Mental Hospital Research Articles

Impact Of Work Environment Factors On The Mental Health Of Nurses In Psychiatric Settings

Background: The mental health of nurses in psychiatric settings is profoundly influenced by specific work environment factors, including the health profession's culture, excessive workload, and workplace violence (Ugwu, 2020; Neves, 2021). This study explores the impact of workload, bullying, and support mechanisms, uniquely focusing on their effects within mental health nursing. Objective: To identify and analyze how distinct environmental stressors such as workload, role ambiguity, and lack of support affect mental health outcomes among nurses in psychiatric care facilities, aiming to propose targeted interventions. Methods: Employing a mixed-methods approach, the study surveyed 382 mental health nurses using both quantitative Likert-scale questionnaires and qualitative interviews. The methodology, supported by the postpositivist paradigm, was selected for its appropriateness in addressing the complex dynamics of psychiatric nursing settings (Ugwu, 2020). Results: The study found that high workload, frequent exposure to workplace bullying, and insufficient support systems are critical stressors significantly compromising mental health nurses' well-being and job satisfaction. Particularly, nurses with less than two years of experience in mental health settings were most vulnerable to these negative impacts. Conclusion: Addressing these key environmental factors is crucial for improving mental health nurses' working conditions and, consequently, the quality of care provided in psychiatric settings. The study suggests implementing structured support systems and policy reforms aimed at reducing workplace stressors

The therapeutic alliance in blended versus face-to-face cognitive behavioral therapy for adolescents and young adults with a depressive disorder

IntroductionA depressive disorder during adolescence is a serious and disabling disorder, which has a high impact on the development of adolescents. Blended treatment, combining online and face-to-face sessions, is effective and can reduce some of the barriers for adolescents to use mental health care. There is a lack of knowledge about whether therapeutic alliance is established in blended treatment for adolescents and young adults suffering from a depressive disorder. This study examines whether the quality of the therapeutic alliance differs when cognitive behavior therapy (CBT) is delivered in combination with online intervention (b-CBT) compared to solely face-to-face (FtF-CBT) and the extent to which a stronger therapeutic alliance is associated with better treatment outcome. MethodsA pragmatic quasi-experimental design was used. Data collected within two separate studies were combined. A total of 85 participants (80 % female), aged 13–22 (mean = 16.63, SD = 1.92) were recruited within mental health care institutions and diagnosed with a depressive disorder (using K-SADS). Assessments were done at pre-treatment (T0), after five weeks (T1), after ten weeks (T2), post-treatment (T3) and one to four weeks after treatment (T4) and included measures of depressive symptomatology (CDI-2). The therapeutic alliance was measured at T1, T2 and T3 by the TASC. t-tests for independent samples were used to test differences in therapeutic alliance rates between b-CBT and FtF-CBT at post-treatment. A linear growth model for depressive symptoms based on five time points with Latent Growth Curve Analysis (LGCA) was used to test whether the therapeutic alliance is associated with depressive symptoms. ResultsNo differences in therapeutic alliance between b-CBT and FtF-CBT were found on either client-rated or therapist-rated therapeutic alliance. For both intervention groups, no significant association between the therapeutic alliance and depressive outcome was found. DiscussionThis study shows that providing part of CBT using an online environment does not have a negative impact on the therapeutic alliance. In contrast to earlier research, no association was found between the therapeutic alliance and therapy outcome in neither the b-CBT nor the FtF-CBT intervention.

