Psychiatric Care Research Articles

Risk of suicide after hospitalizations due to acute physical health conditions—a cohort study of the Norwegian population

BackgroundIt is well known that individuals recently discharged from psychiatric inpatient care face a high risk of suicide. Severe physical health conditions have also been linked to suicide risk. The risk of suicide following discharge from somatic hospitals is not known for individuals admitted due to acute physical health conditions.MethodsA Cohort study using data from the entire Norwegian population aged 12 years and older from 2008 to 2022 linked with information on health service use and cause of death. We used Cox regression with age as time axis to estimate sex-adjusted hazard ratios of suicide following discharge for ages 12 to 64 years and 65 years and older. We also performed analyses after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. To assess individual risk, we performed an adapted case-crossover analysis among discharged patients who died from suicide.ResultsA total of 4 632,980 individuals aged 12 to 64 years and 1,469,265 individuals aged 65 years and older were included. Compared to unexposed individuals at similar ages, we found an increased risk of suicide in the first 4 weeks after discharge, with a hazard ratio (HR) of 7.0 (95% confidence interval (CI) 5.9 to 8.3) among those aged 12 to 64 years and 6.8 (95% CI 5.4 to 8.6) among those 65 years and older. In the younger age group, the risk was attenuated, with a HR of 2.4 (95% CI 1.7 to 3.2) after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. The corresponding HR was 4.8 (95% CI 3.5 to 6.4) among those 65 years and older, declining to 1.9, (1.2 to 3.1) in weeks 5 to 8 and 1.2 (0.7 to 2.2) in weeks 21 to 24. The case-crossover analysis confirmed that individuals 65 years and older were particularly vulnerable.ConclusionsThe heightened risk of suicide following discharge from acute somatic hospitalization, even in the absence of concurrent mental disorders, self-harm, or prior suicide attempts, underscores the critical need for comprehensive mental health and existential support for patients post-discharge.

Impact of the COVID-19 health crisis on psychotropic drug use in children and adolescents in France

BackgroundIn 2019, the world faced a pandemic brought about by a severe acute respiratory infection caused by SARS-CoV-2 virus. The spread of this virus has profoundly affected societies, particularly in terms of their economic, human and social dimensions, as well as their healthcare systems. Several restrictive measures (reduced social interaction, periodic school closures,…) had to be taken to contain the spread of the virus. These measures have had an impact on the psychological well-being of both adults and children. The aim of this study was to assess the changes in psychotropic drugs prescriptions for children and adolescents living in Limousin, a French region, over the period 2018 to 2021.MethodsThe consumption of psychotropic drugs was studied using a national database of drug reimbursement. These data were extracted and supplied from the nationwide French reimbursement healthcare system database (SNDS). The following therapeutic classes were studied: N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives), N06A (antidepressants) and N06B (psychostimulants). Data were collected for insured persons under the age of 18 who received at least one reimbursement for a psychotropic drug between 2018 and 2021.ResultsOver a 4-year period, 7949 patients under the age of 18 were included with an average age of 12.1 years and a sex ratio of 0.97 M/F. The number of patients increased from 2018 to 2021, as did the number of reimbursements. We observed a statistically significant difference of means of patients reimbursed per week for on five therapeutic classes, with the greatest difference in 2021 (p < 0.0001). An increase in the number of patients of between + 20.7% and + 689% was observed, depending on the drug classes studied. Comparisons between the COVID-19 and pre-COVID-19 periods showed a significantly higher COVID average for psychotropic drugs reimbursements in general and individually for all classes except psychostimulants.ConclusionThe results show a significant increase in the consumption of psychotropic drugs among youth. The increase in psychotropic drug use was continuous and progressive throughout the pandemic. All five classes were increased, but particularly anxiolytics and antidepressants. The COVID-19 context may have been at the origin of a deterioration in the mental health of children and adolescents, or of a heightened awareness of psychiatric care among young people.

Self-Reported Perceptions of Patients and Staff on Participation and Verbal and Social Interactions in High-Security Forensic Psychiatric Care in Sweden.

