Provision Of Psychiatric Care Research Articles

Prescription Practices and Empirical Efficacy of Psychopharmacologic Treatments for Pediatric Major Depressive Disorder

Limited research on pharmacologic treatments for pediatric major depressive disorder (MDD) exists. Prescription practices data for MDD from 1,209 American Academy of Child and Adolescent Psychiatry members collected in 1998 are compared to the current empirical support for this treatment approach. Results indicated that psychiatrists have willingly used medication as a first-line treatment for MDD in children under age 7, despite a paucity of research support for this practice. Recent warnings regarding the use of selective serotonin reuptake inhibitors warrant the need to reexamine current prescription practices of psychiatric care providers for children diagnosed with MDD.

How to Prevent Antipsychotic Overuse in NHs

How to Prevent Antipsychotic Overuse in NHs

Problems in the provision of psychiatric services in Europe

The workshop deals with various aspects of the provision of psychiatric services in Europe in general and in selected European countries.The differences in the provision of psychiatric care between East and West will be highlighted and the need to channel the recommended action in an appropriate need – centered way is emphasized. Other challenges in the provision of psychiatric services will also be dealt with.The advances, the challenges and the problems in mental health provision in selected European countries in East and West (Serbia, Germany and France) will be presented under the light of recent developments in these Countries (e.g. the new French Mental Health Plan).Special emphasis will be given to the difficulties in the transition from Mental Hospital Psychiatry to community care and to the ethical aspects of this transition.

Balancing Efficacy and Safety in Treatment with Antipsychotics

Balancing efficacy with tolerability and safety of prescribed treatments is critical to optimizing antipsychotic treatment outcomes in the mentally ill. Symptom control, symptom remission, and functional recovery are only realistic goals when treatments are both effective and well tolerated. The consideration of predictable differences in antipsychotic adverse-effect profiles is central to successful illness management. Minimizing adverse effects on alertness, motivation, cognition, sexual/reproductive functioning, and physical health enhances mental health outcomes, partly through improving treatment adherence. Neuroendocrine and metabolic side effects of antipsychotics for cardiovascular morbidity and mortality need to be addressed proactively and aggressively. In view of the widespread lack of primary care engagement and the adverse effects of psychotropic medications on cardiovascular health, psychiatric care providers should function as key facilitators of an integrated mental and physical health management approach. In addition to psychoeducation and healthy lifestyle counseling, clinicians can improve psychiatric and physical health by selecting medications carefully, routinely screening and monitoring for reversible cardiovascular risk factors, and playing an active role in the prevention and interdisciplinary management of cardiovascular risk factors and medical illness in the vulnerable mentally ill.

Countertransference to psychiatric patients in a clinical setting: Development of the Feeling Checklist–Japanese version

Countertransference is an important dimension of the therapeutic alliance between care providers and patients. The Feeling Checklist (FC) is a self-report questionnaire for the assessment of countertransference by hospital staff toward patients. The FC was translated from English into Japanese and its factor structure, reliability, and validity in the Japanese version (FC-J) were examined. A total of 281 Japanese psychiatric nurses were tested with the FC-J. All nurses were primarily involved in provision of psychiatric care. Principal-component factor analysis with varimax rotation was performed to identify the potential components of the FC-J. In a factor analysis of the FC-J, seven factors were extracted. The five subscales that were determined and labeled included Reject, Distance, Helpfulness, Closeness, and Involvement, which collectively accounted for 56.0% of the variance. Cronbach's alpha, a measure of internal consistency, for individual subscales was 0.833 for Reject, 0.763 for Distance, 0.768 for Helpfulness, 0.617 for Closeness, and 0.663 for Involvement. Notably, there was a significant correlation between the FC-J and the Nurse Attitude Scale (P < 0.0001). Moreover, one-way anova was performed with each FC-J subscale to examine differences among psychiatric diagnoses in the study sample. A significant difference was found for Involvement (P < 0.001), with the total score on Involvement being the highest in the personality disorder group. These results are considered to verify the reliability and validity of the FC-J as a scale to measure countertransference among Japanese care providers. The use of this scale allows individual care providers to recognize and be cognizant of their own countertransference objectively and thereby contributes to improve the relationship between patients and care providers.