Effectiveness and prediction of treatment to guided internet-based cognitive behavioural therapy for health anxiety: A cohort study in routine psychiatric care

ObjectiveHealth anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence. MethodA longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventory (SHAI-14) and a within-group design with repeated measures was utilized for the primary analysis. ResultsParticipants showed significant improvements from pre- to post-treatment (d = 1.61). At post-treatment, 60 % (95 % CI 58–62) demonstrated statistically reliable change (RCI), and 44 % (95 % CI 42–46) were in remission. On average, participants completed 7 (SD = 4) out of 12 treatment modules. For each additional completed module, the mean reduction was 0.31 (95 % CI 0.10 to 0.54) points on the SHAI-14. ConclusionsGuided ICBT for health anxiety can be effective when delivered within the context of routine psychiatric care. The study suggests that effect sizes are comparable with those in RCTs and higher treatment adherence is associated with better outcomes in health anxiety. ICBT could be used to increase availability to effective therapy for health anxiety.

Prevalence of treatment-resistant depression and associated factors among major depressive disorder follow-up patients at Saint Amanuel Mental Specialised Hospital in Ethiopia: a cross-sectional study

ObjectivesThis study aimed to assess the prevalence of treatment-resistant depression (TRD) and associated factors among patients with major depressive disorder (MDD) on follow-up at Amanuel Mental Specialised Hospital, Addis Ababa,...

Efficacy of yoga-breath linked intervention to stop smoking (Y-BLISS) in reducing the number of cigarettes smoked per day among smokers attempting to reduce or quit: Study protocol for a randomized controlled trial

Background The proposed research aims to test the effects of a two-month yoga-breath linked intervention to stop smoking (Y-BLISS) as an add-on to standard treatment in tobacco use disorder (TUD; in the form of cigarette smoking) by conducting a randomized controlled study with the following primary outcome variable: number of cigarettes smoked per day. Secondary outcome variables are motivation to stop smoking, craving, dependence severity, lung capacity, and exhaled carbon-monoxide. In this single-blinded, randomized, controlled, parallel-group superiority trial with 1:1 allocation ratio, 100 patients with TUD availing the outpatient/ inpatient clinical services at a tertiary mental healthcare hospital in India will be enrolled after giving informed consent. Consecutive consenting patients will be randomly allotted to one of the two groups – yoga arm (Y-bliss arm), or desktop exercise arm (D-exercise arm). Allocation concealment will be followed, the clinicians, outcome assessors and data analysts will remain blind to subject-group allocation. A validated and standardized 12-minute yoga program (Y-BLISS) for TUD will be used as an intervention. The control group will receive an equivalent 12-minute desktop exercise module. Participants in respective arms will receive 40 online supervised sessions over 8 weeks, 5 sessions per week in the mornings as they will be asked to practice the same on sos basis whenever they feel cravings for cigarette smoking. Assessments will be done at baseline, 4th week and 8thweek. Data from all randomized subjects will be analyzed using intent-to-treat analysis and mixed model multivariate analysis. Dissemination Findings will be disseminated through peer-reviewed publications, conference presentations, and social media. Trial registration number The trial has been registered under Clinical Trials Registry India (CTRI) with the registration number: CTRI/2022/12/048117, date of registration: 14th December 2022.

Intravenous Ketamine to Facilitate Transport of Agitated Patients to the ECT Clinic.

Electroconvulsive therapy (ECT) can be effective for a variety of psychiatric conditions, including for some patients who are very psychotic or agitated. Transferring such patients from the psychiatric ward to the ECT clinic can pose significant challenges for treating teams, as they try to minimize the use of restraint. We developed a protocol for safe transfer of such patients using sedation with ketamine. An intravenous cannula is inserted on the ward in a low stimulus environment with gentle supportive holds. Intravenous ketamine is given in a bolus at 0.5-2.0 mg/kg. The patient is transported on a transfer bed to the ECT clinic within a few minutes, and usual ECT process is immediately followed. We describe 6 patients who were given between 1 and 11 ECT treatments using this method. All of them finished ECT courses without the need for ketamine sedation. Five of them regained capacity, provided informed consent for further ECTs, and eventually reached remission. Ketamine can be used to manage risk and transfer agitated patients to an ECT clinic for treatment.