Studies suggest that experiences of patient participation, as described by both patients and staff, are associated with a significant caring relationship of high quality. This study aimed to investigate staffs' and patients' self-reported perceptions on participation and the frequency and importance of verbal and social interactions in high-security forensic psychiatry. The questionnaire Verbal and Social Interactions (VSI) was used together with the subscale Participation from Quality in Psychiatric Care (QPC). The study was conducted at a large forensic psychiatric clinic in Sweden. Staff and patients rated the frequency of VSI differently while reporting the same perceived degree of patient participation. All categories of VSI were significantly correlated with perceived level of participation with medium or small effect size for the patients. Patients' perceived participation seems to depend on verbal and social interaction within the specific categories 'Showing interest in the patients' feelings, experiences, and behavior' and 'Helping the patients establish structure and routines in their everyday life'. There was, however, a negative association for the latter. The results give a better understanding of what kind of interactions that affect patients' perceived level of participation. Patient participant is a prioritised area for development in forensic psychiatry. The study contributes to a better understanding of what types of interactions that affect the perceived level of participation, while at the same time, it shows important similarities and differences between patient and staff perspectives.

Accepting and committing to caregiving for schizophrenia—a mixed method pilot study

BackgroundEnd of traditional institutionalized psychiatric care, diagnostic complexities, and associated stigma often negatively impact the social networks of caregivers, making them experience social isolation. Not the “identified patients”, caregiver perspectives are typically overlooked further adding to anticipatory stigma resulting in social death among them. Caregiving experience results in developing coping skills, preventing carers from responding to the nuances of the context, and identifying the useful rules— “Experiential Avoidance”. Psycho-education is typically combined with other formal treatment programs for case conceptualization, and to provide a clear rationale for the treatment approach but less as a distinct psychotherapy. Borrowing the philosophy of Functional Contextualism, the present study developed a “Present-Moment Awareness” guided psychoeducational intervention. The aim was to reduce schizophrenia caregiver burden and anticipatory stigma and promote the value of caregiver participation as ‘experts by experience’.MethodFive family caregivers of remitted schizophrenia patients were recruited using purposive sampling. Pre-post measure was taken on caregiver burden, caregiving experience, sense of personal mastery, and caregiving competence. Results were analysed quantitatively and qualitatively.ResultsA significant decrease in caregiver burden, stigma, and negative effects on the family in post-intervention was observed. Self-compassion led to a rise in a sense of empowerment.ConclusionA caregiver-centred “Present-Moment Awareness” guided psycho-education for schizophrenia caregivers can be considered a possible means to address perceived stigma in caregivers and to reduce associated distress of carers.

Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children.

The authors explored whether neighborhood context is associated with psychotropic polypharmacy and psychotherapy among a cohort of children with high needs for psychiatric and general medical care. Electronic health record data from a large health care system were used in a cross-sectional design to examine psychotropic polypharmacy and psychotherapy in 2015-2019 among children ages 2-17 years (N=4,017) with geocoded addresses. Inclusion criteria were a diagnosis of a mental health condition, an intellectual and developmental disability, or a complex medical condition and one or more clinical encounters annually over the study period. Polypharmacy was defined as two or more psychotropic drug class prescriptions concurrently for ≥60 days. Psychotherapy was defined as receipt of any psychotherapy or adaptive behavior treatment. Neighborhood context (health, environment, education, and wealth) was measured with the Child Opportunity Index. Multilevel generalized linear mixed models with random intercept for census tracts were used to assess the associations between individual and neighborhood characteristics and psychotropic polypharmacy and psychotherapy. Moderate (vs. low) child opportunity was associated with higher odds of polypharmacy (adjusted OR [AOR]=1.79, 95% CI=1.19-2.67). High (vs. low) child opportunity was associated with higher odds of psychotherapy (AOR=2.15, 95% CI=1.43-3.21). Black (vs. White) race (AOR=0.51, 95% CI=0.37-0.71) and Hispanic ethnicity (AOR=0.44, 95% CI=0.26-0.73) were associated with lower odds of polypharmacy. Among high-need children, neighborhood Child Opportunity Index, race, and ethnicity were significantly associated with treatment outcomes in analyses adjusted for clinical factors. The findings underscore concerns about structural disparities and systemic racism and raise questions about access.

