Psychiatric Care Research Articles

Repetitive transcranial magnetic stimulation enhanced by neuronavigation in the treatment of depressive disorder and schizophrenia

This editorial assesses the advancements in neuronavigation enhanced repetitive transcranial magnetic stimulation for depressive disorder and schizophrenia treatment. Conventional repetitive transcranial magnetic stimulation faces challenges due to the intricacies of brain anatomy and patient variability. Neuronavigation offers innovative solutions by integrating neuroimaging with three-dimensional localization to pinpoint brain regions and refine therapeutic targeting. This systematic review of recent literature underscores the enhanced efficacy of neuronavigation in improving treatment outcomes for these disorders. This editorial highlights the pivotal role of neuronavigation in advancing psychiatric care.

Progress of rehabilitation in assisted living for mentally ill according to STAX-SA taxonomy.

The transition from institutional psychiatric care to community-based mental health services has resulted in the rapid development of assisted living services (AL) for mentally ill. Focus of the current study is to add internationally comparable evidence-based knowledge on the rehabilitation of AL residents by examining progression and mortality in relation to the level of service provided in AL units. This study utilized data gathered from a longitudinal study conducted in Finland during the years 2020 to 2022. A total of 340 health- and social care records of residents in AL services were examined over a 3-year study period. Progression (changes in AL service level) and mortality of AL residents were explored through the level of service provided in AL units, by applying the Simple Taxonomy for Supported Accommodation (STAX-SA). Progression was grouped into (1) progressed, (2) stable, and (3) regressed. During the 3-year study period progression was examined for 95.3% (n = 324) of the AL residents of which 18.8% progressed into less supported AL, 79.3% remained stable and 1.9% regressed into more supported AL. In the entire population (n = 340) mortality was 4.7%. AL residents progressed into less supported AL services rarely although they had similarities in clinical characteristics. This might indicate that the development of AL services has evolved into a more custodial type rather than rehabilitation. Progress of rehabilitation in AL services should be investigated further by examining AL resident characteristics in relation to the level of service and level of support provided in AL services.

Unethical conduct as a multifaceted phenomenon in psychiatric care: Nurse leaders' perspectives.

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization.

Occupational therapy practice in psychiatric day hospitals: A scoping review

Introduction: The aim of this scoping review was to explore whether clear guidelines for the practice of occupational therapists in psychiatric day hospitals exist, both locally and globally. Methodology: Searches were conducted in January 2024; 38 articles were screened and 22 were identified for data extraction. Articles were imported onto Covidence software. Data charting was done, and data were exported into a Microsoft Excel sheet, where content analysis was performed based on the review’s objectives. Synthesis of the results was done through discussion and reported according to the PRISMA for Scoping Reviews guidelines. Results: Thirty-eight articles were included but only 22 were relevant. Group therapy, individualised therapy, vocational and community workshops were identified as common modes of intervention in psychiatric day hospitals. Occupation-based activities are integral to intervention. However, there was no explicit definition regarding the role of occupational therapy and practice guidelines for psychiatric day hospitals. Conclusion: The general scope of occupational therapy remains the same for overnight hospitals, day hospitals and community-based centres. It is mainly occupation-centred, function-orientated, and patient-centred. However, there remains ambiguity on specific practice principles and guidelines that clearly define the role of occupational therapists in day hospitals. There is a need for occupational therapy practice guidelines specific for psychiatric day hospitals. Implications for Practice The study provides valuable insights into the current knowledge and availability regarding the role and scope of practice for occupational therapy in the rapidly expanding psychiatric day hospital setting, emphasising areas for further development. Tangible evidence was identified on therapeutic principles, practice approaches, program content, and guidance for resource allocation in psychiatric day hospitals, which can be translated into practical guidelines. Ultimately, the results inform occupational therapy service delivery, solidify the profession’s role in psychiatric care, and contribute towards National Health Insurance (NHI) policy development.

Leptin and leptin receptor gene polymorphisms and depression treatment response.

