Psychiatric Center Research Articles

Sleep Quality and Self-Stigma Mediate the Association Between Problematic Use of Social Media and Quality of Life Among People With Schizophrenia in Taiwan: A Longitudinal Study.

Problematic use of social media (PUSM) may affect sleep quality and self-stigma in people with schizophrenia and consequently reduce their quality of life (QoL). This longitudinal study investigated if sleep quality and self-stigma mediated relationships between PUSM and QoL. One-hundred-and-ninety-three outpatients with schizophrenia were recruited from a psychiatric center in Taiwan from April 2019 to August 2021 and participated in a longitudinal study at intervals of three months between measurements. QoL was assessed using the World Health Organization Quality of Life Questionnaire Brief Version; sleep quality using the Pittsburgh Sleep Quality Index; self-stigma using the Self-Stigma Scale-Short; and PUSM using the Bergen Social Media Addiction Scale. Via SPSS 20.0, general estimating equation models assessed temporal associations between variables. Via R software, mediating effects of self-stigma and sleep quality were examined through Monte Carlo simulations with 20,000 repetitions. Mean scores of physical, psychological, social and environmental QoL ranged from 11.86 to 13.02. Mean scores of sleep quality and self-stigma were 9.1±4.5 and 2.2±0.8, respectively. Sleep quality and self-stigma were directly related to QoL (p<0.001) and mediated indirect relationships between PUSM and all components of QoL with a range of 95% confidence intervals spanning from -0.0591 to -0.0107 for physical QoL; -0.0564 to -0.0095 for psychological QoL; -0.0292 to -0.0035 for social QoL; and -0.0357 to -0.0052 for environmental QoL. Sleep quality and self-stigma mediated relationships between PUSM and QoL in people with schizophrenia. Developing interventions targeting PUSM, sleep, and self-stigma may help improve QoL in people with schizophrenia.

Prevalence of Comorbidities of Psychotic Disorders in Patients with Substance Use Disorders in Iran Psychiatric Hospital in Tehran, Iran

Background: Substance use disorders are highly prevalent among psychotic patients and are associated with poorer clinical outcomes. Objective: This study aimed to investigate the prevalence of psychotic disorders in substance users and the epidemiological features of this population. Material&amp;Methods: In a cross-sectional study, we investigated 455 outpatient and inpatient participants with SUD referred to the Iran psychiatric hospital from April, 2020, to March, 2021. All participants were substance users, referred to Iran psychiatric center to follow up on their comorbidities and psychiatric disorders. The Structured Clinical Interview for DSM-5 (SCID) was used for psychotic disorders and substance use disorder diagnoses. Finally, gathered data were analyzed by SPSS-25. Results: A total of 455 patients were involved in the study. The mean age was 34.66 years, of which 89.7% were men. The most common main substances include methamphetamine (39.1%) and heroin (27%). The prevalence of psychotic disorder was 36.7%, and the most common type was substance-induced psychotic disorder (26.4%) and schizophrenia (8.4%). There was a significant association between methamphetamine and opium use and the presence of substance-induced psychotic disorder and schizophrenia, respectively (p˂ 0.001). Conclusion: The most common type of substance use was methamphetamine, and the most common type of psychotic disorder was substance-induced psychotic disorder. There was a significant association between methamphetamine and opium use and the presence of substance- induced psychotic disorder and schizophrenia, respectively. It should be noted that this was a sample of individuals hospitalized for substance abuse. It was not a general population sample and was very biased toward substance use.

Urban vs. rural differences in psychiatric diagnoses, symptom severity, and functioning in a psychiatric sample.