Effort–reward imbalance and well-being among psychiatric nurses: the mediating role of burnout and decent work

BackgroundPsychiatric nurses face additional challenges due to negative perceptions, workplace violence, and a lack of respect, impacting their well-being and job satisfaction, which are crucial for improving psychiatric care and patient outcomes.ObjectivesThis study aims to examine the relationship between effort-reward imbalance, well-being, burnout, and decent work among psychiatric nurses.MethodsThis study used a cross-sectional design. Data were collected using a convenience sampling method in February 2024 from 397 psychiatric nurses at two psychiatric hospitals in Hangzhou and Huzhou, Zhejiang Province. The Effort-Reward Imbalance Scale, Decent Work Perception Scale, Maslach Burnout Inventory-General Survey, and General Well-Being Schedule Scale were used for data collection. Data analysis was conducted using SPSS 26.0 and the PROCESS macro.ResultsThe study found that effort-reward imbalance among psychiatric nurses was negatively correlated with decent work (r = -0.564, p < 0.001) and well-being (r = -0.541, p < 0.001), and positively correlated with burnout (r = 0.603, p < 0.001). Burnout mediated the relationship between effort-reward imbalance and well-being (95% CI [-0.386, -0.257]), while decent work also served as a mediator (95% CI [-0.100, -0.012]). Additionally, burnout and decent work were found to mediate the relationship between effort-reward imbalance and well-being (95% CI [-0.050, -0.006]).ConclusionThis study highlights the impact of effort-reward imbalance on well-being, confirming that burnout and decent work serve as mediators. Enhancing support, fair compensation, reasonable work schedules, and professional development can promote psychiatric nurses’ perception of decent work and improve their well-being.

Examining The Care Pathways Patients Experience When Accessing Outpatient Psychiatric Care in British Columbia

The British Columbia (BC) mental health roadmap prioritizes equitable access to care. This study investigates the equity of care pathways experienced by BC residents accessing outpatient psychiatric care for the first time. Community-based care pathways are paramount as they indicate timely access to care and are less expensive for the health system. We analyzed linked administrative BC health data spanning April 1st 2013, to March 31st 2022, to study how sociodemographic factors relate to accessing psychiatric care pathways. Pathways to outpatient psychiatric care include a community-based pathway, hospitalization to primary care to outpatient psychiatry, and hospitalization directly to outpatient psychiatry. Sociodemographic factors considered were administrative sex, immigration recency and status, neighbourhood income quintile and being a recipient of a low-income drug plan. These relationships were analyzed using multinomial logistic regression, adjusting for age, location, fiscal year, and stratifying by mental disorder diagnoses. Being male, a low-income drug plan recipient, living in a lower income neighbourhood, or being a recent economic immigrant or permit holder was associated with increased odds of accessing outpatient psychiatric care via either hospitalization pathway. Having a diagnosis of schizophrenia/bipolar disorder was independently associated with both hospitalization pathways, and this diagnosis exacerbated the magnitude of the estimates for the sociodemographic characteristics. We find clear disparities in pathways to accessing outpatient psychiatric care. These disparities indicate health system failures in addressing specific population needs, highlighting the importance of targeted interventions, such as increasing the number of community health workers, to achieve equitable mental health care in BC.

RELEASE: Preliminary results from a novel data-linkage study into mental health and substance use service utilisation by people released from Scottish prisons

ObjectivesPeople released from prison are at increased risk of dying by suicide, drug overdose, and illnesses related to drugs and alcohol. International literature demonstrates patterns in health service access that imply service accessibility may be insufficient to meet the mental health and substance use needs of this population. This study aims to compare the use of health services for mental health and substance use between people released from Scottish prisons and the general population, using national Scottish data for the first time. ApproachRetrospective observational cohort study, comparing all individuals released from Scottish Prison in 2015 (n=8,917), and a random general population sample (n=42,455), matched on age, sex, postcode and Scottish Index of Multiple Deprivation (SIMD) deciles. Scottish Prison Service data were linked with community prescriptions, death registrations, inpatient admissions to general and psychiatric hospitals, outpatient contacts, and emergency care. ResultsDescriptive summaries of the demographic characteristics of the cohort and bivariate comparisons of service use across different services will be presented, alongside planned approaches using Poisson regression models of service contacts. ConclusionsThis study advances our understanding of the feasibility of conducting research using national linked data from health and justice services and provides insight into differences in access to mental health and substance use support. ImplicationsThis research expands applications of public health approaches and administrative data research in Scotland. It provides crucial evidence to inform interventions that optimise access to appropriate services, to improve the lives of people released from Scottish prisons and to reduce inequalities.