Associations between leptin (LEP) and leptin receptor (LEPR) gene polymorphisms and mood disorders have been found but not yet confirmed in multiple studies. The aim of our study was to study the associations between LEP and LEPR single nucleotide polymorphisms (SNPs) and treatment response of depression. Associations between leptin levels and depression severity were also investigated. The data included 242 depressed patients in secondary psychiatric care. Symptoms of depression were assessed with the Montgomery–Åsberg Depression Rating Scale (MADRS). Previously found LEP and LEPR SNPs associated with depression and other mood disorders were studied. Furthermore, all available LEP and LEPR SNPs were clumped using proxy SNPs to represent gene areas in r2 > 0.2 linkage disequilibrium and their association with treatment response was analysed with logistic regression. Two proxy SNPs of LEPR gene, rs12564738 and rs12029311, were associated with MADRS response at 6 weeks (p adjusted = 0.024, p adjusted = 0.024). SNPs from previous studies were not associated with MADRS response, but LEPR rs12145690 from a previous study was strongly associated with rs12564738 (r2 = 0.94). The positive association between leptin levels and MADRS score at baseline after adjusting with age, sex, body mass index (BMI), Alcohol Use Disorders Identification Test score, and smoking was found (p = 0.011). Our findings suggest that LEPR polymorphisms are associated with depression treatment response. We also found associations between leptin levels and depression independently of BMI. Further studies and meta-analyses are needed to confirm the significance of found SNPs and the role of leptin in depression.

The relationship between sleep difficulties and externalizing and internalizing problems in children and adolescents with mental illness.

Sleep difficulties are presumably a transdiagnostic factor in the complex aetiology of psychiatric disorders in youth. This study assessed the prevalence of sleep difficulties in children and adolescents seeking specialized psychiatric care, examined the relationships of internalizing and externalizing problems, and considered the moderating role of sex and age on these relationships. Parent-reported data on difficulties initiating sleep, difficulties maintaining sleep, early morning awakenings and daytime fatigue from a large sample of children and adolescents referred for specialized psychiatric care (n = 4638; < 18 years) were used to estimate prevalence rates. To examine associations between these sleep difficulties and internalizing/externalizing problems, multiple linear regression analyses were conducted on available data (n = 3768) stratified in three age groups (1.5-5 years; 6-11 years; 12-18 years). Overall prevalence, i.e. at least one sleep difficulty was reported to be often or always present, was 65%. Difficulties initiating sleep occurred the most, closely followed by daytime fatigue. In all age groups, sleep difficulties were positively related to internalizing and externalizing problems. In young children and school-age children, age moderated the interaction between sleep difficulties and internalizing problems. To conclude, prevalence rates of sleep difficulties in children with mental illness appear higher than it has been reported in the general youth population, especially difficulties initiating sleep and daytime fatigue. We observed that the associations between internalizing problems and sleep difficulties in young children and school-age children seemed to be amplified with age, suggesting a negative, bidirectional, spiral in development.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai

BackgroundChild and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training.ObjectiveThis study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai’s primary care setting. It also assessed family physicians’ involvement and preparedness in this domain.MethodsUsing a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges.ResultsFindings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages.ConclusionEnhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai’s primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

Suicide risk among adult subjects hospitalized in an acute psychiatric ward: 6-yearretrospective investigation.

