Psychiatric Care Settings Research Articles

Improvement of anxiety in ADHD following goal-focused cognitive remediation: a randomized controlled trial.

Despite the high prevalence and detrimental consequences of cognitive and executive dysfunction in ADHD, the evidence base of cognitive remediation in the adult ADHD population is sparse. Executive problems can increase both anxiety and depression in ADHD. Thcus, it is important to develop treatment options for adults with ADHD, aiming to improve goal-directed behavior and mood. Goal Management Training (GMT) is an intervention that has received empirical support in improving executive functions and mood in normal aging and for various neurological and psychiatric conditions. The present randomized controlled trial investigated the effects of a goal-focused intervention combining 1) group-based GMT incorporating psychoeducation about ADHD and 2) guidance in implementing individual goals for coping with executive problems in everyday life, compared to treatment as usual (TAU). The primary outcome was perceived executive functioning in everyday life. Secondary outcomes included psychological well-being (anxiety, depression, and coping with ADHD symptoms). We recruited 81 adult participants with a verified ADHD diagnosis (Mage = 31 years). Inclusion was based upon the presence of executive functioning complaints. The participants were randomly assigned to either the intervention or TAU. The intervention group (n = 41) received 16 hours of GMT and psychoeducation, in addition to 4 individual sessions focusing on formulating goals. The goals were assessed in 6 bi-weekly phone calls in the first three months following the group sessions. Participants in the TAU group (n = 40) received standard, individually-adapted follow-up in an outpatient psychiatric health care setting. All participants were assessed at baseline, post-intervention, and at 8-month follow-up (main measurement time point). Significant improvements in everyday executive functioning, psychological wellbeing, and symptoms of ADHD from baseline to 8-month follow-up were reported in both groups. The intervention group reported a significantly higher reduction in symptoms of anxiety compared to TAU. Conclusions. Our findings provide support for considering cognitive remediation as a treatment option for patients with ADHD.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04638283?term=NCT04638283&rank=1, identifier: NCT04638283.

(062) Examining Barriers and Facilitators of COVID-19 Vaccination in an Acute Care Psychiatric Setting

(062) Examining Barriers and Facilitators of COVID-19 Vaccination in an Acute Care Psychiatric Setting

Integration of a peer practitioner in a hospital unit for patients with psychotic disorders: an exploratory qualitative study.

Studies on the integration of peer mental health practitioners (PMHP) in hospitals are sparse, despite significant benefits being reported for patients and professionals. The integration of PMHP requires the consideration of several parameters and a change in the culture of care. This study aims to understand the impact of the integration of a PMHP in a hospital unit caring for patients with psychiatric disorders. A qualitative content analysis of three focus groups with the interdisciplinarity team were conducted. A consulting PMHP was integrated into the entire research process. Data analysis revealed five main themes: the importance of integration, benefits for patients linked to the identification process, benefits for the team and institution, potentials risks, and perspectives. The study was conducted in a hospital setting with patients suffering from severe psychiatric disorders associated with behavioral disturbances. The benefits reported in the results outline the feasibility of PMHP integration in an acute psychiatric care setting. Nevertheless, further formalization of the PMHP role is required to minimize possible areas of tension between respective fields of activity of each professional.

Addressing Impaired Sleep Among Adults in the Psychiatric Care Setting

Insomnia is highly comorbid with mental disorders and commonly treated by mental health care clinicians. A review of literature provides evidence for shared pathophysiology in systems regulating arousal and sleep–wake cycles in insomnia, anxiety, and mood disorders. Evidence-based pharmacological treatment rationales, based on patterns of dysregulation, are presented. Sleep quality is essential to mental health, and early identification and treatment of insomnia can aid in recovery. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (9), 6–9.]