Long-term trends in co-occurring medical and psychiatric hospitalizations among children and adolescents in Ontario, Canada.

BackgroundPsychiatric conditions are common amongst hospitalized children. Co-occurring psychiatric conditions for medical hospitalizations contribute to length of stay, costs, and readmissions. We sought to measure trends over 20 years in pediatric hospitalizations for co-occurring medical and psychiatric conditions and compare with those without psychiatric comorbidity, overall and in free-standing children’s hospitals. MethodsWe identified all 3- to 17-year-olds hospitalized in Ontario, Canada between April 1, 2003 and March 31, 2022. Using health record discharge diagnoses, hospitalizations were assigned to 1 of 4 groups: 1) medical-diagnosis-only, 2) psychiatric-diagnosis-only, 3) primary medical diagnosis with psychiatric comorbidity, and 4) primary psychiatric diagnosis with medical comorbidity. Hospitalization trends for 1) all hospitals, and 2) free-standing children’s hospitals were described and compared. ResultsFrom 2003 to 2022, medical-diagnosis-only hospitalizations declined 39% (41,909 to 25,486 hospitalizations), psychiatric-diagnosis-only hospitalizations increased 96% (3227 to 6337), medical hospitalizations with psychiatric comorbidity increased 127% (977 to 2221) and psychiatric hospitalizations with medical comorbidity increased 100% (2051 to 4096). Among pediatric hospitals, medical-diagnosis-only hospitalizations increased 23% (12,430 to 15,318), psychiatric-diagnosis-only hospitalizations increased 420% (271 to 1408), psychiatric hospitalizations with medical comorbidity increased 172% (539 to 1468) and medical hospitalizations with psychiatric comorbidity increased 235% (478 to 1599). ConclusionsHospitals have experienced large absolute and relative increases in volumes for psychiatric conditions both with and without co-occurring medical conditions, particularly among free-standing children’s hospitals. Healthcare provider training, hospital resourcing, and health system planning must consider how best to accommodate the increasing acute psychiatric care needs of hospitalized children and adolescents.

Advances, challenges, and prospects of electroencephalography-based biomarkers for psychiatric disorders: a narrative review.

Owing to a lack of appropriate biomarkers for accurate diagnosis and treatment, psychiatric disorders cause significant distress and functional impairment, leading to social and economic losses. Biomarkers are essential for diagnosing, predicting, treating, and monitoring various diseases. However, their absence in psychiatry is linked to the complex structure of the brain and the lack of direct monitoring modalities. This review examines the potential of electroencephalography (EEG) as a neurophysiological tool for identifying psychiatric biomarkers. EEG noninvasively measures brain electrophysiological activity and is used to diagnose neurological disorders, such as depression, bipolar disorder (BD), and schizophrenia, and identify psychiatric biomarkers. Despite extensive research, EEG-based biomarkers have not been clinically utilized owing to measurement and analysis constraints. EEG studies have revealed spectral and complexity measures for depression, brainwave abnormalities in BD, and power spectral abnormalities in schizophrenia. However, no EEG-based biomarkers are currently used clinically for the treatment of psychiatric disorders. The advantages of EEG include real-time data acquisition, noninvasiveness, cost-effectiveness, and high temporal resolution. Challenges such as low spatial resolution, susceptibility to interference, and complexity of data interpretation limit its clinical application. Integrating EEG with other neuroimaging techniques, advanced signal processing, and standardized protocols is essential to overcome these limitations. Artificial intelligence may enhance EEG analysis and biomarker discovery, potentially transforming psychiatric care by providing early diagnosis, personalized treatment, and improved disease progression monitoring.

Mind the gap: exploring stakeholder perspectives on police-led pathways to crisis mental health care for young people in Ireland

ABSTRACT Over the past few decades, the level of police involvement at a community level in matters of mental health has increased significantly. Police are often the only agency immediately available day or night to respond to such emergencies and are often left to deal with mental illness and associated social crises with very limited support. Whilst recent years have witnessed an upsurge in governmental policy intended to safeguard vulnerable groups, such as young people and people with mental illness, there is a dearth of research regarding the proficiency and operability of these directives in practice. Even less is known about how these policies are practically applied to young people in crisis. The study examines the police-led care pathways of Irish youth experiencing a crisis mental health event from the commencement of police involvement through to the initiation of psychiatric care. Qualitative interviews were conducted with police and a group of stakeholders comprised of medical professionals and a social worker. Results indicate a complex care pathway beset with ambiguous policy and legislation, deficits in specialist training, and chronic under-resourcing of services. In the face of these shortcomings, police innovate informal practices that sometimes help and at other times pose a risk to young people in crisis. Furthermore, uncertainties surrounding formal procedure was a source of significant psychological burden for police and potential disciplinary action. These findings are discussed in the context of existing theory and research, and recommendations for policy and practice are offered.