Letters

Back to table of contents Previous article Next article LettersFull AccessAidan Altenor, Ph.D.Aidan AltenorSearch for more papers by this author, Ph.D.Published Online:1 Dec 2005https://doi.org/10.1176/appi.ps.56.12.1622-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We too are grateful for the editorial decision to dedicate a section of the September issue of Psychiatric Services to reports of current efforts to reduce and eliminate the use of seclusion and restraint. We hope that publication of our study from the Pennsylvania state hospital system and other such studies will lead to further research on more positive strategies to support a person in crisis.The safe and minimal use of seclusion and restraint, as Dr. Herzog indicates, should now be a requirement for all psychiatric health care providers. However, too many people continue to be injured from the use of these restrictive measures. In our Pennsylvania state hospital system, which trains staff in the most current strategies, we discovered that one in five applications of mechanical restraint resulted in an injury to the patient or staff member involved. These are high-risk activities that have no therapeutic value in supporting a person with serious mental illness, and, as we have discovered, they do far more harm than any short-term gain that their use may provide. Psychiatric treatment providers need to find more positive ways to support people who are in crisis.Ten years ago most people in our hospital system accepted the use of seclusion and restraint and regarded these practices as clinical interventions for managing a person in crisis or as proactive interventions in anticipation of a crisis. During this period the "dogma" of the nonrestraint approach was polarizing our hospital community. However, the hospital system's leadership—physicians, nurses, direct care workers, and program staff—who supported a less traumatizing approach prevailed and drove the culture change that has resulted in a safer hospital system.Most people served in our hospital system are first cared for within a short-stay acute care setting. People who were admitted to our civil hospitals were unable to be stabilized within such a setting. Moreover, in our three forensic units at Mayview, Norristown, and Warren state hospitals, where direct acute admissions continue to occur, reduction in the use of seclusion and mechanical restraint has been equally dramatic. Since January 2005 the three forensic centers have had an average daily census of 190 and have provided 5,700 days of care each month. During this period mechanical restraint has been used only 34 times and seclusion has been used 22 times. Several forensic units have not needed to use these measures at all in the past nine months.Early next year the hospital system will discontinue the use of the mechanical restraint in all civil and forensic units. The traumatizing effects of these measures, for both patients and staff, have eclipsed any short-term safety benefit they may provide and are inconsistent with the recovery approach that we have adopted. FiguresReferencesCited byDetailsCited ByNone Volume 56Issue 12 December 2005Pages 1622-a-1622 Metrics History Published online 1 December 2005 Published in print 1 December 2005

The reform of the Greek mental health services

Background: The Greek Psychiatric reforms began in the early 1980s with the introduction of the National Health System and the financial support of the then European Community.Aims: To describe the ongoing process of psychiatric reforms and the current situation of mental health services in Greece.Method: Official reports and relevant publications were used as information sources.Results: The de-institutionalization of patients from psychiatric hospitals has almost been achieved. Psychiatric hospital beds have been reduced, psychiatric units in general hospitals have been developed, a substantial number of community mental health services has been established and the standards of care have been improved. New legislation has been introduced and the stigma attached to mental illness is gradually reduced. However, psychiatric units in general hospitals and Community Mental Health Centres have not yet fulfilled their role as principal providers of psychiatric care, while decentralization, sectorization and completion of the network of mental health services are still to be completed.Conclusions: Although the process of the Greek Psychiatric reforms has been slow and laborious, the progress achieved is undeniable. The identification of problems and gaps together with a stronger collaboration and common efforts with the other European countries will ensure the firmer establishment of the reforms in Greece.

Perspectives on Private Practice. Handling the Finances: HMO versus Private Pay

We have created a new column for advanced practice psychiatric nurses who are in private practice or are thinking about this option. It will give you the needed information to develop a practice – the nuts and bolts of working for yourself – and how to navigate the ongoing challenges of being a competent and successful therapist. We are excited about introducing this new column and we welcome your participation! It offers a question-and-answer forum that will bring you news and views that will hopefully make contributions to your private practice and the quality of your work life. Pat Barry has a wealth of knowledge and expertise with private practice. She has 21 years’ experience working as a private practice psychotherapist in West Hartford, CT. Pat's specialty is consultation psychiatry. Approximately 1/3 of her clients are persons who are seeking assistance coping with their physical conditions. The remaining 2/3 of her clients are individuals with depression, anxiety, trauma, and related conditions. Pat was active in the legislative process that resulted in the opportunity for advanced practice nurses in Connecticut to obtain third party insurance reimbursement for their services. Pat is the author of Mental Health and Mental Illness, Ed.7 and Psychosocial Nursing: Care of Physically-Ill Persons and Their Families, Ed.3 published by Lippincott, Williams & Wilkins.