The phenomenon of suicide risk (SR) represents a psychiatric, social and environmental emergency. The acute psychiatric ward as the Italian Service for Psychiatric Diagnosis and Care (SPDC) represents the place where SR is high due to the acute and serious conditions of people hospitalized. The objective of this study was to evaluate the characteristics of subjects admitted to a SPDC over a 6-year period for SR represented by: suicidal ideation, attempted and failed suicide. With a retrospective single-center observational design, we collected hospitalizations from 01/01/2017 to 31/12/2022 in the SPDC of AUSL-Modena for SR, analyzed the modality of SR and compared the demographic and clinical variables of subjects with SR with those hospitalized for other clinical reasons in the same period. Data were statistically analyzed. In the 6-year of study period, we collected 2,930 hospitalizations in the SPDC of AUSL- Modena and among them, 68% (n = 528) were carried out due to SR, which represented the second leading cause of hospitalization (18%), in particular among females (Pearson Chi2 = 17.41, p < 0.001). Individuals with SR were more frequently voluntary admitted (Pearson Chi2 = 215.41, p < 0.001) for a shorter period (7.36 ± 8.16 vs 11.66 ± 15.93, t = 6.03, t-test, p < 0.001) and less frequently repeated the hospitalization during the study period for the same reason (Pearson Chi2 = 6.0, p = 0.014). The most frequent psychiatric disorders associated with SR were depressive, personality and adjustment disorders, which represented the most common factor associated with SR (68%), followed by family/relationship problems (12%) and alcohol/substance abuse (8%). We highlighted three kinds of suicidal risk: suicidal ideation (40%), often associated with personality disorders and substance use disorders, drug ingestion (30%) concomitant with conflicting family relationships and use of violent means (30%) associated with depressive disorders (Pearson Chi2 = 42.83, p = 0.002). Our study provides a real-world setting evaluation of subjects hospitalized for SR and, in accordance with literature, suggests that suicidal behavior is the product of many clinical and social factors' interaction, that occurred in a crucial moment of life in vulnerable individuals. The identification of subjects at SR represents the first step of preventive multi-professional interventions.

“It’s an Extra Twist That’s a Bit Tricky to Solve”: Staff Balancing Parental Involvement When Supporting the Participation of Adolescents in a Family-Oriented Practice

This study explores staff balancing parental involvement when performing recovery-oriented work via Patient-Initiated Brief Admission (PIBA) for adolescents. Data from focus group interviews with employees in Swedish Child and Adolescent Psychiatry (CAP) is discussed and analyzed using ecological systems theory. Findings suggest dualistic views on participation and parental involvement, where safety and security have to be considered supporting adolescents’ participation in psychiatric inpatient care. Staff has the potential to involve parents during PIBA without automatically diminishing adolescents’ participation, and this has to be legitimized if PIBA is to become an integrated tool to promote recovery-oriented care in CAP.

Work readiness and Work-changing ability: exploring the employability profiles of a social psychiatric care graduate programme’s alumni

PurposeWork readiness and the ability to change how work is conducted are key dimensions of employability. This study focuses on alumni from the social psychiatric care (SPC) programme at University West in Trollhättan, Sweden. As their work readiness and work-changing abilities have not been studied to this point, the purpose was to explore the eventual main employability profiles in these alumni.Design/methodology/approachBetween 8th November 2022 and 2nd January 2023, 94 SPC alumni responded to the Employee Agility and Resilience Short Swedish Version Measurement Scale, consisting of five subscales that represent different employability features. Cluster analysis was used to explore eventual employability profiles in these alumni.FindingsThree clusters of SPC alumni with different employability profiles were identified. Cluster 1: Highly employable profile, which is represented by SPC alumni who scored high on each of the five employability features. Cluster 2: Employability with alliance-creating profile; this cluster comprise SPC alumni whose strengths lie in creating collegial relationships. Cluster 3: Employability with a strong social support profile, which comprise SPC alumni with a strong social backing at work. We discuss that SPC alumni of these employability profiles are variously equipped to (1) follow and develop how work is conducted in their fields and (2) adapt to changes at work.Originality/valueThe study presents employability profiles of SPC alumni and offers valuable insights that could enhance the prospects of these alumni becoming a recognised occupation within the realms of psychiatry, social services, institutional work and community work.

The Spanish Adaptation of the Quality in Psychiatric Care—Forensic Inpatient (QPC-FIP) Instrument: Psychometric Properties

