Mental Hospital Research Articles

Diminishing restrictive practices in psychiatric wards via virtual reality training: Old wine in a new bottle?

This editorial examines the application of virtual reality (VR) training to mitigate restrictive practices (RPs) within psychiatric facilities. RPs include physical restraints, seclusion, and chemical restraints, used to ensure patient safety but with varying usage rates across regions. In recent years, there has been a growing focus on the adverse effects of RPs on both healthcare workers and patients, leading to calls for its reduction. Previous research has shown the efficiency of VR training in RP reduction. This editorial will analyze the limitations of VR training in prior research aimed at reducing RP, emphasizing that the essence of RPs is a medical safety issue, calling for careful differentiation of the causes of RPs, and avoiding the use of AR technology as a "new bottle" for "old wine" to improve the quality and reproducibility of future research in this field.

Suicide prevention inpatient group treatment-A treatment development and feasibility study.

One mainstay of psychiatric treatment for suicidal crises is inpatient psychiatric hospitalization. Despite the need to secure immediate safety and stabilization, inpatient treatment for acutely suicidal patients remains diagnosis-specific, which may fail to directly target and adequately manage suicidal behavior as a symptom and reason for admission or treatment. The post-discharge period is a high-risk period for repeat suicide attempts or death by suicide, but overburdened workforce and high patient turnover make it difficult to provide suicide-specific treatment. In response to this need, we developed the Suicide Prevention Inpatient Group Treatment (SPIGT), a four-module, group-based intervention, which provides evidence-supported concrete tools and psychoeducation to directly address suicidality. To assess feasibility and acceptability of implementation, the SPIGT was piloted on an inpatient psychiatric unit starting in 2016. Group participants were given optional, anonymous surveys after each module. Unit clinicians also completed optional, anonymous surveys to assess their attitudes towards the intervention. Results indicate that participants responded very favorably to each module, and that unit clinicians felt that the implementation of this intervention was feasible and acceptable. The SPIGT shows promise as a scalable suicide-specific, brief intervention, which addresses an unmet and critical need in suicide prevention.

The limited clinical utility of a routine creatine kinase (CK) on admission to a psychiatric inpatient unit

BackgroundCreatine kinase (CK) is an intracellular enzyme expressed most commonly in tissues such as skeletal muscle. CK can be used as an investigation to support the diagnosis of conditions such as neuroleptic malignant syndrome (NMS), a rare idiosyncratic drug reaction – classically to antipsychotic medications – which can be fatal. Routine screening of CK in psychiatric inpatients is a known practice, but its value is uncertain. We aimed to ascertain whether such screening resulted in new diagnoses of NMS or other conditions, and changes in clinical management.MethodsUsing an electronic case register, we conducted a descriptive retrospective cohort study, identifying all psychiatric inpatient admissions in a South London mental health trust over a four-year period where a CK test was conducted within 48 h of admission. We extracted the demographic and clinical characteristics (e.g., diagnosis) of those who met inclusion criteria. Free-text review was performed on all those with a CK potentially suggestive of NMS (CK ≥ 4x upper limit of normal reference range (ULN)) to determine the impact of this abnormal result on subsequent management and diagnosis (including NMS if identified).ResultsOf 14,236 inpatient episodes in the specified window, 2358 (16.6%) had a CK test within 48 h of admission. This was ≥ 4x ULN in 327 (13.8%) cases (free-text successfully reviewed in 318). There were no cases of NMS identified. An abnormal CK result led to a new alternative diagnosis, such as dehydration or catatonia, in only 14 patients (4.4% raised CK sample, 0.6% total CK sample). Impact on subsequent management appeared limited, with the most common adjustment being an increase in frequency of physical observations in 47 instances (14.8%).ConclusionsThe clinical utility of untargeted screening using a serum CK for psychiatric inpatients appears limited, with poor specificity in detection of NMS and a minimal impact on subsequent clinical management.