Application of a virtual reality-based cognitive-behavioural therapy of social phobia in the treatment of inpatients diagnosed with schizophrenia and social anxiety – a feasibility study

The co-occurrence of social anxiety symptoms and schizophrenia is a significant clinical problem. So far, social anxiety symptoms have been treated as an integral symptom of schizophrenia, receiving little attention as a target of direct therapeutic interventions. However, some evidence indicates that a high level of social anxiety in this group of patients may be a barrier to the recovery process. This feasibility study evaluated the use of a standard protocol for cognitive-behavioural therapy in the treatment of social phobia, in which social exposure was implemented with the usage of virtual reality (CBT + VRET). The study was conducted in a group of inpatients in a clinical psychiatric unit. Twenty inpatients diagnosed with schizophrenia and comorbid social anxiety symptoms were examined. Eleven patients were assigned to 10 weekly individual CBT+VRET interventions and nine to the control condition. Baseline and post-treatment assessments of social anxiety, psychotic symptoms, stigma, self-esteem, and depressive symptoms were measured before and after intervention. There was a decrease in social anxiety in the CBT+VRET group, while no such decrease was noted in the control group. This study provides preliminary evidence that CBT+VRET is acceptable, safe, and initial data that bears on the question of effectiveness for treating social anxiety disorder in people with schizophrenia. Future research should investigate the efficacy of CBT+VRET for the treatment of social anxiety symptoms and co-morbid schizophrenia in a larger randomised controlled trial.

Male hysteria in theory and practice: Analyzing patient records of the Tartu Psychiatric Hospital (Estonia), 1881–1895

ABSTRACT During 1881–1895, a small number of male patients—18 in total—were diagnosed with hysteria at the University of Tartu Psychiatric Hospital. Rather than constituting an obscure psychiatric institution on the margins of European medical traditions, Tartu during these years witnessed the arrival of several influential psychiatrists: Hermann Emminghaus (1845–1904), Emil Kraepelin (1856–1926), and Vladimir Chizh (1855–1922). Yet, when comparing patient case records of male hysteria written by doctors who also published journal articles and medical textbooks on the topic, one can detect a clear inconsistency between the theory and practice of psychiatry at an important moment of its formation. Contrary to the simplified characterizations in the textbooks, there was no uniform formulation of male hysteria in the case records. The clinical description differed remarkably, throughout the career of individual doctors, between symptomology presented in a textbook and clinical picture described in a patient record, and between different doctors who practiced in the same clinic during this 15-year period. This study highlights the importance of using patient case records in conjunction with a formal medical treatise to provide new insights and nuances to the intellectual history of hysteria, but also other diagnoses and clinical practice more broadly.

Prescribing Pattern of Psychotropic Drugs in Bipolar Disorder in Mental Hospital, Lalitpur

Prescribing Pattern of Psychotropic Drugs in Bipolar Disorder in Mental Hospital, Lalitpur

Only half of psychiatric facilities offer MOUD: Study

In “Availability of Medications for Opioid Use Disorder in U.S. Psychiatric Hospitals,” Shawn M. Cohen, M.D., and colleagues expose the inadequacy of methadone, buprenorphine and naltrexone in psychiatric hospitals. The study, published as a research letter in JAMA Network Open this month, consisted of a cross‐sectional analysis of facility‐level responses to the 2022 National Substance Use and Mental Health Services Survey. The study sample included all facilities in the U.S. that self‐reported their facility type as a psychiatric hospital and reported their availability of medications for opioid use disorder (MOUD).

A descriptive analysis of Aboriginal adolescents admitted to a regional inpatient mental health unit: Was culture considered?