Background/Objectives: The quality of care in forensic mental health services is a factor that significantly impacts recovery and constitutes a right of the individuals receiving treatment. However, there is a lack of instruments to assess the perceived quality of care among individuals in this setting. Quality in Psychiatric Care—Forensic Inpatient (QPC-FIP) is a Swedish instrument that measures the perception of quality care from the perspectives of patients in the forensic setting. The aim of this study was to perform a cross-cultural adaptation of the QPC-FIP instrument into Spanish and to assess its reliability and validity. Methods: For the adaptation process, a translation–backtranslation of the instrument was performed. Regarding psychometric properties, the sample consisted of 120 inpatients in the forensic setting to whom the instrument was applied. To assess temporal stability, the instrument was readministered after 10 days (n = 98). Results: The confirmatory factor analysis showed an equivalent seven-factor structure with the original version, presenting a satisfactory model fit. Regarding reliability, the Cronbach’s alpha value was 0.933, and the intraclass correlation coefficient was 0.836 (95% IC: 0.742–0.896), revealing results higher than 0.70 in six of the seven factors. Conclusions: The Spanish version of the QPC-FIP instrument showed adequate validity and reliability values, indicating that is a useful tool for measuring quality in psychiatric care in the forensic context.

The Influence of Emotional Intelligence on Psychiatric Nurses' Care Behavior, and the Chain Mediating Role of Compassion Fatigue and Perception of Management.

To investigate psychiatric nurses' emotional intelligence and its effect on care behavior, while also examining the mediating effect of compassion fatigue and perception of management. This cross-sectional study was conducted in several specialized psychiatric hospitals with 360 psychiatric nurses. Self-report surveys were administered, which included the Caring Factor Survey-Caring of Manager, Caring Behaviors Inventory, Compassion Fatigue Short Scale, and Wong Law Emotional Intelligence Scale. Data were analyzed using descriptive, correlation, and path analyses. Mean score for care behavior was 4.78 (SD = 0.83), which was at a moderate level. Compassion fatigue exhibited negative correlations with other variables. Results of mediation effect analysis showed that emotional intelligence directly predicted care behavior (p < 0.001). Emotional intelligence also indirectly affected care behavior through the mediating roles of perception of management and compassion fatigue, and affected care behavior through the chain mediation effect of perception of management and compassion fatigue. Nurse managers should pay attention to the influence of emotional intelligence on care behavior and improve care behavior by strengthening leadership and alleviating compassion fatigue. [Journal of Psychiatric Nursing and Mental Health Services, xx(xx), xx-xx.].

An integrated alcohol and suicide intervention for adolescents in inpatient psychiatric treatment.

Despite the bidirectional relationship between alcohol use and STB, the two issues are often treated separately in adolescent inpatient psychiatric hospitals, highlighting the need for brief interventions that address both alcohol use and STB in an integrated fashion. This study tested the feasibility, acceptability, and preliminary effectiveness of a brief integrated Alcohol and Suicide Intervention for Suicidal Teens (iASIST) with a post-discharge mHealth booster for adolescents in inpatient psychiatric treatment. We conducted an RCT of iASIST relative to an attention-matched comparison condition with adolescents hospitalized following STB (N = 40). iASIST demonstrated feasibility and acceptability and mixed models indicated that both groups had significant decreases in substance use over the 3-month follow-up, but post-intervention group differences were not significant. In terms of cannabis use, however, iASIST participants significantly improved over time. Intervention group participants showed a significant decrease in suicide plans from baseline to follow-up, which was not the case for control group participants. Study findings suggest a larger RCT is warranted to test the effectiveness of the iASIST intervention. iASIST shows promise in its ability to target the public health problems of alcohol use and STB in an integrated fashion with a high-risk adolescent population receiving acute psychiatric care.

Outcomes of Universal Suicide Risk Screening in Medical Inpatients

Objectives Universal screening for suicide risk has not been shown to reduce suicide rates or reliably predict suicide, but there have been few studies assessing other potential benefits of this practice. We aimed to investigate the feasibility of implementing a universal inpatient suicide risk screening protocol and determine if a positive suicide screen was predictive of the need for psychiatric admission, and if it reduced the length of stay prior to psychiatric admission. Methods We conducted a retrospective chart review of non-psychiatric admissions over 1 year at a tertiary care academic hospital. We calculated the proportion of patients screening positive for suicidal ideation (SI), and among those screening positive, the proportion receiving a psychiatric consult and being admitted to psychiatry. Length of stay among groups was determined. We performed chi square analysis and adjusted multivariate logistic regression comparing different demographics. Results 97.2% of patients were screened, with 2.6% screening positive. Of these patients, 44.6% received a psychiatric consultation and 9.2% were admitted to psychiatry. Psychiatric admissions who screened positive for SI averaged 5.7 days until transfer to psychiatry, compared to 17.9 days for those who screened negative. Suicide risk screening had a sensitivity of 62.0%, specificity of 97.6%, positive predictive value of 9.2%, and a negative predictive value of 99.8% for psychiatric admission. Conclusions Universal suicide risk screening is feasible and may help identify patients requiring psychiatric care sooner, reducing length of stay of those requiring psychiatric admission.