The effect of depression on non-suicidal self-injury and psychological status in adolescents with unipolar and bipolar disorders

ObjectiveTo investigate the effects of depression on non-suicidal self-injury (NSSI) and related psychological conditions in adolescents with unipolar disorder (UD) and bipolar disorder (BD), and to provide a basis for accurate prevention and intervention of NSSI behaviors in adolescents.MethodsThis cross-sectional study collected data from adolescents aged 12–18 years with depressive episodes who exhibited NSSI behaviors and attended the psychiatric outpatient clinic of Huangshi City Psychiatric Specialized Hospital from 2018 to 2023. Depressive episodes were clinically diagnosed by two psychiatrists according to the ICD-10.ResultsIn terms of NSSI behavioral patterns and severity, adolescents with UD displayed more frequent behaviour of intentionally burning themselves with cigarettes and had more instances of self-inflicted suicidal thoughts that were not carried out compared to those with BD, and the differences between the two groups were statistically significant (P < 0.05). For psychological status, Nurses′ Global Assessment of Suicide Risk (NGASR) scores were significantly higher in adolescents with BD than in those with UD (P < 0.05). There was a significant negative correlation between anxiety scores and the frequency of NSSI in adolescents with BD (P < 0.05); that is, the more anxious the adolescents with BD, the lower the frequency of NSSI. The NGASR scores of adolescents with UD and BD were significantly and positively correlated with the frequency of NSSI occurrences (P < 0.05); higher NGASR scores of adolescents with UD and BD corresponded with higher frequencies of NSSI.ConclusionThe differences in NSSI behaviors between adolescents with UD and those with BD were statistically significant in terms of self-injury method and severity. Adolescents with UD experienced more severe consequences related to NSSI behaviors. Regarding psychological conditions, adolescents with BD are at a higher risk of suicide. An inverse relationship was observed between anxiety severity and the frequency of NSSI in adolescents with BD; severe anxiety was associated with lower NSSI frequency. Additionally, higher suicide risk was associated with a higher frequency of NSSI in adolescent patients with either UD or BD. Therefore, different prevention and intervention measures are needed to address NSSI behaviors in adolescents with UD and BD.

The impact of emotional burnout in psychiatrists on the outcomes of the care they provide

The quality of medical care largely depends on the mental well-being of medical staff. One of the most common manifestations of work-related distress is emotional burnout syndrome (EBS). The emotional burnout in psychiatrists is favored by many specific work factors.Objective: to investigate the relationship between EBS in psychiatrists and the outcomes of the care they provide.Material and methods. Eighty-two psychiatrists working in psychiatric clinics in Moscow took part in the study. They completed the Maslach Burnout Inventory on their own. Two hundred medical records of hospitalized patients suffering from paranoid schizophrenia were selected. A total of 100 patient records of psychiatrists with emotional burnout and 100 patient records of psychiatrists without emotional burnout were analyzed.Results. Emotional burnout was found in 25.6% of psychiatrists. In cases of emotional burnout, psychiatrists were more likely to prescribe anticholinergic corrective medication for extrapyramidal symptoms (61% versus 44%; p=0.023). The presence of emotional burnout in psychiatrists correlated with a longer duration of hospitalization of patients they cared for (31.2 versus 29 days; p=0.004) and with more frequent polypharmacy (67% versus 51%; p=0.031).Conclusion. Emotional burnout in psychiatrists has a negative impact on the quality of care they provide.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PERAWATAN KELUARGA TERHADAP ORANG DENGAN GANGGUAN JIWA (ODGJ)

Family care is very important for people with mental disorders, because the family is the most important person to optimize mental peace for people with mental disorders. The aim of this research is to find out what factors are related to family care for people with mental disorders at the Regional Mental Hospital Polyclinic, Dr. Samsi Jacobalis Bangka Belitung Islands Province in 2024. This research is a quantitative study with a cross-sectional. The samples in this study were families of people with mental disorders who were recorded and registered as visiting the Polyclinic at the Regional Mental Hospital, dr. Samsi Jacobalis of Bangka Belitung Islands Province as many as 89 people. Data analysis used the chi square test with a confidence level of 95%. The results of this study concluded that the factors related to family care were education level (p=0.000), economic level (p=0.001), genetics (p=0.000) and the more dominant factor was knowledge (p=0.000 and POR=11.340). The conclusion in this study is that educational level, economic level, genetics and knowledge have a relationship with family care for people with mental disorders at the Regional Mental Hospital Polyclinic, Dr. Samsi Jacobalis Bangka Belitung Islands Province in 2024. The suggestion from this research is that it is hoped that the results of this research will be used as literature and reference to improve outreach and education in the community about the importance of family care for people with mental disorders, because ODGJ really need a helping hand and care.