Peer workers to address discrimination against women in psychiatry and mental health

Compared to the general population and to males with mental health disorders, women with these disorders face more obstacles in psychiatric and mental health care settings. This strongly encourages mental health policies and psychiatric care to consider specific strategies that prevent gender bias in treatment among women with mental health issues. A growing body of research demonstrates the benefits of having peer workers–professionals with a lived experience of mental health issues who use their own experiences of mental distress to support others with comparable experiences–in mental health services. We postulate that peer support can become an important and integrated aspect of preventing and addressing discrimination against women in psychiatry and mental health care. First, women peer workers may combine their lived experiences as service users and as women to provide unique, experience- and gender-based support to women users who experience discrimination. Non-women or women peer workers who did not experience gender discrimination in psychiatric settings may nevertheless benefit from the integration of gender education in their curriculum and, in turn, bring a feminist lens to their work to achieve this mission. Second, using their experience as service users, peer workers have the credible ability to communicate and translate women patients’ needs to the medical staff, and thus facilitate concrete, need-based adjustments of services. Third, peer workers’ involvement as instructors in medical schools could provide early awareness of injustices experienced by women in psychiatry and mental health care. Further research is required to test the effectiveness of peer workers in addressing discrimination against women in real-world clinical settings. More broadly, from a diversity perspective, we believe that peer workers are one of the critical elements in the fight against discrimination in psychiatry and mental health.

Service users' perceptions of recovery from recent-onset psychosis and their long journey to and through psychiatric treatment.

A growing body of evidence highlights that individuals' understanding of mental illness and recovery influences their mental health care preferences. Journeys to psychiatric care settings vary across regions with different socio-economic and developmental characteristics. However, these journeys in low-income African countries have not been well explored. This descriptive qualitative study aimed to describe service users' journeys to and through psychiatric treatment and explore their conceptualizations of recovery from recent-onset psychosis. Nineteen adults with recent-onset psychosis were recruited from three hospitals in Ethiopia for an individual semi-structured interview. Data from in-depth face-to-face interviews were transcribed and thematically analysed. Participants' conceptualizations of recovery are summarized into four themes; "domination over the disturbance of psychosis", "complete medical treatment course and stay normal", "stay active in life with optimal functioning", and "reconcile with the new reality and rebuild hope and life". These perceptions of recovery were reflected in their accounts of the long and hurdled journey to and through conventional psychiatric care settings. Participants' perceptions of psychotic illness, treatment, and recovery seemed to result in delayed or limited care in conventional treatment settings. Misunderstandings about only requiring a limited period/course of treatment for a full and permanent recovery should be addressed. Clinicians should work alongside traditional beliefs about psychosis to maximize engagement and promote recovery. Integrating conventional psychiatric treatment with spiritual/traditional healing services may make an important contribution to early treatment initiation and improving engagement.

Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences.

Evidence-based practice (EBP) is the preferred approach to treatment in mental health settings because it involves the integration of the best available research, clinical expertise, and patient values to optimize patient outcomes. Training on empirically supported treatments (ESTs) in mental health settings is an important component of EBP, and supervision of therapists' implementation of ESTs is critical for therapists to develop and maintain a strong EBP skill set. This study aimed to evaluate training and supervision histories of therapists in outpatient and inpatient psychiatric care settings as an essential first step in improving patient outcomes. Electronic surveys were completed by 69 therapists, most of whom had a master's degree, within a psychiatry and behavioral sciences department at an academic institution. Participating therapists were recruited from several outpatient and inpatient mental health settings serving children, adolescents, and adults. Although most therapists reported completing some form of EST-related coursework, a majority did not receive any supervision related to implementation of ESTs (51% for cognitive-behavioral therapy cases, 76% for dialectical behavior therapy cases, and 52% for other EST cases) during graduate and postgraduate training. Although research from the past decade has supported the need for improvements in training on ESTs, and especially in supervision, problems related to limited exposure to training and supervision among therapists still exist. These findings have implications for how mental health centers can evaluate staff members' EST training and supervision experiences, training needs, and associated training targets to improve the quality of routine care.