Clients with long-term mental disabilities in a Swedish county—conditions of life, needs of support and unmet needs of service provided by the public health and social service sectors

Objective. – The purpose of the study was to identify and describe conditions of life and needs of support and public service for clients with a mental disability in a Swedish county population. Methods. – Public health care and social service providers identified clients and completed a questionnaire concerning the clients’ conditions of life and their special needs. A consecutively recruited sample of clients completed a similar questionnaire. Results. – Totally, 1261 clients were identified. The prevalence of clients with mental disabilities was in the urban and rural areas, 6.4/1000 inhabitants and 4.5/1000 inhabitants, respectively. The most prevalent unmet need (42.9%) was to participate in social and scheduled activities. Almost half of the group was reported to need support in activities of daily living. Clients living in urban settings more often needed support with activities of daily living ( P < 0.001), whereas clients living in rural settings more often needed support with job training ( P < 0.001) or finding work ( P < 0.01). Clients and psychiatric care providers reported the needs of the clients in the same areas; however, clients reported a fewer number of needs than did the care providers. Conclusions. – By using both psychiatric care and social service providers, effective case findings of clients with a mental disability were possible to achieve. In general, there was high agreement between psychiatric care providers and clients regarding the clients’ number of needs of support and their unmet needs of service. However, at the individual level, the agreement between client and psychiatric care providers was lower.

A Comparison of the Performance of For-Profit and Nonprofit U.S. Psychiatric Inpatient Care Providers Since 1980

The authors synthesized evidence from a systematic review of the literature reporting substantiated performance differences between private for-profit and private nonprofit psychiatric inpatient care providers in the United States since 1980. They also compared reported differences in performance between nonprofit and for-profit inpatient psychiatric care providers with reported differences between nonprofit and for-profit providers of other types of health care. Studies were located by means of computerized bibliographic searches and follow-up searches of studies cited in the articles located in the computerized search. The analysis included peer-reviewed studies that compared the performance of for-profit and nonprofit health service providers, including inpatient psychiatric services, in the areas of access, quality, cost-efficiency, and amount of charity care on the basis of quantitative data collected after 1980. The studies were classified in one of three categories according to the study conclusion: for-profit superiority, nonprofit superiority, or no difference or mixed results. Almost all studies (with one exception) found that the nonprofit psychiatric providers performed as well as or better than their for-profit counterparts. The proportion of studies reporting performance superiority of nonprofit versus for-profit psychiatric inpatient providers was greater than the proportion of studies reporting the same conclusion for providers of all other types of health care taken together. On the basis of data collected since 1980, nonprofit psychiatric inpatient care providers in the United States had superior performance on access, quality, cost-efficiency, and amount of charity care, compared with for-profit providers. Caution is warranted in pursuing public policies that permit or encourage the replacement of nonprofit psychiatric inpatient care providers with for-profit providers of these services.

The interface between general and prison psychiatry – the consultant's perception

AIMS AND METHODA postal questionnaire was sent to 100 Section 12 (2) approved consultant psychiatrists in the West Midlands to ascertain their perceptions of the role of general psychiatric services in the care of imprisoned patients with mental disorder previously cared for by generic services.RESULTSOf 59 respondents 90% believed they could contribute to the care of imprisoned patients with mental disorders. Ten per cent would delegate total responsibility to specialist forensic services. Lack of awareness of imprisonment of patients was a common problem.CLINICAL IMPLICATIONSInsufficient liaison between prison and general psychiatric services may impede the provision of psychiatric care in prison and prevent discharge planning in line with the Care Programme Approach and current Government guidelines.

Development of a forensic psychiatric service in Tasmania

Objectives: This paper describes the development of a Statewide Forensic Psychiatric Service in Tasmania.Methods: The recent history of psychiatric services to Tasmania's forensic population is examined and new developments described.Results: Forensic psychiatry is that area of psychiatry that intersects with the law. A public forensic psychiatry service usually deals with psychiatric aspects of criminal law, leaving forensic psychiatric practice in the domain of the private sector. Defining exactly what constitutes a ‘forensic’ patient is a critical starting point in the planning of services.The proposed service will include provision of psychiatric care to individuals with mental disorders who have a current involvement with the criminal justice system, both in prison and in the community, treatment of sex offenders and court liaison services. The planning process has become the focus of intense scrutiny following events in the last 3 years, in which Risdon Prison has seen a rash of ear amputations (8 i...

Opportunities and challenges for psychiatry.

