the healthcare professionals suffer from varied aspects when encountering the youths with NSSI, which they often hid inside without expressing. Future improvement such as care guideline or staff’s support system should be built to decrease the negative effects inside the healthcare professionals’ mind.DisclosureNo significant relationships.

Emergency Psychiatry before and during COVID-19 pandemia

IntroductionThe COVID-19 pandemic had a significant impact worldwide. Consultations in the Emergency Service of the Hospital Clínic of Barcelona varied in terms of reasons for consultations, psychopathology, and other aspects, before and after the pandemic.ObjectivesTo examine changes in the profile of patients admitted before and during the COVID-19 pandemic to our Psychiatric Emergency Service.MethodsAll children, adolescent and adult psychiatric inpatients admitted from December 4th 2019 to March 31st 2021 to the Psychiatric Emergency Service of Hospital Clínic of Barcelona, Spain, were retrospectively included for analysis and divided into two groups –groups 1 or 2- including the first one all patients who attended before lockdown and the second group those who attended during the pandemic.ResultsA total of 1991 patients were included -1224 in the first group and 767 in the second group. The majority of patients were male (52.08%), with a mean age of 41.21 years (SD 16.53). A proportion significantly higher of men was found in the second group (p&lt;0.05). The proportion of patients consulting with substance use disorders was significantly higher in the second group (p&lt;0.05). Patients from the second group presented a significantly higher proportion of admissions in an acute psychiatric ward (p&lt;0.05), and also a significantly higher proportion of consultations of patients with dementia (p&lt;0.05).ConclusionsThe COVID-19 pandemic lead to a significant reduction in the overall consultations, with a higher proportion of severe cases. The lack of availability of caregivers and telework might have influenced the increase in consultations of patients with dementia.DisclosureAG has received travel and financial support from Janssen, Otsuka-Lundbeck and Angelini, and research support from Instituto de Salud Carlos III, and declares no support related with the subject of this presentation.

Improving the Use of the Mental Health Risk Assessment (MHRA)

AimsThe MHRA is a comprehensive form on our electronic patient records system. It includes 11 sections assessing different risk categories, with tick boxes to evidence input from various members of the MDT. Anecdotal experience suggested that these forms were sometimes incomplete and often lacked input from MDT members other than nursing staff. We aimed to increase the completion rate and multidisciplinary team (MDT) involvement, particularly doctor involvement, in the electronic MHRA documentation on an acute inpatient psychiatric assessment ward at the Royal Edinburgh Hospital.Methods•Baseline survey (November cohort of 12 patients): data collection on number of sections completed (total number = 11) and whether the ‘psychiatrist’ box was ticked, indicating medical input.•Intervention: doctors on the ward reviewed all inpatient MHRAs, added additional assessments if appropriate, and ticked ‘psychiatrist’ involvement in the MHRA.•Repeat survey (February cohort of 11 patients): data collection as before and review of findings.ResultsIn our baseline survey (November 2021), 75% (9/12) of patients had all sections of the MHRA completed. 33% (4/12) had the ‘psychiatrist’ box ticked. In our repeat survey (February 2022), 91% (10/11) of patients had all sections of the MHRA completed. 100% (11/11) had the ‘psychiatrist’ box ticked.ConclusionAccurate assessment and management of risk is an important factor in the safety of patients and staff on acute psychiatric wards. Our baseline data showed that risk assessments had limited medical input and at times had sections which were not filled in at all. Review of the MHRA by medical staff improved this, and in some cases found and added relevant information which had been missed. As a person dependent intervention, this may not be a sustainable change. As a first step to introduce a sustainable system change, a visual prompt has been introduced, in the form of a blue triangle icon in the duty room whiteboard to highlight whether each patient has a complete and up to date MHRA. Further interventions could include integrating a review of the MHRA in weekly ward rounds. This audit also raised the issue of some relevant information having been missed from risk assessments and showed that further audit of the quality of risk assessments is indicated.

A Human Rights-Based Approach To Acute Mental Health Crisis Care

The United Nations Convention on the Rights of Persons with Disabilities as well as the new guidance on community mental health services recently published by the World Health Organization formulate clear goals for the future of psychiatry and psychosocial support. Innovative concepts of psychiatric care that focus on full participation, recovery-orientation and the prevention of coercion play an important role in achieving these goals. Implementing and scientifically evaluating the effects of such models in mental health services needs to be prioritized in national mental health planning and budgeting decisions. In this lecture, Dr. Lieselotte Mahler will address the requirements of psychiatric concepts, specifically on acute psychiatric wards, to enable participation and prevent coercion. Using practical examples and evaluated models (e.g. Weddinger Modell, standardized post-coercion review sessions), she will make suggestions on how a psychiatry oriented towards human rights can also be implemented within existing clinical structures. Dr. Lieselotte Mahler will discuss, based on the current state of research as well as practical experience, which challenges exist with regard to patient autonomy and prevention of coercion in clinical practice and how these can be addressed from a human rights perspective.DisclosureNo significant relationships.