Self-Reported Experience of Abuse During the Life Course Among Men Seeking General Psychiatric or Addiction Care—A Prevalence Study in a Swedish Context

A prevalence study was conducted using the NorVold Abuse Questionnaire for men (m-NorAQ) to estimate the prevalence of self-reported experience of life-course abuse and to identify the perpetrators of the abuse. This among men seeking general psychiatric and addiction care in a Swedish context. In total, 210 men completed the questionnaire, and were included in the study. The total prevalence of life-course abuse (i.e., any emotional, physical or sexual abuse during the life course) was 75% (n = 157). The results of this study indicate the importance of identifying experiences of life-course abuse among men in general psychiatric and addiction care settings.

How subjective well-being, patient-reported clinical improvement (PROMs) and experience of care (PREMs) relate in an acute psychiatric care setting?

Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly acknowledged as critical tools for enhancing patient-centred, value-based care. However, research is lacking on the impact of using standardized patient-reported indicators in acute psychiatric care. The aim of this study was to explore whether subjective well-being indicators (generic PROMs) are relevant for evaluating the quality of hospital care, distinct from measures of symptom improvement (disease-specific PROMs) and from PREMs. Two hundred and forty-eight inpatients admitted to a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardized generic PROMs on well-being, symptom improvement was assessed using standardized disease-specific PROMs, and experience of care using PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of providing treatment using adapted PREMs items. Change in subjective well-being (PROMs) at discharge was significantly (p < 0.001), but moderately (r2 = 28.5%), correlated to improvement in symptom outcomes, and weakly correlated to experience of care (PREMs) (r2 = 11.0%), the latter being weakly explained by symptom changes (r2 = 6.9%). Patients and clinicians assessed the experience of care differently. This study supports the case for routinely measuring patients' subjective well-being to better capture the unmet needs of patients undergoing psychiatric hospital treatment, and the use of standardized patient-reported measures as key indicators of high quality of care across mental health services.

Exploring Hybrid Leadership: Experiences of Remote Leadership in Healthcare.

The aim of this study was to describe leaders' experiences of remote leadership during the 1st year of the COVID-19 pandemic. The COVID-19 pandemic accelerated remote work. However, there is little research on the experience of remote leadership in the healthcare setting. Data were collected using focus group interviews and analyzed by thematic analysis. A total of 8 leaders from a psychiatric care setting participated. The following themes were identified: increased work efficiency, work well-being, lack of organizational support, the need to be present, and the desire for a hybrid leadership model for the future. Remote leadership includes both benefits and challenges for healthcare leaders and organizations. Leaders in this study emphasized the need to be present for the clinical personnel and proposed a hybrid leadership model. To succeed in combining remote and face-to-face work and leadership in a new model, organizations need to provide clear guidelines and training for remote work and leadership.

Relationship Between the Dynamic Appraisal of Situational Aggression (DASA) Score and Incidents of Aggression Within 24 Hours in Patients in a Psychiatric Intensive Care Setting

The Dynamic Appraisal of Situational Aggression (DASA) is a risk assessment instrument developed in 2006 to assess the likelihood of a patient engaging in violence within 24 hours in a psychiatric inpatient environment. The aim of this study was to investigate whether DASA scores predict incidents of violence, restraints and seclusion in a 24-hour period on a psychiatric intensive care unit (PICU). This study also aimed to identify a meaningful DASA score which would suggest a high risk of an incident of violence occurring within 24 hours on a PICU. For two months, data collected for every inpatient on PICU were: daily DASA scores, incidents of violence, physical restraint or seclusion and whether the patient was deemed appropriate to transfer from PICU to an acute ward. Receiver operating characteristic (ROC) curves assessed the ability of DASA scores to predict incidents. Higher DASA scores were significantly associated with decreased odds of a patient being deemed fit for transfer to an acute ward and with increased odds of an incident of violence, seclusion or restraint within 24 hours. With a DASA score of 4 or above, there is a 16% probability there will be an incident of violence, 21% probability of seclusion and 11% probability of restraint within 24 hours. The DASA score can be used to predict incidents of violence, seclusion and restraint in the following 24 hours in a PICU setting.