Identifying whether certain groups of people experience elevated rates or severities of psychiatric symptoms provides information to guide healthcare allocation. People living in urban areas have higher rates of some psychiatric disorders relative to people living in rural settings, however, it is unclear if psychiatric severity is more elevated in urban vs. rural settings. This study investigates the urban vs. rural differences in rates of psychiatric disorders and severity of psychiatric symptoms. A cohort of patients (63% women, 85% White) presenting to an outpatient psychiatric treatment center in the U.S. completed patient-reported outcomes at all clinic visits as part of standard care. Rurality was determined by municipality population density. Sociodemographic characteristics, psychiatric diagnoses, trauma exposure, psychiatric symptom severity, functioning, and suicidality were compared by rural vs. urban municipality. There were virtually no differences between patients living in rural vs. urban municipalities on rates of psychiatric disorders, severity of psychiatric symptoms, functional impairment, and suicidality (ps≥.09). The only difference was that patients living in rural municipalities had higher exposure to serious accidents than patients living in urban municipalities (p < .01); exposure to nine other traumatic events did not differ between groups (p≥.07). People living in urban and rural municipalities have a similar need for mental health treatment. Access to care may be one explanatory factor for the occasional rural-urban differences in rates of psychiatric disorders. In other words, if people living in rural areas can access care, their symptom presentations appear unlikely to differ from those of people living in urban areas.

Effects of Baduanjin Qigong in Individuals With Schizophrenia: A Preliminary Quasi-Experimental Pilot Study.

The current quasi-experimental study explored the effects of Baduanjin qigong on body mass index (BMI) and five metabolic indexes in people with schizophrenia. Inclusion criteria were body mass index >25 kg/m2 or metabolic syndrome. Twenty-two service users were recruited from a psychiatric center and were assigned to the experimental group (EG) or control group (CG) using blocked randomization. The EG performed Baduanjin qigong lasting 1 hour for 12 weeks three times per week, whereas the CG received routine care. Generalized estimating equations showed that the EG achieved a greater decrease in BMI and waist circumference (WC) than the CG post-intervention. Baduanjin qigong may provide an effective nonpharmacological approach to reducing BMI and WC in people with schizophrenia. This study showed that performing Baduanjin qigong for 12 weeks is a feasible and effective strategy for improving the body shape of individuals with chronic schizophrenia, thus providing results that can serve as a reference for health professionals working in psychiatry departments. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 41-48.].

High unrecognized SARS-CoV-2 exposure of newly admitted and hospitalized psychiatric patients

BackgroundPatients with pre-existing mental disorders are at higher risk for SARS-CoV-2 infection and adverse outcomes, and severe mental illness, including mood and psychosis spectrum disorders, is associated with increased mortality risk. Despite their increased risk profile, patients with severe mental illness have been understudied during the pandemic, with limited estimates of exposure in inpatient settings. ObjectiveThe aim of this study was to describe the SARS-CoV-2 seroprevalence and antibody titers, and pro-inflammatory cytokine concentrations of newly admitted or hospitalized psychiatric inpatients without known history of COVID-19 infection, using robust quantitative multi-antigen assessments, and compare patients’ exposure to that of hospital staff. MethodsThis multi-centric, cross-sectional study compared SARS-CoV-2 seroprevalence and titers of 285 patients (University Psychiatric Centre Duffel [UPCD] N = 194; Assistance-Publique-Hopitaux de Paris [AP-HP] N = 91), and 192 hospital caregivers (UPCD N = 130; AP-HP N = 62) at two large psychiatric care facilities between January 1st and the May 30th 2021. Serum levels of SARS-CoV-2 antibodies against Spike proteins (full length), spike subunit 1 (S1), spike subunit 2 (S2), spike subunit 1 receptor binding domain (S1-RBD) and Nucleocapsid proteins were quantitatively determined using an advanced capillary Western Blot technique. To assess the robustness of the between-group seroprevalence differences, we performed sensitivity analyses with stringent cut-offs for seropositivity. We also assessed peripheral concentrations of IL-6, IL-8 and TNF-a using ELLA assays. Secondary analyses included comparisons of SARS-CoV-2 seroprevalence and titers between patient diagnostic subgroups, and between newly admitted (hospitalization ≤ 7 days) and hospitalized patients (hospitalization > 7 days) and correlations between serological and cytokines. ResultsPatients had a significantly higher SARS-CoV-2 seroprevalence (67.85 % [95% CI 62.20–73.02]) than hospital caregivers (27.08% [95% CI 21.29–33.77]), and had significantly higher global SARS-CoV-2 titers (F = 29.40, df = 2, p < 0.0001). Moreover, patients had a 2.51-fold (95% CI 1.95–3.20) higher SARS-CoV-2 exposure risk compared to hospital caregivers (Fisher’s exact test, P < 0.0001). No difference was found in SARS-CoV-2 seroprevalence and titers between patient subgroups. Patients could be differentiated most accurately from hospital caregivers by their higher Spike protein titers (OR 136.54 [95% CI 43.08–481.98], P < 0.0001), lower S1 (OR 0.06 [95% CI 0.02–0.15], P < 0.0001) titers and higher IL-6 (OR 3.41 [95% CI 1.73–7.24], P < 0.0001) and TNF-α (OR 34.29 [95% CI 5.00–258.87], P < 0.0001) and lower titers of IL-8 (OR 0.13 [95% CI 0.05–0.30], P < 0.0001). Seropositive patients had significantly higher SARS-COV-2 antibody titers compared to seropositive hospital caregivers (F = 19.53, df = 2, P < 0.0001), while titers were not different in seronegative individuals. Pro-inflammatory cytokine concentrations were not associated with serological status. ConclusionOur work demonstrated a very high unrecognized exposure to SARS-CoV-2 among newly admitted and hospitalized psychiatric inpatients, which is cause for concern in the context of highly robust evidence of adverse outcomes following COVID-19 in psychiatric patients. Attention should be directed toward monitoring and mitigating exposure to infectious agents within psychiatric hospitals.