An Audit to Assess the Level Pregnancy Screening Conducted on Admission for Female Inpatients on an Acute Psychiatric Ward

AimsCurrently, practice is that if patients of childbearing age provide a urine sample on admission they will also be consented to test for pregnancy. As many new patients may refuse to provide a urine sample often due to their mental state or concerns about drug testing this results in some patients not being tested for pregnancy during admission unless required for medication or at patient request. Given the high level of vulnerability and the medication implications for pregnant patients, ascertaining pregnancy status early on in admission is beneficial to patients found to be pregnant. Therefore, we aimed to audit how pregnancy status is assessed and documented on admission and aim to improve the practice where areas for development are identified.MethodsOver the 6 month period July-December 2021 there were 105 inpatient admissions on an acute female psychiatry ward. Using a random number generator 15 patients from this cohort were selected and their notes audited as to whether a urine pregnancy test or bHCG serum pregnancy test was completed on admission. If not, we searched the admission notes for documentation of ‘pregnancy, last menstrual period (LMP), sexually active status, contraceptive use’.ResultsOf the 15 patients audited, 7 had a documented urine pregnancy test on admission (47%). Of the 8 patients that had not had testing only 1 patient had documentation of contraceptive use prior to admission, the other 7 non-tested patients had no notes regarding their LMP/contraception. 2 patients who did not have a pregnancy test had in fact had a urinary drug screen on admission, this coincided with a time of approximately 1 month when there were no urine pregnancy test strips available on the ward. At this time serum bHCG or LMP were not routinely used. One of these patients was found one month later to be pregnant.ConclusionWe propose based on our findings that a more robust enquiry as to the risk of pregnancy should be conducted on admission for female acute inpatients. We have made recommendations that this should be in the form of a checklist to be conducted as part of the nursing admissions assessment such that if a urine sample is refused then a form detailing LMP, contraceptive use and any recent unprotected sexual activity will be completed. This can then be reviewed by the medical team prior to commencing medications. The use of this checklist will be reaudited between January-June 2022.

Psychiatric admission among migrants: a retrospective study in acute psychiatric ward in Bologna, Italy

IntroductionNumerous evidences point out how migrants use health services differently than the natives. Migrants turn more frequently to the ED for psychiatric problems and less to territorial psychiatric services than the native population. Other differences can be found in terms of diagnosis, type of discharge, type of hospitalization.ObjectivesOur study has the objective of evaluating the incidence of psychiatric hospitalizations of migrant patients compared to natives in a well-defined area of the metropolitan city of Bologna and evaluate the effect of the Covid 19 pandemic on the incidence of psychiatric hospitalizations among migrants and on their clinical characteristics.MethodsThe study conducted is of an observational and retrospective type on migrant and native patients admitted to the psychiatric unit “SPDC-Malpighi” of the DSM-DP of Bologna AUSL between 01/01/2018 and 31/12/2020.Results Migrants were more likely to be admitted via ED and less likely to be referred from a CMHC or from non-psychiatric hospital unit compared with natives. Most migrants were discharged at home while natives more frequently chose to self-discharge. With regard to diagnosis, migrants were more likely to be admitted due to a SSD, while natives were more likely to be diagnosed with a MD or SUD.ConclusionsWe confirm the presence of differences in access to care, type of discharge and type of diagnosis between migrants and natives. Further studies to investigate changes in pre and post Covid admissions in migrants would be needed.DisclosureNo significant relationships.

Prevalence and forms of aggressive behavior among patients admitted to an acute psychiatric ward

IntroductionAggressive behavior is frequently associated with acute psychiatric admission. Several studies highlight the increased risk of aggression in certain psychiatric disorders.ObjectivesThe aim of the study was to explore the extent of aggressive behavior, its various manifestations, and its association with gender, age, and diagnosis among patients admitted to an acute psychiatric ward.MethodsPatients admitted to our acute psychiatric ward in a three months period were included and the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA-IV) questionnaire was administered in the first seven days after admission for all patients.ResultsA total of 290 patients, 153 men and 137 women, with a mean age of 46.9 years (SD=17.5) participated in the study. Men were overrepresented among patients who showed aggressive behavior (p=.008). There was no correlation between age and DASA-IV score (p=.259). 40% of patients (N=116) did not show aggression, while 60% (N=174) experienced some form of aggression. Of those who exhibited some form of aggressive behavior, 94% had only low, 4% had high, and 2% had extremely high levels of aggression. Aggression was most common in patients with intellectual disabilities, dementia, and bipolar disorder.ConclusionsAccording to our findings the majority of the acutely admitted psychiatric patients shows no or only low level of aggression. There were also differences in the forms and extent of aggressive behavior between the diagnostic groups. Risk assessment is important because it provides an opportunity for early detection and prevention, and the development of personalized treatment plans.DisclosureNo significant relationships.