To describe the characteristics of Aboriginal adolescents admitted to a Child and Adolescent Mental Health (CAMH) inpatient unit and assess if cultural identity was acknowledged, and what proportion received cultural support. A retrospective chart review of adolescents who identified as Aboriginal and were admitted to a regional CAMH Unit over 10years. Medical records were reviewed for demographics, diagnosis, details of admission, acknowledgement of Aboriginal identity, cultural information and cultural support provided. A total of 172 patients who identified as Aboriginal were admitted during this period, comprising a total of 266 admissions. Most frequent admission reason was suicidal ideation or self-harm (66%), then psychosis (14%) and 49% were admitted involuntarily. Most frequent discharge diagnosis was a stress-related disorder (23%) followed by post-traumatic stress disorder (18%). A referral for Aboriginal clinician cultural support was made for 30%. Thirty patients (23%) had any detail regarding cultural identity documented. Amongst young Aboriginal people admitted to a psychiatric inpatient unit, the minority had cultural identity acknowledged or were provided cultural support. There is a need for increased access to Aboriginal Mental Health Clinicians and improved training for the broader workforce in the provision of culturally considered care.

Assessing the impact of COVID-19 on outpatient psychiatric population well-being and symptomology utilizing COVID-19 Events Checklist (CEC) and Measurement Based Care

BackgroundThis study examines the impact of SARS-CoV-2 (i.e., coronavirus, COVID, COVID-19) using data from a measurement-based care (MBC) system utilized in an outpatient psychiatric clinic providing telemedicine care. A novel Patient Rated Outcome Measure (PROM), the COVID-19 Events Checklist (CEC) was administered in a hospital system based ambulatory clinic beginning April 2020 to track COVID-19-19’s impact on patients’ mental, emotional, and health-related behaviors during the pandemic. The study (1) provides descriptive CEC data, and (2) compares CEC results with PROMs evaluating anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire; PHQ-9), and psychological distress (Brief Adjustment Scale-6; BASE-6).MethodsThis retrospective observational study included patient intake data collected from April 2020 to March 2021. Patient (N = 842) reports on the CEC’s five domain questions were aggregated to calculate average reports of COVID-19 related impacts at intake over the initial 12 months of the pandemic. Trends in COVID-19 related impacts were examined, and non-aggregated scores on the PHQ-9, GAD-7, and BASE-6 were compared to primary dichotomous (yes/no) CEC survey questions via Wilcoxon rand sum testing.ResultsResults capture the relationship between COVID-19 exposure, COVID-19- related sequelae and behaviors, and psychological symptom severity. Specifically, Wilcoxon rank-sum tests indicate that social determinants of health (SDOH), negative mental health impacts, and positive coping skill use were significantly associated with psychological symptomatology including overall psychological functioning via the BASE-6, anxiety via the GAD-7, and depressive symptoms via the PHQ-9. Results regarding SDOH were as follows: BASE-6 (w = 44,005, p < 0.001), GAD-7 (w = 44,116, p < 0.001), and PHQ-9 (w = 43,299, p < 0.001). Regarding negative mental health outcomes, the results were: BASE-6 (w = 38,374, p < 0.001), GAD-7 (w = 39,511, p < 0.001), and PHQ-9 (w = 40,154, p < 0.001). As the initial year of the pandemic elapsed, incoming patients demonstrated increased rates of suspected or confirmed exposure to COVID-19, (+2.29%, t = 3.19, p = 0.01), reported fewer negative impacts of COVID-19 on SDOH (−3.53%, t= −2.45, p = 0.034), and less engagement in positive coping strategies (−1.47%, t = −3.14, p = 0.010).ConclusionsPsychosocial factors related to COVID-19 are discussed, as well as opportunities for further research on the relationship between psychological symptomatology and the impact of COVID-19 on health-related behaviors.

Patient Safety Incidents in Inpatient Psychiatric Settings: An Expert Opinion Survey.