Discontinuity of psychiatric care among patients with bipolar disorder in the Netherlands.

Patients with bipolar disorder benefit from guidelines recommended continuous community-oriented psychiatric and somatic healthcare, but often discontinue psychiatric care. The first objective was to identify predictive factors of discontinuity of psychiatric care among patients who had received psychiatric care. The second objective was to examine if practice variation in discontinuity of psychiatric care existed between providers of psychiatric care. Registry healthcare data were used in a retrospective cohort study design using logistic regression models to examine potential predictive factors of discontinuity of care. Patient-related predictive factors were: age, sex, urbanization, and previous treatment (type and amount of psychiatric care, alcohol, and opioid treatment). Patients already diagnosed with bipolar disorder were selected if they received psychiatric care in December 2014 to January 2015. Discontinuity of psychiatric care was measured over 2016. A total of 2,355 patients with bipolar disorder were included. In 12.1% discontinuity of care occurred in 2016. Discontinuity was associated with younger age and less outpatient care over 2013 to 2014. Discontinuity of patients who received all eight quarters outpatient care including BD medication was very low at 4%. The final model contained: age, type of psychiatric care, and amount of outpatient care in 2013 to 2014. Practice variation among providers appeared negligible. The (mental) health service in the Netherlands has few financial or other barriers toward continuity of care for patients with severe mental disorders, such as bipolar disorder. An active network of providers, aim to standardize care. This seems successful. However, 12% discontinuity per year remains problematic and more detailed data on those most at risk to drop out of treatment are necessary.

Court-ordered forensic psychiatry treatment in prison: determinants of outcome and risk mitigation.

Court-ordered forensic psychiatry treatments (COT) are specifically designed to reduce the risk of violence in mentally disordered offenders. Given their high costs and ethical issues, mental health professionals need admission criteria to be able to select those candidates with optimal benefit. This study analyses offender-related and treatment-related determinants of COT outcome and risk mitigation. This two-year longitudinal study assessed the evolution of 117 adult offenders admitted to a specialized medium-security forensic psychiatry clinic. Treatment outcome included court-ordered discharge locations and the Historical Clinical Risk Management (HCR) score evolution. Treatment progress was assessed every six months across five time-points including measures of protective factors, work rehabilitation and security. Outcome determinants included psychiatric diagnosis and type of offence. Discharge locations are predicted by pre-treatment risk level. Lower HCR scores are associated with discharge into low-security psychiatry wards independently of the psychiatric diagnosis. Risk reduction follows diagnosis-specific and offense-related patterns and reveals that mentally disordered offenders with Cluster B personality disorders or those sentenced for drug crimes are significantly less prone to benefit from COT. Our findings indicate that criminological characteristics at baseline as well as diagnosis of personality disorders are the main determinants of treatment outcome in our care setting. Inmates with concomitant higher violence risk at baseline and presence of Cluster B personality disorders might benefit the least from court-ordered forensic inpatient psychiatric care in prison.

Long-Term Impact of Community Psychiatric Care on Quality of Life amongst People Living with Schizophrenia: A Systematic Review.