Corrosion of care and disempowerment in acute psychiatry: As seen from the positions of therapists and suicidal patients.

For people in suicidal crisis, referral to a psychiatric hospital is common. However, acute psychiatry is characterized by a lack of resources in terms of time and beds, making it challenging for therapists to provide person-centered care. In this qualitative study, we explored the experiences and positionings of therapists and suicidal patients in an acute psychiatric ward in Norway. We generated data through participatory observation and interviews with therapists and patients and analyzed the material using principles from Systematic Text Condensation supplemented with an analysis from a Positioning theory perspective. We developed two themes: Therapists positioned as professionals with authority in a context with restricted action radius, and Patients in suicidal crisis positioned as medical subjects with limited influence. In this resource-limited context, therapists managed their work and obligations by simplifying the patient's suffering and suicidality and by emphasizing medical aspects. Ensuring an efficient patient flow was a high priority. The therapists' authority and actions were closely connected to how patients were positioned and their experiences of the care. Positioning theory provides new perspectives for understanding the power imbalance in the positions of therapists and patients. The findings provide insights into acute inpatient psychiatry as a normative field where the choices and actions of both therapists and patients are restricted. In that sense, both patients and therapists can feel powerless. The findings point to significant limitations in the acute mental health care of people in suicidal crisis.

Charles Dickens: the Legacy of “a Rock Star” in Lowell, Massachusetts (1842). Navigating the Victorian Writer’s Concern for Social Welfare

The article will introduce the first American tour, with a focus on the visit to Lowell, Massachusetts, of the famous Victorian writer Charles Dickens (1812-1870). When he arrived in Boston in January 1842 with his wife, he was welcomed like “a rock star”. He then embarked on a tour of the American prisons, hospitals, mental institutions and in February he reached the industrial town of Lowell, where he was mostly interested in the recently opened textile mills, the “mill girls” and immigration. Upon his return from the US, Dickens published American Notes, portraying America in both negative and positive notes. All in all, it appears that America had a significant role in Dickens’s career as it made him use his growing influence as a public figure. The UMass Lowell organized in 2012 a Dickens in Lowell celebration of the tour, continued by an extended Dickens in Lowell Project, meant to promote the town as a cultural and literary tourist destination by focusing on a writer deeply concerned with the welfare of the society. Virtual tourists are also encouraged to learn more about Dickens’s stay in Lowell by accessing an online guide of the writer’s stops in the town (https://dickens.archives-uml.com/VWT/WalkingTour/INDEX.html).

Suicidality and use of psychotropic medications in patients with schizophrenia: a prospective cohort study.

The lifetime prevalence of suicide is around 5% in patients with schizophrenia. Non-adherence to antipsychotic medication is an important risk factor, but prospective studies investigating joint effects of antipsychotic drugs, antidepressants, and benzodiazepines on suicidality are scarce. We aimed to investigate how use and non-use of psychotropic medications are associated with suicidality in schizophrenia. An open cohort study followed all patients consecutively admitted to a psychiatric acute unit during a 10-year period with a diagnosis of schizophrenia (n = 696). Cox multiple regression analyses were conducted with use of antipsychotics, antidepressants, and benzodiazepines as time-dependent variables. Adjustments were made for age, gender, depressive mood, agitated behavior, and use of alcohol and illicit substances. A total of 32 (4.6%) suicide events were registered during follow-up. Of these, 9 (28%) were completed suicides and 23 (72%) were attempted suicides. A total of 59 (8.5%) patients were readmitted with suicidal plans during the follow-up. Compared to non-use, use of antipsychotics was associated with 70% lower risk of attempted or completed suicide (adjusted hazard ratio [AHR] = 0.30, p < 0.01, CI 0.14-0.65) and 69% reduced risk of readmission with suicidal plans (AHR = 0.31, p < 0.01, CI 0.18-0.55). Use of prescribed benzodiazepines was associated with 126% increased risk of readmission with suicidal plans (AHR = 2.26, p = 0.01, CI 1.24-4.13). Adherence to antipsychotic medication is strongly associated with reduced suicidal risk in schizophrenia. The use of prescribed benzodiazepines was identified as a significant risk factor for being readmitted with suicidal plans.