Inner Peace needs of male psychiatric patients in post-war Croatia are associated with their needs to clarify open issues in their life and their needs for forgiveness.

More than 25 years after the end of the Balkan war, many people belonging to the post-war population are still traumatized by the war events and have been treated for post-traumatic stress disorder or other psychiatric diagnoses. We were interested in their Inner Peace needs, how these relate to indicators of mental health, and their needs to clarify open processes in their lives and to forgive and be forgiven. In a cross-sectional survey with standardized questionnaires (i.e., SpNQ, PCL-M, HADS, and BMLSS), 638 male patients who were treated in seven psychiatric centers in Croatia were enrolled. 68% were diagnosed with PTSD and 32% had other psychiatric diagnoses. Most had actively participated in the Balkan war (79%), and 60% for the whole war period. Strong needs to "immerse into beauty of nature" were stated by 47%, to "dwell at a place of quietness and peace" by 66%, and to "find inner peace" by 57%. These Inner Peace needs were highest in men treated with PTSD diagnoses as compared to men with other psychiatric diagnoses and were slightly lower in men who were active during the whole war period as compared to shorter phases of war participation. Regression analyses with Inner Peace needs as a dependent variable revealed that Clarification/Forgiveness needs were the best predictor, with further influences of PTSD symptoms and life satisfaction, explaining altogether 49% of the variance. The best predictors of their PTSD symptoms were life satisfaction, perceived burden, depressive symptoms, Inner Peace needs, religious trust, and duration of war participation, explaining 60% of the variance. In Croatian male war participants in clinical treatment decades after the war, Inner Peace needs indicate their ongoing intention to let go of their disturbing experiences and to find states of inner peace, particularly at specific places of quietness and peace. These needs can be considered metaphors for longing for wholeness, integrity, and safety, in contrast to the ongoing impact of unresolved issues. Thus, apart from psychotherapeutic treatment, sheltered places of nature, inspiration, and reconciliation might be elements to improve the difficult situation of post-war victims still suffering from their experiences.

Developing a Parenting Program for Mothers with Children with Gender Dysphoria and Examining Its Impact on the Resilience and Quality of the Parent-Child Relationship

Introduction: The present study aimed to develop a parenting program for the mothers of children with gender dysphoria and investigate its impact on the resilience and quality of the parent-child relationship. Method: The research method was a semi-experimental pre-test-post-test type, with a control group and follow-up. The statistical population consisted of mothers who were referred to the Psychiatric Center of Tehran in 2023 and had a child with gender dysphoria, of whom, 30 cases were selected in an available manner and randomly categorized into the experimental and control groups. Both groups were evaluated by means of a pre-test with the short-form resilience scale (2009) and the parent-child relationship assessment questionnaire (1983). The parenting program was taught to the experimental group; then, the post-test was carried out. After three months, a follow-up test was performed. Results: The data were analyzed by statistical method of variance with repeated measurements and Bonferroni's post-hoc test in SPSS software (version 23). The results showed that the developed program improved resilience and the quality of the parent-child relationship in mothers of children with gender dysphoria, and this improvement was maintained until the follow-up stage (P&lt;0.05). Conclusion: According to the obtained results, the prepared parenting program can help mothers of children with gender dysphoria increase their resilience and improve their relationships with their children. Therefore, it is suggested to use this type of intervention to work with this group of mothers, which should be included in the agenda of psychologists and relevant organizations.