Improving COVID-19 Vaccination Uptake in Service Users Admitted to an Acute Inpatient Psychiatric Ward

AimsIt is well known that individuals suffering from mental illness have more comorbidities and lower life expectancies compared to the general population. It is unsurprising therefore, that these individuals are more vulnerable to both contracting COVID-19, and developing severe illness if infected. When patients are admitted to a psychiatric inpatient unit this offers an invaluable opportunity to ensure that unvaccinated patients are identified, and if consenting, are supported to receive whichever dose of the vaccine they require. We undertook an audit to examine the proportion of patients admitted who had not received their first, second or third dose of the COVID-19 vaccination. Reviewed in the context of gender, age, ethnicity, legal status, mental health diagnoses and additional comorbidities, in order to determine any trends that might assist in improving uptake. We then repeated the audit aiming to offer the appropriate COVID-19 vaccination to every newly admitted unvaccinated patient. If refused, to then council reluctant patients, providing simple, understandable vaccine information, and to re-offer vaccination.MethodsThe audit took place on a mixed adult psychiatric inpatient ward in London.The first cycle of the audit was completed retrospectively. Data were collected from the electronic notes of new admissions from November and December 2021 (total 41). This included information on COVID-19 vaccination status, and documentation of vaccines offered and administered during admission. Additional information was also compiled to calculate risk stratification scores.Subsequently, we repeated the audit cycle for admissions in January and February 2022 (on-going). However, this time with the aim that all patients have their COVID-19 vaccination status documented promptly, and that their next vaccination is offered/administered during admission if required.ResultsResults from the initial audit cycle showed 33/41 patients had not received a full set of COVID-19 vaccinations (or no vaccination record found). Only 6/33 unvaccinated patients were offered the next vaccination during admission, and 3/33 actually received one. 21/33 patients without a full set of vaccinations were BAME (Black, Asian and minority ethnic).Initial results from the second cycle showed an improvement in the number of patients offered the vaccine. 5/10 unvaccinated patients were offered vaccines in January, however data collection is ongoing.ConclusionAlthough our data set is not yet complete, initial results show that a simple intervention such as early identification of unvaccinated patients on admission, can act as a prompt to clinicians to ensure vaccines are offered. Thereby, increasing vaccine compliance in this vulnerable patient group.

Implementing a Physical Health Clinic on an Acute Adult Inpatient Psychiatric Ward

AimsAcute Inpatient Psychiatric Wards present the challenge of a high turnover of patients who have multiple physical health comorbidities that both contribute to patients’ overall morbidity and may exacerbate any mental illness. Furthermore, there are a number of physical health parameters which must be checked and monitored in the initiation of psychiatric treatments. It is therefore important that patients receive physical examination, blood tests and Electrocardiograms (ECGs). The busy environment of inpatient units and the acute presentation of patients, who often decline interventions, lack capacity or cannot communicate their physical health problems, mean these assessments are often missed when offered in an ad hoc fashion. This Quality Improvement Project looked at implementing a Physical Health Clinic to look at whether this structured environment would provide better coverage of these physical health assessments.MethodsThe number of physical examinations, blood tests and ECGs both offered but declined and successfully obtained was measured on an Inpatient Ward with 20 patients and 2 junior doctors over 2 weeks with assessments being offered in an ad hoc fashion. Following this, a structured clinic run by a doctor and nurse with three 20 minute appointments three times a week was implemented and the same data collected over 2 weeks. A paired T-test was used to evaluate the results.ResultsThere was a statistically significant increase in the number of successfully obtained physical examinations, bloods tests and ECGs when the Physical Health Clinic was implemented (Mean difference = 7.33, Two tailed P value = 0.0480,95% confidence interval 0.16–14.50, t = 4.4, df = 2, standard error of difference = 1.667). However, there was no difference between the number of bloods, examinations and ECGs offered but declined (Mean difference = 4.83, Two tailed P value = 0.2495, 95% confidence interval −3.92–8.58, t = 1.6059, df = 2, standard error of difference = 1.453).ConclusionThe clinic led to a statistically significant increase in the number of examinations, blood tests and ECGs successfully obtained. The reasons for this are hypothesized that having a structured clinic prepares the patient to have a physical assessment and ensures their availability, provides motivation for staff and increases the efficiency of assessments with appropriate teamwork between doctors and nurses. Issues with the Clinic are limited availability of junior doctor and nursing staff and emergencies disrupting the functioning of the clinic. Implementing the clinic on a wider scale is required to assess its effectiveness.