A-177 Relationship between Subjective Well-Being and Interpersonal Relationships in the sheltered workshop

Abstract Objective: The purpose of this study was to examine the influence of social participation on subjective well-being, especially among those who used employment support facilities, based on the understanding of subjective well-being in inpatient and psychiatric day care settings. Methods: Subjects were clinically stable individuals diagnosed with endogenous psychosis. A total of 40 individuals were hospitalized (n=14), in psychiatric day care (n=10), or in a supportive employment facility (n=16). There were 18 women. The Japanese version of the Short Version of the Subjective Well-being Scale under Antipsychotic Treatment (SWNS-J) was used to assess subjective well-being. The Brief Psychiatric Symptom Rating Scale (BPRS) was used to assess the severity of psychiatric symptoms. The WHO DAS2.0 Japanese version (WHODAS2.0) was used for the social life assessment scale. Spearman's rank correlation was used for statistical analysis. Results: The SWNS-J scores for subjective well-being were 75.7 (standard deviation=21.2) for inpatient, 71.2 (±22.6) for psychiatric day care, and 68.2 (±15.3) for employment support facilities. In employment support facilities, relatively low correlations were found between the SWNS-J and the WHODAS2.0 sub-items such as "understanding and communication," "independence," "self-care," and "daily life (family)," especially in interpersonal relationships (getting along with others: ρ = -0.65, P &amp;lt; 0.01) was significantly correlated with the SWNS-J. Conculsion: The results suggest that it is important for occupational therapists to be aware of some daily stressors in interpersonal interactions when working with people in employment support facilities, and to give appropriate consideration to these stressors.

Repeated subcutaneous racemic ketamine in treatment-resistant depression: case series.

Interest in the use of parenteral ketamine has been increasing over the last 2 decades for the management of treatment-resistant depression (TRD). While intravenous (IV) ketamine has been the most common parenteral route of administration, subcutaneous (SC) and intramuscular options have been described. We developed a clinical treatment protocol for the use of repeated SC racemic ketamine (maximum six treatments, twice per week) in an inpatient psychiatric care setting with inclusion/exclusion criteria, dosing schedule, and description of treatment, assessment, and monitoring procedures. Results from the first 10 consecutive patients demonstrated the effectiveness of SC racemic ketamine in relieving symptoms of TRD as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) and Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR 16 ). Response (≥50% reduction in scores from baseline to endpoint) was achieved in 8/10 cases on the MADRS and 6/10 on the QIDS-SR 16 . Remission was achieved in 8/10 (based on MADRS ≤10) and 5/10 (based on QIDS-SR 16 ≤6). Patients tolerated the treatments well with only transient blood pressure changes and dissociative side effects. Repeated SC ketamine treatments could be a safe, feasible, and effective alternative to IV ketamine infusions for patients with TRD.

Obtaining informed consent: psychiatric nurses&amp;#8217; knowledge and practice at federal neuropsychiatric hospital Enugu, Nigeria

Background: Within a psychiatric care setting, informed consent is the voluntary acceptance of a plan for medical care by a competent patient after full disclosure of the care plan, its risks, benefits, and alternative approaches. This implies that the patient must have full information about any treatment options and must be competent to make the needed decisions. Objective: To assess psychiatric nurses’ knowledge and practices of obtaining informed consent. Research Method: The study used a quantitative, descriptive cross-sectional survey design. Data were collected from a random sample of 99 nurses selected from a total of 131 nurses of different professional cadres working in the hospital, by means of a structured questionnaire constructed by the researchers. Data were analyzed using descriptive statistics. Results: Respondents’ score on Knowledge of Informed Consent was above average (15.06 ± 2.671 out of a possible total score of 25). Likewise, their score on the disclosure of full information to psychiatric patients before treatment was well above average (6.01 ± 2.198 out of a maximum possible score of 8). However, respondents’ score on the practice of obtaining Informed Consent was below average (2.41 ± 0.940 out of a maximum possible score of 5). Conclusion: Though a majority of the participants indicated good knowledge of informed consent, there was no corresponding correct practice of obtaining informed consent from patients in the hospital.