Patient safety in psychiatric inpatient facilities remains under-researched despite its crucial importance. This study aims to address this gap by using expert opinion to estimate the frequency of diverse patient safety incidents (PSIs) in psychiatric settings and to compare it with the existing literature. Utilizing a seven-step approach, a questionnaire based on the World Health Organization's International Classification for Patient Safety was developed and deployed. A total of 33 expert opinions were collected. Results showed a higher estimated incidence of PSIs in psychiatric settings compared to general healthcare, highlighting categories such as patient behavior, medication, and infrastructure as significant contributors. Experts emphasized the prevalence of incidents related to behavioral issues and inadequate infrastructure, areas often overlooked in the existing literature. Unlike general settings, psychiatric facilities appear more vulnerable to specific PSIs, such as those related to medication and building safety, underscoring the need for targeted safety measures. Our study suggests the existence of significant discrepancies between expert opinion and available research, with several underexplored domains in psychiatric patient safety.

Development of a core outcome set for psychological therapy trials on acute psychiatric inpatient wards

BackgroundConsensus on what outcomes should be included in trials of psychological therapies on acute psychiatric inpatient wards is currently lacking. Inclusion of different viewpoints, including service user perspectives, is crucial in ensuring that future trials measure outcomes which are meaningful and important. Development of a Core Outcome Set (COS), a minimum standardised set of outcomes to be measured and reported, would help improve synthesis and interpretation of clinical trial data in this area.MethodsStage 1 of the COS development involved compiling a comprehensive long-list of outcomes from key sources including i) a systematic review of outcomes from published trials, ii) online survey of key stakeholders (service users, carers, healthcare professionals, researchers, and end users of research), iii) qualitative interviews with service users and carers. Stage 2 involved stakeholder groups short-listing the outcomes using consensus methods (e-Delphi survey). The final outcome set was derived from the short-list at a consensus meeting of stakeholders, facilitated by an Independent Chair.ResultsA long-list of 68 outcomes was compiled from the systematic review (n = 30 trials), online stakeholder survey (n = 100 participants) and qualitative interviews (n = 15 participants). Fifty stakeholders took part in the e-Delphi study, where the long-list was cut down to a short-list of 12 outcomes over 2 rounds. Nine stakeholders took part in the final consensus meeting, and after some outcomes were removed and/or amalgamated, a final set of 6 outcomes was recommended for inclusion in the COS. These were Ability to Cope, Hopefulness, Quality of Life, Psychosis Symptoms, Mood, and Self-Harm Behaviours.ConclusionsWidespread future adoption of the COS will reduce research waste by ensuring that outcomes are more easily comparable across trials, and that the full range of stakeholder priorities are represented in trial outcomes. This makes it more likely that effective therapies will be identified in a timely fashion and successfully implemented in routine clinical practice. The final 6-outcome COS should be feasible to implement given the need keep participant burden to a minimum in inpatient trials. Further work is needed to make recommendations for the best outcome measurement instruments to use, including the use of patient-reported outcomes alongside clinician-rated measures.Trial registrationNot applicable.

Health Professionals on Cross-Sectoral Collaboration Between Mental Health Hospitals and Municipalities: A Critical Discourse Analysis.

This study investigates the role of language in cross-sector collaboration between mental health hospitals and municipalities, focusing on the challenges of maintaining continuity of care and integrating patient-centered approaches. Using Fairclough's framework for critical discourse analysis, we examined focus group interviews with 21 healthcare professionals, including nurses, social workers, and psychiatrists, to identify key themes and patterns in how cross-sector collaboration is discussed. The analysis revealed a dominant medicalized discourse in hospital settings, which often emphasized structured care processes like treatment plans and medication management, overshadowing more flexible, patient-centered approaches common in community-based services. Power dynamics were evident, with hospital professionals frequently positioned as active agents, while patients and community-based workers were portrayed in more passive roles. Although efforts to involve patients in decision-making were noted, these were often controlled by professionals, reflecting a mediated approach to patient empowerment. The findings highlight the cultural and structural divides between hospital and community services and suggest the need for improved communication strategies, integrated care pathways, and a shift toward more inclusive, patient-centered care models. Addressing these discursive barriers is crucial for achieving more effective, integrated, and patient-centered care, ultimately improving outcomes for patients.