The Impact of Child and Adolescent Inpatient Psychiatric Admissions Out-of-Area or to Adult Wards: A Systematic Review

Aims/Background Child and adolescent psychiatric inpatient admissions out-of-area or to adult wards are frequently discussed in the national media. No previous systematic reviews have investigated the impact of such admissions. Methods Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, PsycArticles, King’s Fund, Google Scholar, The Health Foundation, Social Care Online, Cochrane Library, Royal College of Psychiatrists, Web of Science and Econ light databases were conducted alongside grey literature searches. All eligible studies investigating the impact of acute psychiatric inpatient admission out-of-area or to adult wards in children and adolescents were included. Risk of bias was assessed using an adapted version of the Hawker critical appraisal tool. Results 18 studies were included (4 reported on out-of-area admissions, 13 on adult ward admissions, 1 study reported on both). Study quality was variable. Out-of-area admission impacts included longer emergency department waits, higher travel costs for families, and were described as ‘time-inefficient’. For studies of admissions of under-18s to adult psychiatric wards the most commonly reported impact was on length of stay. Opinions from staff and young people of these types of admissions were mostly negative. Conclusion Further studies looking at the full range of impacts of these admissions over the long term are needed.

Persisting unhealthy eating behaviors and the role of dieting in outpatients treated for severe mental illness: Findings from a longitudinal study.

Individuals living with severe mental illness (SMI) are at higher risk of being overweight and obese. In addition to medication side effects, poor dietary habits are considered as modifiable factors. However, individuals with SMI face a variety of barriers to healthy eating, and it is still unclear which dietary strategies are best. The current study aimed to examine the course of dietary habits in dieting and non-dieting patients treated at a psychiatric day clinic. In this longitudinal observational study, symptom severity, dietary habits, and other health-risk behaviors of n = 53 psychiatric outpatients with a primary ICD-10 diagnosis (85% F3 and 15% F2) were assessed at the start of treatment in a psychiatric day clinic and after 3 months using semi-structured interview data and anthropometric measurements. Patients' mental health improved after 3 months of treatment (e.g. lower scores on a modified Global Assessment of Functioning Scale (m-GAF) and on the 9-item Patient Health Questionnaire (PHQ-D)). However, BMI and lifestyle behaviors (e.g. diet quality, physical activity, and smoking) remained unchanged. Fewer depressive symptoms and dieting were even associated with weight gain over the 3 months (+1.7 kg). Compared with non-dieters, dieters had higher levels of neuroticism and ambivalence about eating, were more likely to overeat and were more dissatisfied with their body weight. The group of dieters may benefit from professional support to achieve a healthier lifestyle.

Barriers to Mental Health Services Utilization

The use of health services is defined as the process of seeking professional healthcare and submitting oneself to the application of regular health services with the purpose to prevent or treat health problem .Person suffering from mental illness usually face different barriers . The problem of underutilization of mental health services may be due to: (1) barriers to initiation of mental health services and (2) barriers to persistence in treatment once it is sought. People with a number of unmet needs are likely to experience poor quality of life as well. Any mental health service that aims to improve the quality of life of patients’ needs to actively assess for these factors as early recognition can help in optimizing planning of treatment and implementation of care ensuring effectiveness of psychiatric care. It also plays a critical role in mental health rehabilitation Such an identification could lead to implementation of targeted stigma reduction strategies in addition to regular management plan. Methodology A cross sectional study was performed in Mental Hospital, Lalitpur, Nepal. People suffering from mental illness who fulfilled the inclusion criteria were recruited and BACE scale was administered along with relevant details of participants . Results Most of the participants were from Bagmati Province (65.1%, n=192) whereas least participation was from Sudurpaschim Province (2.1%, n=6). The mean age of participants was 35 years with majority belonging to the age group of 26-35 years (37.3%, n=109). The participation of males (54.5%, n=159) was greater than that of females (45.5%, n=133). The participation of divorced and widow/er was very less (2.4%, n=7) compared to those who were married (71.2%, n=208) or unmarried (26.4%, n=77). A vast majority were Hindus (77.4, n=226) followed by Buddhist (12%,N=35 and Christians (9.6%, n=28 ) and others (1%,n=3). Majority of the participants had completed their higher secondary (38.4%, n=112) and secondary (19.5%, n=57) education followed by no formal education (13.4%,n=39) and those with post graduate education and above (1.7% ,n=5). Regarding occupation, the number of unemployed (36.6%, n=107) was highest followed by service holders (17.8%, n=52), others (16.1%, n=47 ),farmer (15.8%,n=46) and business owners (13.7%, n=40) respectively. Socioeconomic status was measured using Kuppuswamy scale and it was found that most of the participants belonged to middle (63.4%, n=185) followed by upper (22.6%, n=66) and lower (14%, n=41) socioeconomic status. Among the patient reported barriers related to stigma ,the most reported concern was “ concerned that I might be seen as weak for having a mental health problem “(33.6 %),followed by “concern that I might be seen as crazy “ (26.4%) ,followed by “Concern that my children may be taken into care or that I may lose access or custody without my agreement “ (22.6%) and ” feeling embarrassed or ashamed “ (21.6 %) . Among the reported instrumental barriers in BACE scale , “having no one who could help me get professional care (18.2)“ was the most reported major barrier followed by “ being unsure where to get professional care “(17.8)“ followed by being too unwell to ask for help “ (14.4%). Among the different attitudinal components in BACE scale “wanting to solve problem on my own” (21.9%) was the most reported barrier followed by “dislikes of talking about my feelings, emotions or thought “(19.5%) and “thinking that I don’t have problem”(17.8%). Conclusion Thus, it can be concluded that people people suffering from mental illness also experience different barriers during help seeking . This barriers is found more on people below 45 years of age and people with low socio economic status . This barriers influences the quality of life in terms of decline in physical health and environment.