Considerations for implementing evidence-based practices for youth anxiety in an acute psychiatric care setting.

Considerations for implementing evidence-based practices for youth anxiety in an acute psychiatric care setting.

Personality predictors of 6-month readmission in adult psychiatric inpatients.

Readmission of psychiatric inpatients is highly prevalent and places a significant financial burden on the healthcare system. Rehospitalisation is often used as a metric of quality of care in psychiatric settings, but little is known about how specific personality traits impact readmission in adult psychiatric inpatients. A convenience sample of 94 adults (mean age=36.8 years; female=54.3%; European American=76.6%) at an inpatient psychiatric hospital completed the Personality Inventory for DSM-5-Brief Form (PID-5-BF; American Psychiatric Association, 2013); demographic and medical information and readmission data were extracted via chart review. Poisson regression was used to predict number of readmissions at 6months after discharge from PID-5-BF domain scores of Negative Affectivity, Detachment, Antagonism, Disinhibition and Psychoticism. Twenty-three patients (24.5%) were readmitted at least once by 6-month follow-up. Higher PID-5-BF Negative Affectivity domain scores predicted greater number of readmissions at 6months (incidence rate ratio (IRR)=1.14, robust standard error (RSE)=0.05, p< .01, 95% confidence interval [1.04, 1.25]). The other PID-5-BF domain scores were not significantly related to number of readmissions. Thus, greater negative affect, indicative of higher trait neuroticism, heightened experience of negative emotions and poor self-concept, was a significant personality predictor of readmission in the study. These results suggest that assessing this trait domain might help to identify psychiatric inpatients at greater risk for readmission and determine those most in need of enhanced services to reduce rehospitalisation.

Experience of psychosis during the COVID-19 pandemic among hospitalized patients

ABSTRACT Background The content of auditory hallucinations (AHs) and delusions is malleable and reflects the social environment and the local culture. COVID-19 is a significant new feature of the social environment, yet research has not yet determined how the phenomenology of psychosis has changed since the COVID-19 outbreak. Methods Adult patients (N = 17) receiving care within an acute inpatient psychiatric care setting in Boston were recruited to participate in an hour-long Zoom interview about their psychosis phenomenology and the potential impact of COVID-19. Results Thematic analysis of interview data found that for many, ideas about COVID-19 were present in the content of their AHs and shaped their paranoid ideation. Some felt that the frequency and loudness of the AHs had increased. However, not all participants spoke in ways that suggested the virus had affected their experience. Discussion Results demonstrate that COVID-19 influenced the content of psychosis for many, but the effect of COVID-19 on psychosis was not uniform. The increased social isolation, financial insecurity, and socio-political climate of the period also seemed to negatively impact individuals with psychosis. Understanding how COVID-19 specifically has influenced psychosis helps to illustrate how societal and external factors may shape this experience.

Factors Associated with Age of Onset of Bipolar Affective Disorder from a Tertiary Care Hospital in Southern India: A Cross-sectional Study