"Out-of-Hospital and with Qualified Exercise Professionals": Keys to the CORTEX-SP Physical Exercise Program According to the Experience of the Participants.

Physical exercise programs are useful and necessary for the treatment of schizophrenia. The aim of this study was to assess the experiences of participants with schizophrenia in an out-of-hospital exercise program designed and supervised by qualified exercise professionals. Thirty-five individuals with schizophrenia from the intervention group of the CORTEX-SP study were interviewed. The interviews were transcribed verbatim and content analysis was performed using inductive coding. Two main categories emerged: the importance of the program being conducted out-of-hospital, and the individuals responsible for the program being qualified exercise professionals. The participants highlighted the importance of conducting the program outside the psychiatric center since it gave them greater satisfaction. They perceived greater seriousness and a greater number of resources and felt encouraged to repeat the program or prolong it. The success of the program, in addition to the space, was due to the personnel in charge of the program, i.e., the qualified exercise professionals, and the fact that the activities were designed and supervised. Participants emphasized the qualifications of the exercise professionals, key for this type of program, their social skills and the level of involvement with participants and their follow-up.

Evictions and psychiatric treatment.

Stable housing is critical for health, employment, education, and other social outcomes. Evictions reflect a form of housing instability that is experienced by millions of Americans each year. Inadequately treated psychiatric disorders have the potential to influence evictions in several ways. For example, these disorders may impede labor market performance and thus the ability to pay rent, or increase the likelihood of risky and/or nuisance behaviors that can lead to a lease violation. We estimate the effect of local access to psychiatric treatment on eviction rates. We combine data on the number of psychiatric treatment centers that offer outpatient and residential care within a county with eviction rates in a two-way fixed-effects framework. Our findings imply that 10 additional psychiatric treatment centers in a county lead to a reduction of 2.1% in the eviction rate.

Problematic smartphone use and two types of problematic use of the internet and self-stigma among people with substance use disorders

Background and aimsGuided by the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and a self-stigma framework, this study aimed to investigate relationships between cognitive and affective self-stigma and behavioral self-stigma, problematic use of internet (PUI), and problematic smartphone use (PSU) among people with substance use disorders (SUDs). It also examined mediating roles for affective self-stigma in the relationships between cognitive self-stigma and behavioral self-stigma/PUI/PSU. MethodsUsing a cross-sectional design, 530 participants diagnosed with SUDs in Taiwan were recruited from a psychiatric center in Taiwan. Mediation models were investigated using the Hayes’ Process Macro Model 4. ResultsMediation analyses indicated that cognitive self-stigma was directly associated with behavioral self-stigma (p < 0.001), but not with either types of PUI or PSU (p-values ranging from 0.41 to 0.76). Affective self-stigma was directly related to behavioral self-stigma (p < 0.001), two types of PUI, and PSU (β = 0.24–0.30; all p < 0.001); cognitive self-stigma was indirectly associated with behavioral self-stigma (β = 0.53; 95 % bootstrapping CI = 0.46, 0.60), two types of PUI, and PSU (β = 0.20–0.25; 95 % bootstrapping CI = 0.08–0.14, 0.31–0.37) via a mediating effect of affective self-stigma. Discussion and conclusionFindings support the I-PACE model in a self-stigma context. The findings also suggest that addressing affective self-stigma may help prevent or reduce behavioral self-stigma, PUI, and PSU among people with SUDs. Longitudinal studies are warranted to investigate over time relationships between self-stigma and PUI/PSU in people with SUDs.