Opportunities and challenges for psychiatry.

Clinical and Community-Service Activities of Psychiatric Teaching Hospitals

Because funding for teaching hospitals is threatened in the cost-conscious era of managed care, teaching hospitals must demonstrate their value. To examine the clinical and community-service activities of teaching hospitals, this study compared academic medical centers (AMCs) and other hospitals operating psychiatric residency programs with nonteaching hospitals. Data for the study are from the National Mental Health Facilities Survey, a national survey of providers of inpatient psychiatric care in the United States conducted at the beginning of the current managed care era. When compared with nonteaching hospitals, both types of teaching hospitals offered a larger number of specialized services and had a higher psychiatrist-to-patient ratio. The AMCs received a higher proportion of their revenues from Medicaid than did the nonteaching hospitals. Other teaching hospitals collected a lower percentage of their inpatient charges than the nonteaching hospitals. This study supports the notion that psychiatric teaching hospitals provided more care to low-income and underinsured persons than the nonteaching hospitals and that they offer more services and more psychiatric oversight. The authors find justification for supporting psychiatric teaching hospitals for their clinical and community-service activities.

Issues in Community-Based Rehabilitation for Persons with Mental Illness in Costa Rica

Costa Rica has a long history of provision of psychiatric care. In recent years proponents of reform of mental health care have successfully moved decentralization of psychiatric services, development of community mental health services, prevention, and rehabilitation to the forefront. Nonetheless, obstacles to implementation of proposed reforms persist. Among these obstacles are a lack of communication between the communities served by the health system and that system, unequal geographic distribution of providers of mental health care, and primary-care providers' level of training in mental health care. In this paper we shall first trace the evolution of the system of care for the mentally ill in Costa Rica and then describe the current system and its limitations and strengths.

North Staffordshire Community Beds Study: longitudinal evaluation of psychiatric in-patient units attached to community mental health centres. 2: Impact upon costs and resource use.

Innovative approaches to the provision of psychiatric care must justify their ability to improve the quality of life within the resource constraints imposed on psychiatry. To examine the average costs per patient of the experimental and control group services. An individual patient costing methodology that identified, measured and valued all public and private resources. The experimental group was more likely to remain in contact with services over a 12-month period, had fewer acute readmissions and spent less time in acute in-patient units. There were significantly different levels and patterns of resource consumption between the groups and between the two separate catchment areas. The cost analysis should be assessed in the context of the previous outcome analysis. It is likely, but not inevitable, that such units will increase the overall costs of care provision; this largely depends on the effectiveness with which such units are integrated into existing care provision.

Psychiatric Liability

Psychiatric health care providers' liability extends from clinical cases--medication errors, misdiagnosis, etc.--to particular issues unique to the mental health setting. Part 1 discusses lawsuits common to this setting.

A Partial Hospitalization Program Provided Through a Public-Private Partnership

Dramatic changes in the nation's health care delivery system and the lack of specialized services in rural areas necessitate collaboration between public community-based mental health service providers and private health care providers to address new demands by various types of payors and managed care systems. This study evaluated a community-based geriatric mental health partial hospitalization program developed through the collaborative effort of a public non-profit community mental health provider and a private for-profit psychiatric care provider. The study examined the impact of the program on measures of depression and global functioning. It found statistically significant changes in the measures of depression and global assessment of functioning between pre- and post-test scores. Findings associated with the process of developing a partial hospitalization program as a public-private partnership are summarized with recommendations for similar future ventures.

THE FEMALE ATHLETE TRIAD

THE FEMALE ATHLETE TRIAD

Joint meeting between the Royal College of Psychiatrists and the American Board of Psychiatry and Neurology (ABPN), 6 July 1996

The following summarises discussions which took place at the above meeting, regarding provision of psychiatric care in the United States. The method of accreditation (i.e. approving training) in the United States is totally indepen dent of government intervention. Residency Re view Committees (RRCs) have been established for all medical specialities and some subspecialities, and training schemes are visited at least every five years with a view to inspecting their standards and training programmes. These are closely monitored to ensure that such recommendations are implemented. General training in psychiatry consists of one year of general medical training which includes some psychiatry and neurology. This is followed by a further three in general psychiatry or neurology, and includes various aspects of subspeciality training. The most developed subspeciality in the US is Child and Adolescent Psychiatry, which requires two years of training beginning either in the fourth or Fifth year. For the new sub-specialities, which include Geria tric, Addiction and Forensic Psychiatry, the postresident training schemes are of one year's