Introduction: Bipolar Affective Disorder (BPAD), is a chronic debilitating disorder. The mean age at onset for BPAD is observed to be around 20-30 years. The Age at Onset (AO) of BPAD is affected by various factors, including gender, family history, substance use, and other environmental factors. Aim: To assess the AO of BPAD in the clinical population and the relationship of socio-demographic and clinical factors with AO. Materials and Methods: A cross-sectional study, was conducted at Department of Psychiatry, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India, from January 2020 to January 2021. The socio-demographic details of total of 53 participants suffering from BPAD attending the tertiary care psychiatric setting were collected. The AO of the sample data and its correlation with gender, family history, substance use, marital status, residential background, etc was analysed by using Statistical Package for the Social Sciences (SPSS) version 22.0. Independent t-test and Analysis of Variance (ANOVA) were applied to compare AO among different variables. Pearson’s correlation and multiple linear regression were applied to assess the correlation. Results: Out of the 53 participants, 30 participants (56.6%) were males and 23 (43.4%) were females of which 31 (58.5%) of the participants had a family history of psychiatric illness. Eighteen (33.8%) had some substance use before onset. No substance use was reported by females. The mean AO of the sample was 24±7.8 years. The mean AO was significantly earlier for, males (t= -2.598; p=0.012), those with a family history of psychiatric illness (t=968; p&lt;0.01) and urban dwellers (t=-3.752; p&lt;0.01). Multiple linear regression analysis showed only family history (B=-3.07, p=0.01) and urban background (B=3.60, p=0.01) significantly predicted earlier AO. AO also negatively correlated with number of suicides per person years of illness (r= -0.387; p&lt;0.01), and number of episodes per person years of illness (r=-0.322, p=0.01). Conclusion: Presence of a family history of psychiatric illness and residing in urban areas showed an overall early prediction of AO rather than gender, and other environmental factors. Earlier AO was associated with worse clinical outcomes of BPAD. Knowledge about AO and its factors might help in predicting treatment outcomes, and in planning primary preventive strategies for vulnerable populations.

MU-Opioid Receptor (OPRM1) Gene Polymorphism and its Association with Alcohol Dependence: A Single Centre Study from Southern India

Introduction: Asn40Asp Opioid Receptor (OPRM1) polymorphism of the MU-OPRM1 gene has been widely studied with regard to its association with alcohol dependence however results have been conflicting with evidence of ethnicity mediated effects. Aim: To examine the association between OPRM1 polymorphism and alcohol dependence in patients of South Indian ethnicity. Materials and Methods: This cross-sectional study was conducted at Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India, from November 2018 to May 2019. Cross-sectional assessments and peripheral venous blood genotyping were done in 50 male South Indian participants attending a tertiary care psychiatric setting. Clinical parameters such as severity of dependence and craving were assessed in addition to the subject’s OPRM1 genotype. The data collected was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The mean age of the subjects was 39.62±8.50 years. This study showed a statistically significant association between alcohol dependence and the OPRM1 polymorphism Asn40Asp among the study subjects (p-value &lt;0.05). Furthermore, there was a higher than expected prevalence of the polymorphism of 86% among patients. However, there was no significant association between the polymorphism and clinical phenotypes such as severity of dependence or craving. Conclusion: This study indicates a possible role of OPRM1 polymorphism in alcohol dependence in South Indian patients and warrants further research with larger sample sizes. The association if replicated will shed light on aspects of aetiopathogenesis as well as have implications on treatment.

COVID-19 Vaccination Rates in a Cohort Study of Patients With Mental Illness in Residential and Community Care.

Background: Patients with mental illness are at increased risk for COVID-19-related morbidity and mortality. Vaccination against COVID-19 is important to prevent or mitigate these negative consequences. However, concerns have been raised over vaccination rates in these patients.Methods: We retrospectively examined vaccine uptake in a large sample of Belgian patients admitted to or residing in a university psychiatric hospital or community mental health care setting between 29th of March 2021 and 30th of September 2021 in the Flanders Region. All patients were offered vaccination. Descriptive statistics were used to analyse the data. Logistic regression was used to examine factors associated with vaccine uptake.Results: 2,105 patients were included in the sample, of which 1,931 agreed to be vaccinated, corresponding with a total vaccination rate of 91.7%. Logistic regression showed an effect of the diagnosis “other disorders” (OR = 0.08, CI = 0.005–0.45), age (OR = 1.03, CI = 1.02–1.04) and residing in the psychosocial care center (OR = 0.50, CI = 0.32–0.80) on vaccination status.Conclusion: Vaccine uptake among people with mental illness is high and comparable to the general population, when implementing a targeted vaccination program.