Early non-response as a predictor of later non-response to antipsychotics in schizophrenia: a randomized trial

BackgroundIt remains a challenge to predict the long-term response to antipsychotics in patients with schizophrenia who do not respond at an early stage. This study aimed to investigate the optimal predictive cut-off value for early non-response that would better predict later non-response to antipsychotics in patients with schizophrenia.MethodsThis multicenter, 8-week, open-label, randomized trial was conducted at 19 psychiatric centers throughout China. All enrolled participants were assigned to olanzapine, risperidone, amisulpride, or aripiprazole monotherapy for 8 weeks. The positive and negative syndrome scale (PANSS) was evaluated at baseline, week 2, week 4, and week 8. The main outcome was the prediction of nonresponse. Nonresponse is defined as a < 20% reduction in the total scores of PANSS from baseline to endpoint. Severity ratings of mild, moderate, and severe illness corresponded to baseline PANSS total scores of 58, 75, and 95, respectively.ResultsAt week 2, a reduction of < 5% in the PANSS total score showed the highest total accuracy in the severe and mild schizophrenia patients (total accuracy, 75.0% and 80.8%, respectively), and patients who were treated with the risperidone and amisulpride groups (total accuracy, 82.4%, and 78.2%, respectively). A 10% decrease exhibited the best overall accuracy in the moderate schizophrenia patients (total accuracy, 84.0%), olanzapine (total accuracy, 79.2%), and aripiprazole group (total accuracy, 77.4%). At week 4, the best predictive cut-off value was < 20%, regardless of the antipsychotic or severity of illness (total accuracy ranging from 89.8 to 92.1%).ConclusionsSymptom reduction at week 2 has acceptable discrimination in predicting later non-response to antipsychotics in schizophrenia, and a more accurate predictive cut-off value should be determined according to the medication regimen and baseline illness severity. The response to treatment during the next 2 weeks after week 2 could be further assessed to determine whether there is a need to change antipsychotic medication during the first four weeks.Trial registrationThis study was registered on Clinicaltrials.gov (NCT03451734).

Brief report: Implementing and evolving suicide prevention strategies at Taoyuan Psychiatric Center inspired by NIC Umbrella review.

This brief report discusses the implementation and evolution of suicide prevention strategies at Taoyuan Psychiatric Center in Taiwan. These strategies are inspired by the nursing interventions presented in an "Umbrella review of nursing interventions NIC for the treatment and prevention of suicidal behavior." The interventions are a part of an employee assistance program (EAP) designed to support the mental health of the nursing staff and other employees, with a particular focus on preventing and managing suicidal behaviors. The EAP involves multi-tiered primary, secondary, and tertiary prevention measures, offering different levels of psychological interventions.

Architectural Interventions in Psychiatric Centre towards Treating Social Isolation: A Review

Abstract: Tackling isolation is much more complex than bringing people's private space physically closer. Bullying and harassment among peers, adult abuse and neglect of children, and suicide as a kind of self-abuse are the primary cause of social isolation. To improve the overall well-being of human beings, mental health should be kept in the first place for that. Since mental illness is sometimes stigmatized, sufferers may feel humiliated or embarrassed about needing treatment. Even worse, mental health facilities are stigmatized as depressing, institutional places where no one wants to spend time. So, the study of alternate method of treatment is required which include architectural interventions.

Implementation of Hospital Information System in Psychiatry

Considering the growing awareness and acceptance towards mental health, the COVID-19 pandemic opened new windows to incorporate technology into psychiatry. With reduced hospital visits and social distancing being the new normal implementation of the Hospital Information System (HIS) for secure and easy data storage or transfer, the record of multiple hospital areas has become necessary. Mental health is still taboo in developing countries like Pakistan; therefore, developing a HIS system for psychiatry must be taken forward with high data security. This article proposes a HIS system built for psychiatric clinics or therapy centres on a cloud-based platform to make it cost-effective for low-medium income countries like Pakistan. A survey was conducted to determine the feasibility of this proposal in which 70 people participated through an online platform. Results were analysed using SPSS 26.0, which concluded that 81.4% of the respondents agreed on implementing HIS into psychiatric clinics, while 12.9% of respondents were unsure.