Emergency psychiatric care for children and adolescents: factors associated with multiple visits and hospital admissions.

Given the increased demand for mental health resources in the child and adolescent population, this study aims to describe the emergency psychiatric care of the children and adolescents and to explore factors associated with multiple visits and hospital admissions. All patients < 18 years of age who visited the psychiatric ED(ED) of a University Hospital in Madrid, Spain, during 2022 were included. Data were collected by the attending psychiatrist upon first 2022 ED visit (index visit) and during any ED revisit. Electronic health records of all included patients were revised to contrast information and complete missing data. Logistic regressions and correlation analyses were used to explore factors associated with multiple ED visits and hospitalisations. N = 397 patients were included. Factors associated with multiple ED visits were: being LGTBQ+, having eating problems, substance use, consulting for psychosis upon first visit, having a history of suicidal behaviour, previous mental health service use or previous hospitalisations, having two or more psychiatric diagnoses, and being diagnosed of eating disorders or depression. Factors associated with hospitalisation include female gender, older age, LGTBQ+, family conflicts, first or second-generation migrants, history of abuse, eating problems, drug use, history of suicidal behaviour, previous mental health service use or previous hospitalisations, psychiatric comorbidity, and eating disorders diagnosis. Identifying predictors that lead to different clinical pathways and use of mental health services can improve clinical outcomes and resource use.

Optimizing Chronotherapy in Psychiatric Care: The Impact of Circadian Rhythms on Medication Timing and Efficacy

In many medical settings, medications are typically administered in the morning or evening, aligning with patients’ daily routines. This practice does not stem from chronotherapy, which involves scheduling drug administration to enhance its effectiveness, but rather from the way clinical operations are structured. The timing of drug administration can significantly affect a medication’s effectiveness and side effects, with the impact varying by up to ten times based on circadian rhythms. Disorders such as major depression, bipolar disorder, and schizophrenia are linked to disruptions in these rhythms. Recent studies have found that circadian dysfunctions, including genetic and neurohumoral changes, underlie many psychiatric conditions. Issues such as an altered glucocorticoid rhythm due to impaired HPA axis function, disturbed melatonin balance, and sleep disturbances have been noted in psychotic disorders. Furthermore, mood disorders have been associated with changes in the expression of circadian rhythm genes such as Clock, Bmal1, and Per. Considering that the absorption, biodistribution, effects on target organs, half-life, metabolism, and elimination of drugs are all influenced by the body’s circadian rhythms, this narrative review explores the optimal timing of medication administration to maximize efficacy and minimize side effects in the treatment of psychiatric disorders. By closely monitoring circadian variations in cortisol, melatonin, and key clock genes, as well as by deepening our understanding of the metabolisms and pharmacokinetics of antipsychotic medications, we propose a chronotherapy approach for psychiatric patients that could significantly enhance patient care.

Detection of suicidality from medical text using privacy-preserving large language models.