Homophobic Abuse &amp; LGBTQ+ Well-being in the Acute Psychiatric Setting

AimsHomosexuality was declassified as a mental illness in 1973 however LGBTQ+ (lesbian, gay, bisexual, transgender, queer inclusive) service users still face discrimination within modern mental health services. This project assessed homophobia and LGBTQ+ abuse among service users on an acute male psychiatric ward. Our aims were to quantify the incidence of abuse, to explore staff attitudes toward LGBTQ+ abuse and to identify targets to improve LGBTQ+ service users’ experience. We hypothesised that incidents of abuse are common and not always challenged or escalated using appropriate channels.MethodsUsing a mixed methods approach we explored staff perceptions of LGBT+ abuse: quantitative data were generated from a questionnaire survey and qualitative data from a focus group.Rates of homophobic incidents were assessed by analysing clinical documentation from two inpatient samples (n = 20), covering 2020–21 and 2021–22.ResultsAnalysis of clinical documentation found three incidents from the 2020–21 sample and two from 2021–22; only one of these was reported via DATIX.The survey captured the views of the ward team including nurses, healthcare assistants (HCAs), doctors and psychologists (response n = 13). Staff attitudes towards LGBTQ+ were rated as “positive” by 77% of responders and “neutral” by 23%; 100% stated it was their professional duty to respect and protect LGBTQ+ clients. Almost two-thirds (62%) had witnessed homophobia on the ward however a similar proportion (61%) had never directly challenged homophobia. Whilst all staff felt able to care for LGBTQ+ clients, and all were familiar with key LGBTQ+ terminology, only 50% felt they had received adequate training to fully support LGBTQ+ clients.The focus group identified a nursing “lead” for LGBTQ+ issues and agreed to incorporate a “diversity statement” into ward admission rules. LGBTQ+ visibility measures were promoted including LGBTQ+ posters across the ward and staff uptake of the Rainbow Badge Initiative.ConclusionOur findings suggest homophobia is prevalent in the male inpatient psychiatric setting and management is suboptimal. Enhanced LGBTQ+ training is required to support staff to challenge every homophobic incident and escalate appropriately.Simple steps to increase LGBTQ+ visibility are feasible and popular among staff. Future work should assess the impact of such interventions, however measuring change may be hampered by underreporting.Further evaluations are needed to assess female wards and patient perspectives to build a full picture of inpatient LGBTQ+ abuse.

Paraphilic Disorder and Gender Dysphoria in a Case with High-Functioning Autism Spectrum Disorder

IntroductionAutism spectrum disorder (ASD) is a neurodevelopmental disorder characterized with difficulties in social interaction/communication, restricted interests, and repetitive behaviors. Sexual issues such as paraphilic behaviors in ASD have gained attention in recent years, however there is still a great paucity of research regarding this issue.ObjectivesThe aim of this presentation is to draw attention to a crucial dimension through a case of ASD with paraphilic disorder (pedophilic tendencies) and gender dysphoria.MethodsOne case from an inpatient unit of a psychiatric clinic in Lower Saxony, Germany will be reported.ResultsCase: An 18-year-old male was referred to our acute psychiatric ward due to suicidal thoughts and other depressive symptoms. In further examination, he stated that he had pedophilic phantasies which he was trying to satisfy by using child pornography in the darknet. He had never been involved in any sexual relationship with a child and described this behavior as an addiction that he wanted to get rid of. Detailed psychiatric examination and developmental history yielded the diagnosis of high-functioning ASD. The compulsory paraphilic engagement is classified as a restrictive-repetitive interest in terms of ASD. In addition, the patient presented gender incongruence with moderate gender dysphoria, dressed in a skirt and wanted to be perceived and named rather gender-neutral, which was supported through the whole course.ConclusionsThrough systemic understanding of the high-functioning ASD structure and complex symptomatology, socio- and psychotherapeutic approaches were implemented which yielded an apparent stabilization. The detailed therapeutic process in the light of the present literature will be discussed.DisclosureNo significant relationships.