The Role of Early Toxic Interaction with Fathers in Males with Bipolar Spectrum Disorder

Purpose: The etiology of bipolar disorder (BD), a most debilitating mental illness worldwide, focuses on childhood traumatic experiences, some concerning parents. This study explored the role of early toxic interaction with fathers in males with BD.Methods: This qualitative study used a descriptive phenomenological approach and purposive sampling in Tehran, Iran, in 2022. The data were generated through 12 semi-structured interviews with males with BD who visited psychiatric centers in Tehran, Iran. The interviews continued until data saturation. The collected data were analyzed using Colaizzi’s seven-step method.Results: The data revealed thirteen subthemes comprising three main themes: the experience of living in constant neglect and rejection, living with fear and abandonment, and reflection of the father’s past interactive patterns in the son’s life.Conclusion: Living in neglect, fear, and abandonment, and repeating past interactive patterns in current life were some of the bitter life experiences of men with BD, who considered the problematic relationship and misbehavior of their fathers to be somewhat effective in the formation of their life problems, but reported that they could not help themselves with personal and social adaptation. Individual and supportive psychotherapies with drug therapy can help the rehabilitation and recovery of these patients.

Impact of Watson’s human caring-based health promotion program on caregivers of individuals with schizophrenia

BackgroundCaring for people with schizophrenia is accompanied by challenges that impact caregiver health. We conducted this study to explore the effect of a Caring Science-Based health promotion program on the sense of coherence and well-being among caregivers of persons with schizophrenia.MethodsThis randomized clinical trial with the Solomon four-group design was conducted on 72 caregivers randomly allocated into two intervention and two control groups. A health promotion program based on Watson’s theory was performed individually through five face-to-face sessions and a four-week follow-up. Settings were the psychiatric centers of the three educational, specialty, and subspecialty Ibn-e-Sina, Moharary, and Hafez hospitals affiliated with Shiraz University of Medical Sciences (SUMS), south of Iran. The data were collected using a demographic information form, the Sense of Coherence Scale, and the Caregiver Well-Being Scale. One-way ANOVA, chi-square, Kruskal–Wallis, and independent t-test were used to determine the homogeneity at baseline. In the post-test, multiple between-groups and pairwise comparisons were assessed by One-way ANOVA and Tukey’s post-hoc. Within-group comparisons were evaluated using paired t-tests. All tests were two-tailed, and the statistical level was considered 0.05.ResultsData analysis showed that the mean scores of caregiver sense of coherence and well-being from pre-intervention to post-intervention were significantly increased in the intervention groups (p < 0.001). At the same time, there were no significant differences in the control groups.ConclusionThe health promotion program based on Watson’s human caring theory facilitated ongoing intrapersonal, and holistic caring and improved the sense of coherence and well-being in caregivers of persons with schizophrenia. Hence, this intervention is recommended for developing healing care programs.Trial registrationhttps://www.irct.ir/trial/55040: IRCT20111105008011N2 (11/04/2021).

Clinical Aspects of Behavioural and Psychological Symptoms in Vascular Dementia

Dementia is a growing problem that presents increasing challenges for health services worldwide. Vascular dementia is the 2nd most common type of dementia after Alzheimer dementia. The aim of the study is to describe the clinical aspects of behavioural and psychological symptoms in patients aged ≥ 60 years diagnosed with vascular dementia. A cross sectional study was carried out in the Psychiatric Centre at tertiary care hospital from Dec 2018 to May 2019 involving elderly (≥ 60 years) with vascular dementia. Patients with other dementia types, condition and medication that stimulate cognitive disturbances were excluded. The tools used were Hindi mini mental status examination (HMSE), Zarit Burden Interview and the 12- item Neuropsychiatric inventory (NPI). All patients presented with two or more behavioural symptoms, Irritability was the most common symptom (80 %) followed by Night-time behaviour (60 %) and Agitation/ aggression (50 %). There was a significant association between Zarit Score and Behavioural Symptoms (p = 0.023), as well as HMSE and Zarit score (p = 0.03). Caregiver burden showed significant correlation with delusion, hallucination, disinhibition, aberrant motor behaviour and night-time behaviour. Most of the patients had multiple behavioural symptoms. Irritability was the most common symptom followed by night-time behaviour and Agitation.