The effectiveness of diabetes training of psychiatric health professionals on individuals with diabetes and psychiatric disorders – a pragmatic controlled trial in Denmark

BackgroundIndividuals with diabetes and co-existing psychiatric disorders have more diabetes complications and lower life expectancy than those with diabetes but no co-existing psychiatric disorders. Psychiatric health professionals may have a role in improving these outcomes but often lack diabetes knowledge and skills. This study aims to examine the effectiveness of a diabetes training course for psychiatric health professionals on their diabetes knowledge and skills and clinical outcomes, diabetes support and diabetes distress among individuals with diabetes and psychiatric disorders treated in psychiatric outpatient clinics.MethodsA pragmatic non-randomized controlled cluster trial was conducted in eight psychiatric outpatient clinics in Denmark. All psychiatric health professionals from four clinics participated in the diabetes training course (the intervention) and completed a questionnaire on experience of the training course and a 20-item pre- and post-test to measure diabetes knowledge and skills. Difference in pre- and post-tests were analyzed using t-tests. From August 2018 – June 2019, individuals with diabetes were recruited from the intervention clinics (n = 49) and from four control clinics continuing usual clinical practice (n = 57). Differences in clinical outcomes, diabetes support and diabetes distress between the intervention and control groups at six and 12 months after the training course, were analyzed using logistic and linear regression models adjusted for baseline levels.ResultsPsychiatric health professionals (n = 64) had more correct answers after completing the course, with a mean increase of 6.3 [95% CI 5.6 to 7.0] correct answers. A total of 49 and 57 individuals were recruited for the intervention and control group, respectively. At follow-up, individuals treated in the intervention group had lower levels (clinical improvement) of systolic blood pressure, but had lower receipt of annual assessment of blood pressure, and body mass index (BMI) (worsening of process measures). While there were observed differences in odds and means for several other outcomes, none of these received statistical significance (see Table 2 and Fig. 2).ConclusionsTraining psychiatric health professionals in diabetes care improved their diabetes knowledge and skills and improved clinical levels of systolic blood pressure in individuals treated in the intervention group. However, this training intervention was associated with a lower likelihood of receiving annual assessment of blood pressure and BMI.Trial registrationISRCTN registry registration number ISRCTN15523920, registration date: 02/10/2019.

Evaluation of the therapeutic relevance of architectural aspects in child and adolescent psychiatric institutions from the perspective of architects and senior physicians

ObjectiveThe concept of “Healing Architecture” addresses the relevance of design and architectural issues on the outcome of medical and therapeutic treatment in hospitals. The questionnaire ARCHI was developed to record data on the opinion of different groups of users on the architectural design of their therapeutic environment in departments of child and adolescent psychiatry.MethodA Questionnaire-based cross-sectional study was conducted in two phases between 2020 and 2022 using ARCHI to gather the perspectives of senior physicians and architects on the significance of architectural design in German child and adolescent psychiatric facilities.ResultsIn the survey of the senior physicians, 49 heads of child and adolescents psychiatric departments initiated the survey, and 73.5% (n = 36) of them completed the questionnaire in its entirety. During the survey for the architect-specific, 145 individuals commenced the survey, and 60.7% of them completed the questionnaire (n = 88). Significant differences between architects and senior physicians became visible for four of the 93 items, namely “environment of the hospital”, “structure of building”, “labelling of floors” and “visible cleanliness”.ConclusionsAlthough senior physicians and architects were characterized by the same opinions on the relevance of architectural design on therapeutic issues for the major part of issues, differences could be obtained for several aspects which are important for the architectural planning of new departments and hospitals. It remains open why both professional groups had different point of views on these four aspects of hospital design which should be clarified to improve the process of hospital development in the future.

"Developing the tool SDM:KOMPASS. Supporting shared decision making implementation processes".