The review examines the long-term impact of community psychiatric care on improving the quality of life of people with schizophrenia. It addresses the global burden of this disorder and the need for effective community-based care strategies. A systematic literature search was conducted in databases such as CINAHL, Medline, Web of Science, Sage and ScienceDirect, with the search lasting until March 2024 and following the PRISMA guidelines. The inclusion criteria targeted studies that addressed the long-term effects of community mental health care for people aged 18 years and older with schizophrenia and included both quantitative and qualitative research designs. Studies unrelated to the research question or with significant methodological flaws were excluded. The risk of bias was assessed using GRADE and GRADECERqual, in addition to critical appraisal using the Joanna Briggs Institute (JBI) checklists. Independent screening and data extraction was performed, with results summarised by thematic analysis. In total, 11 studies met the inclusion criteria and included cross-sectional, cohort, qualitative and randomised controlled trial designs. The results showed that community psychiatric care significantly improves the quality of life, well-being and social integration of people with schizophrenia. Effective interventions identified include psychoeducation, cognitive behavioural therapy, social skills training and individualised care plans. However, challenges such as limited resources, labour shortages and social stigma, particularly in low-income neighbourhoods, were also identified. This study highlights the importance of continuous, personalised, multidisciplinary community-based care for sustainable mental health outcomes. Further research is recommended to investigate the long-term impact and strategies to overcome implementation challenges.

A qualitative study examining medical students′ expectations of psychiatric inpatient and intensive care settings

Background There is limited literature to date regarding medical students’ expectations of the psychiatric inpatient environment. This study aims to explore what medical students expect from psychiatric wards and psychiatric intensive care units prior to their placement. Psychiatric intensive care, arguably the most intense experience students will have in psychiatry, was used to highlight the full extent of student preconceptions. Methodology: Students were invited to complete a semi-structured questionnaire over a six-month period, from July to December 2021. Questions explored emotions prior to placement, expectations of the ward atmosphere, layout, patient behaviour and care strategies. 37 responses were received. Analysis followed the well-recognised six stages of thematic analysis. Results: Five themes emerged from the data: (1) Mixed feelings about placement; (2) Varied views about patient behaviour and illness; (3) Restrictive and controlled practice; (4) Similarities to acute general hospital care; (5) Care with empathy and compassion. Some of the expectations of students were markedly different to the reality of psychiatric inpatient and intensive care settings, with ideas of patients being physically restrained, unconscious and attached to ventilators. Conclusion: This study offers a unique insight into what medical students expect from psychiatry inpatient and intensive care settings, an issue that all clinicians who have student contact should be aware of. Results can better inform student preparation and placement supervision, leading to more meaningful learning and improved wellbeing.

Clinician Perspectives on Palliative Care for Older Adults With Serious Mental Illnesses: A Multisite Qualitative Study

ObjectivesApproximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses. Design, setting, and participantsThis qualitative study utilized thematic analysis of semi-structured interviews of interdisciplinary clinicians practicing palliative care, geriatrics, or geriatric/consultation-liaison psychiatry at four hospitals within an urban health system. MeasurementsThemes related to care of older adults with serious mental illness and serious medical illness with respect to clinician experiences, challenges in care, and opportunities to improve care. ResultsThe authors interviewed 45 clinicians. Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. ConclusionsThe study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

A mixed methods study into the effectiveness of sensory rooms in reducing agitation levels in a psychiatric intensive care unit

Background:Reducing incidences of violence, and the use of restrictive interventions within psychiatric intensive care units (PICUs), is a priority nationally. One method for reducing violence and aggression from escalating in PICUs is sensory rooms. This study aimed to explore the effectiveness of sensory rooms as an alternative strategy to manage agitation levels in a PICU and understand the patient and staff experiences of using sensory rooms as an alternative intervention to standard approaches for agitation reduction. Method:A mixed methods approach collected data over six months using an observational rating scale pre and post-sensory room, and conducting nine semi-structured interviews with patients and staff. Results:71 patient contacts recorded, there was a statistically significant difference in pre and post-sensory room agitation ratings (p&lt;0.001), with 66% (n = 47) experiencing a reduction in agitation rating post-usage. The sensory room was used as both a proactive and reactive strategy to manage agitation. Five themes emerged from the interviews: the sensory room supports emotional regulation, improves the patient's experience, develops therapeutic relationships, and offers an alternative agitation management strategy; however, it can be an underused resource due to access limitations. Conclusion:Staff and patients had positive experiences using a sensory room to manage agitation; it offers a safe space away from the busy ward environment. Several different factors impact staff using the intervention. Findings provide considerations for services when developing sensory rooms in PICUs, to ensure they are established as a reliable alternative for the management of agitation.