Prescribing Practices at a Residential Treatment Center – from Paper to Plastic (Computers)

ABSTRACT Medication prescription procedures were reviewed at psychiatric residential treatment centers (RTC), and a quality improvement project was conducted in order to implement integrated electronic medical records (EMR) and computerized provider order entry (CPOE). To assess the impact of preexisting prescribing practices on RTCs, surveys were sent anonymously to current and past providers of regional and local RTCs. The surveys assessed the impact of the prescribing protocol on workflow, the frequency of medication errors, the impact such errors had on patient care, the overall provider satisfaction, and the discrepancies between electronic and paper charts. Current providers were then re-surveyed after implementing the integrated CPOE system in May 2020, during the COVID-19 pandemic. The first round of provider survey results revealed that the majority of staff (n = 10, 70%) observed frequent medication errors and were largely dissatisfied with the current medication ordering and administration process (n = 10; 70%). Incident Response Improvement System (IRIS) reports revealed the most common medication errors were omissions, incorrect dosing, and incorrect medications administered. After the initiation and implementation of the CPOE, staff satisfaction increased with the process (n = 14; 50%) noting that medication errors were less frequent than before (n = 14; 50%).

Effectiveness of Cognitive-behavioral Therapy on the Positive and Negative Psychotic Symptoms and Emotion Regulation of Patients With Schizophrenia Spectrum Disorders

Objective Schizophrenia is the most debilitating psychiatric disorder with the highest psychiatric ward admission rate. Drug therapy is the first line of treatment. However, it does not result in appropriate therapeutic responses in many patients, and they experience emotional regulation difficulties and psychosis symptoms after initial symptom resolution. Cognitive-behavioral therapy (CBT) is currently an adjuvant treatment besides drug therapy to target the persistent symptoms of psychosis. The present study aims to determine the effectiveness of CBT on the positive and negative symptoms and emotional regulation of those suffering from schizophrenia spectrum disorders. Materials &amp; Methods The research design was single-subject and of the AB type (baseline and intervention) with a follow-up phase. Besides the routine therapy sessions, CBT sessions were held for the study participants. They were patients admitted to Razi Educational and Therapeutic and Research Psychiatric Center in Tehran City, Iran, who were selected based on the inclusion criteria. Thirty patients were selected with convenience sampling, and 5 were randomly placed in the CBT group. They were evaluated with the scales of positive and negative symptoms of Kay, Fiszbein, and Opler (1986) and difficulties in emotional regulation by Gratz and Roemer (2004) in the baseline, intervention, and follow-up phases. The treatment sessions were planned based on the CBT protocol developed by Laura Smith, Paula Nathan, Uta juniper, Patrick Kingsep, and Louella Lim (2003). Non-overlap of all pairs (NAP), percentage of non-overlapping data (PND), percentage of all non-overlapping data (PAND), percentage of data points exceeding the median (PEM), Cohen’s d effect size, and improvement percentages were used to analyze the data, and visual graphs were used for data presentation. Results The outcomes showed that in the intervention phase, compared to the baseline phase, the effect sizes of the positive and negative symptoms in the first to fifth participants were 1.6, 3.1, 3.2, 1.9, and 2.4, respectively. Only the effect sizes of the second and third participants were large. The effect sizes of the emotional regulation factor in the first to fifth participants were 2.8, 1.2, 1.1, 2.2, and 1.9, respectively. The effect size of the second participant was large, and the rest were average. The findings of this study showed that during the post-therapy and follow-up stages, while patients who had received CBT still experienced positive and negative symptoms of psychosis and difficulties in emotional regulation; these symptoms decreased in comparison with the baseline phase. Furthermore, their improvement percentages were not significant. Conclusion Data analysis showed that although CBT is effective in reducing positive and negative psychotic symptoms and improving the emotional regulation of patients, the data obtained from Cohen’s d effect size and recovery indices showed that the results are not clinically significant. In other words, although the patients who received CBT showed a slight improvement in psychotic symptoms and difficulty in emotional regulation, they could not maintain the therapeutic gains in the follow-up phase.

ACTIVITE DES URGENCES PSYCHIATRIQUES DURANT LA PANDEMIE (COVID-19): EXPERIENCE DE MARRAKECH

IbnNafiss Hospital is a psychiatric university center that covers a large region, with a population over three millions. During the period of the pandemic (covid-19), the activity of psychiatric emergencies experienced a marked change. At the start of the pandemic and during the confinement period, we noted a drop in the flow of patients associated with a drop in the number of hospitalizations. After the deconfinement, we noticed an increase in the numbers of consulting patients, however the numbers of hospitalizations did not increase despite the important demand for care. The most diagnoses commonly founded, were psychosis and depression, althought a higher percentage of anxiety disorders was expected. Several adjustments have been made to maintain the daily activity of the hospital.