Shared decision-making (SDM) involves patients in choosing their treatment or care options. SDM enhances patient engagement and treatment satisfaction. SDM has proved difficult to implement and sustain in routine clinical practice, hence a supportive tool is needed. This quality improvement study focuses on the development of a generic tool, labeled SDM:KOMPASS, which is intended to support hospital settings by facilitating the visualization of their formative progress and the setting of goals for the SDM implementation into routine clinical practice. The main objective of the present paper is to describe the development of this generic tool. A six-step development process was performed to develop a tool and investigate the tool's overall perceived usability. Qualitative methods, such as observations, individual and focus group interviews, provided insights. A 10-item quantitative survey gauged informants' immediate attitudes towards the tool. Purposefully sampled informants (N = 20), including healthcare professionals and patients, contributed diverse perspectives regarding; 1) The tool's readability and clarity, 2) the construct's domains and content, and 3) the tool's perceived usability. In alignment with real-world challenges, SDM:KOMPASS emerges as a potentially valuable resource for healthcare organizations embedding SDM. The six-step development process revealed how the tool SDM:KOMPASS has potential to enhance SDM implementation's manageability, goal-setting, and focus. Professionals engaged in strategic implementation within somatic and mental hospital departments find the tool potentially beneficial and feasible. The tool shows promise and usability but requires careful attention due to its comprehensiveness. The next step is to alpha test the tool in clinical practice.

Early Treatment-Resistance in First Episode Psychosis.

Approximately 30% of individuals with schizophrenia experience treatment resistance (TR), with 70% exhibiting it from the onset. Most research fails to distinguish between acquired and innate resistance, with limited data on TR in first episode psychosis (FEP). However, FEP patients with TR experience progressively worse outcomes compared to those with initial response. To further understand these findings, clinical and demographic data of FEP patients with and without TR were compared in this naturalistic study. Information was extracted on FEP patients who were antipsychotic-naive at the time of admission from a retrospective database on F2x diagnosed patients admitted to the LMU psychiatric clinic between 2008 and 2018. Clozapine was used at discharge as a marker of TR in the FEP cohort. A similarly antipsychotic-naïve FEP control group without clozapine at discharge, was generated by matching for gender and age. Thirty clinical and demographic variables were analyzed to identify differences. Two-hundred forty antipsychotic-naive FEPs were included: 33 with clozapine at discharge (TRC group), and 207 in the control group (non-TRC). Significant differences were observed in inpatient stay duration, chlorpromazine-equivalent dosage, number of antipsychotics, and anticholinergic medication at discharge. The findings indicate that longer inpatient stay, an increased number of antipsychotics, and possibly a more extended prodrome may serve as markers for non-clozapine TR in FEP. Further research is necessary to establish the robustness of these variables as early-stage TR markers.

Association between behavioral parameters of men in psychiatric emergency department video recording and subsequent violence in the psychiatric ward

Violence risk is a major challenge among acute psychiatric inpatients. The study aimed to predict violent behavior risk in an acute psychiatric ward using video recordings from the emergency department. 69 videos of the emergency department recording the first ten minutes following patients’ arrivals were included. Psychiatrists watched the videos, completed relevant Brief Psychiatric Rating Scale items and answered intuitive questions about each patient’s risk of violence. Demographic and clinical data were also collected. Motoric mannerisms as rated in the BPRS significantly differed between violent and non-violent patients (p < 0.05). Additionally, we found a significant correlation between intuitive prediction of violence and actual violence (p = 0.008). Violent behavior was predicted in 42.1% of the cases by the intuitive evaluation compared to 11.5% mistakenly evaluated patients. Logistic regression revealed that the intuitive question and the BPRS items regarding tension and motoric mannerism created a successful model for predicting violence with 88.2% sensitivity and 72.5% specificity. We sought to define the factors that most accurately predict violence in the acute psychiatric ward, based solely on behavior in the emergency department. Intuitive impressions of clinicians and motoric mannerisms should be considered when evaluating patients for potential violent behavior.