Attempts to use artificial intelligence (AI) in psychiatric disorders show moderate success, highlighting the potential of incorporating information from clinical assessments to improve the models. This study focuses on using large language models (LLMs) to detect suicide risk from medical text in psychiatric care. To extract information about suicidality status from the admission notes in electronic health records (EHRs) using privacy-sensitive, locally hosted LLMs, specifically evaluating the efficacy of Llama-2 models. We compared the performance of several variants of the open source LLM Llama-2 in extracting suicidality status from 100 psychiatric reports against a ground truth defined by human experts, assessing accuracy, sensitivity, specificity and F1 score across different prompting strategies. A German fine-tuned Llama-2 model showed the highest accuracy (87.5%), sensitivity (83.0%) and specificity (91.8%) in identifying suicidality, with significant improvements in sensitivity and specificity across various prompt designs. The study demonstrates the capability of LLMs, particularly Llama-2, in accurately extracting information on suicidality from psychiatric records while preserving data privacy. This suggests their application in surveillance systems for psychiatric emergencies and improving the clinical management of suicidality by improving systematic quality control and research.

Metabolic dysfunction in severe mental illness: updates on prevalence, aetiology and treatment options

SUMMARY Metabolic dysfunction is an established phenomenon in people with severe mental illness (SMI), and it has a higher prevalence than in the general population. It is associated with increased morbidity and mortality, and effective recognition and management are essential to enable good psychiatric care. Despite widespread awareness of this disparity for several decades, health outcomes continue to worsen, highlighting the need for more effective preventive and treatment measures. This article outlines the risk factors that contribute to metabolic dysfunction in this population, including genetic, environmental and pharmacological factors, and considers underlying metabolic pathophysiological processes as part of SMI itself. To aid discussions with patients, recognition and interpretation of metabolic risk factors are outlined, together with mitigating strategies. Novel areas of uncertainty are discussed, including the use of a ketogenic diet. This article advocates use of the term ‘metabolic psychiatry’, to increase awareness of the significant overlap between psychiatric illness and metabolic dysfunction.

Criteria and diagnostic scale of the post-combat delayed response (tension) syndrome.

War participation risks mental disorders. Ukrainian combatants in Anti-Terrorist Operation/Joint Forces Operation since 2014 receive psychiatric care. Some show unique symptoms, not fitting recognized disorders, termed post-combat delayed response (tension) syndrome. The aim of this study was to establish diagnostic criteria and develop a scale of differential diagnosis of post-combat delayed response (tension) syndrome. This was a clinical retrospective study conducted on the basis of Zaporizhzhia Military Hospital and Zaporizhzhia and State Medical University, Ukraine, in the period from 2015 to 2021. Combatants of Ukraine-members of Anti-Terrorist Operation/Joint Forces Operation were involved in the study. In total, 426 male combatants were surveyed from whom those suffering from post-traumatic stress disorder (n=24), neurasthenia (n=35), and post-combat delayed response (tension) syndrome (n=46) were selected. The key symptoms of post-combat delayed response (tension) syndrome were selected and ranked in order of their differential diagnostic value. The diagnostic scale for post-combat delayed response (tension) syndrome was developed, which consists of 12 points. The received anamnestic information is important for classifying patients at risk of post-combat delayed response (tension) syndrome.

Gratitude despite unease among Swedish male forensic psychiatric patients with substance use disorders: an interview study

ABSTRACT Purpose Forensic psychiatric inpatient care in Sweden is characterized by strict regulations and adherence to court-mandated rules, with a median care time of 7 years. Comorbity has significant clinical implications, impacting health and well-being, violent behaviour and criminal recidivism, and prolonging inpatient stays. This study investigated the individual experiences and perspectives of Swedish patients in forensic psychiatric care with substance use (SU) disorders, focusing on past, present and future orientations. Methods Ten male forensic psychiatric inpatients were individually interviewed following a semi-structured interview guide. A qualitative content analysis was conducted to inductively analyse the participants’ experiences. The study adhered to the Standards for Reporting Qualitative Research. Results Under the main theme of “embracing harmony in opposition”, three categories emerged: (1) unveiling the beginning of SU and its impact on navigating challenges in care, (2) exploring current confined care and gratitude despite unease and (3) yearning for a somewhat normal life. Conclusions Participants’ subjective perspectives underscored the importance of factors such as forensic nurses/healthcare providers in forensic psychiatry considering the patients’ life narratives, their aspirations for the future, their need for a secure environment and patient—staff relationships. These findings highlight the need for structural interventions that emphasize the importance of tailored and comprehensive health plans within rehabilitation.