Assessing COVID-19 transmission risk: Roommate and unit mate exposures at an inpatient behavioral health facility

Inpatient psychiatric facilities have an inherently increased risk of infection transmission. This study aimed to evaluate the impact of roommate and unit mate exposures on COVID-19 transmission to inform on safest isolation practices. A single-center retrospective study was conducted among patients hospitalized in six units of an inpatient behavioral health hospital from July 2020 through August 2023. We compared the risk of COVID-19 acquisition after exposure among patients with a contagious roommate versus those exposed to a contagious unit mate. During the study period, the conversion rate was 10.05% overall, 24.4% for roommates, and 9.3% for unit mates; patients exposed to a roommate were at 3.14 times higher odds (95% confidence interval, 1.42-6.92) of acquiring COVID-19 after exposure. On unit-stratified analysis, patients exposed to a roommate on the geropsychiatric unit had the highest risk of post-exposure conversion compared to unit mate exposed patients (odds ratio 6.38, 95% confidence interval 1.75-23.22). Logistic regression analysis identified a non-significant risk associated with increased time in group therapy. Exposure to a COVID-19 contagious roommate significantly increases the risk of COVID-19 acquisition among exposed patients receiving inpatient psychiatric care. Cohorting contagious and exposed individuals and avoiding multi-bedded rooms may successfully mitigate COVID-19 transmission risk during psychiatric care.

Predictors and shared traits of longevity within 1 year before death in patients with schizophrenia receiving long-term care: 3-year retrospective cross-sectional study.

Research on schizophrenia and life expectancy has mainly focused on premature mortality. This study investigates factors associated with longevity in patients with schizophrenia receiving long-term care and identifies shared traits among these individuals. A retrospective cross-sectional study analysing the clinical records of 138 patients with schizophrenia who died between 2015 and 2017 in a psychiatric long-term care facility was conducted. Longevity was defined by life tables drawn from the national health database. Variables were compared between longevity and control groups to determine predictors of longer lifespans. Cluster analysis was employed to identify shared traits among individuals with longevity. Causes of death by age were compared. In the long-term care setting, of the 138 participants, 45 were in the longevity group. This group had more males, lower antipsychotic doses, but more mobility issues. Significant predictors of longevity included older age at onset, longer length of stay, lower activities of daily living scores and a hypertension diagnosis. Cluster analysis revealed two patterns, suggesting that poorer health indicators did not necessarily lead to shorter lives. Fatalities caused by pneumonia were associated with a higher age, compared to those from cancer and choking. Addressing modifiable risk factors enhances life expectancy in patients with schizophrenia, especially for males, while the age at onset may play a significant role. An integrated long-term care model with close monitoring and timely provision of mental and general healthcare may help extend lifespans. Further research is needed to balance long-term residential care and community-based care for elderly patients with schizophrenia.

Development and Evaluation of the DMIND Questionnaire: Preparing for AI Integration into an Effective Depression Screening Tool

Objective: Thailand’s mental health crisis is exacerbated by high demand and a shortage of mental health professionals. The research objective was to develop and validate the Detection and Monitoring Intelligence Network for Depression (DMIND) questionnaire, designed to be culturally relevant and easily administered in clinical settings. Crafted with expert input, items specifically conducive to artificial intelligence (AI) analysis were selected to facilitate the future development of an AI-assisted depression scoring model. This approach underscores the tool’s dual utility in both human-led and technology-enhanced diagnostics. Materials and Methods: We enrolled 81 participants from psychiatric and tertiary care hospitals in Bangkok. Participants were assessed using the DMIND questionnaire, followed by the Hamilton Depression Rating Scale (HDRS-17). Statistical analyses included the content validity index (CVI), Cronbach’s alpha, Pearson’s correlation coefficient, Cohen’s kappa, and receiver operating characteristic (ROC) analysis. The Liu method, Youden index, and nearest neighbor method were used to determine the optimal cut-off point Results: The DMIND questionnaire showed strong validity, with an item-level CVI (I-CVI) and scale-level CVI (S-CVI) exceeding 1.0, indicating strong consensus on its relevance and utility. The tool also demonstrated high internal consistency (Cronbach’s alpha = 0.96). ROC analysis showed an AUC of 0.88, indicating high accuracy in depression screening. An optimal cut-off score of 11.5 was identified, balancing predictive value and sensitivity. Conclusion: The DMIND questionnaire represents a significant advancement in innovative mental health diagnostics, addressing unmet clinical needs by providing accurate and efficient assessments capable of AI integration for further enhancing mental health service delivery in Thailand.