Who's Prone to Breaking the Rules?-Predictors of Challenging Patient Behavior in Forensic Addiction Treatment.

Many patients in substance use disorder treatment exhibit behavior that is challenging for therapy. In Germany, offenders with addiction problems may be sentenced to treatment in forensic psychiatric institutions (Sect. 64 of the German Criminal Code). In general, therapy-challenging behavior (TCB) increases the risk that forensic addiction treatment (FAT) will fail. This article identifies a set of indicators allowing therapists to assess the risk of TCB during FAT. We define TCB as any substance use, escapes/abscondence and disciplinary incidents by patients. As potential predictors, anamnestic sociodemographic data, disorder-related variables, and delinquency-related data (set A) in addition to the therapists' assessments of the therapy process (set B) were analyzed. N = 548 records of patients, who had been in treatment for at least 12 and at most 24 months, were included in this study. Patients were treated in several forensic institutions throughout Germany. N = 187 patients showed at least one type of TCB (34.1%). In a first univariate step (applying Chi²-tests or t-test) various possible predictors were identified. Their predictive values were then analyzed in three binary stepwise logistic regression models. The first comprises set A predictors, the second set B and a third inclusive model combined both sets of variables (set AB). The combination of anamnestic and treatment-related variables (AB) proved to be superior to the other models and resulted in a significant model for prediction of TCB (p < .001). It includes seven variables and explains more than one third of TCB variance. The findings allow TCB in FAT to be more quickly identified in a population at risk and offer the possibility to provide these patients with appropriate treatment.

‘We tried our best... it wasn’t great’: a qualitative study of clinician experiences on child psychiatry wards at the height of COVID-19

Changing public health and hospital protocols during the height of the COVID-19 pandemic shaped the provision of inpatient mental health care. While a growing body of research explores the challenges of restrictions on adult psychiatric wards, the impact on clinical teams and epidemiological trends in youth mental health, no research has explored inpatient psychiatric hospital services for child and adolescent psychiatry during the pandemic. This study seeks to understand how clinicians in Canada working in child and adolescent mental health wards experienced caring for their patients while navigating pandemic hospital restrictions. Following a qualitative descriptive methodology and also drawing on institutional ethnography we generated data using two methods: 1) an online survey of clinicians across the country asking about experiences providing care and COVID restrictions and 2) in-depth, semi-structured interviews with clinicians. Data from 54 surveys and 14 interviews were analyzed using thematic analysis yielding two major themes. First, clinicians felt that clinical care was compromised with likely impact on patient outcomes. Second, respondents reported that the context of the pandemic provoked tensions and resistance within the clinical teams and the institution. Our findings have important implications not only for future public health crises, but also for rethinking how psychiatric care is provided and prioritized. This study points to the need for 1) mechanisms which support collaborative decision making at the institutional level, to ensure regulations are more flexible and can adapt to the needs of child mental health patients; and 2) that child psychiatry prioritize generating spaces of ethical reflection for clinical teams and institutional decision-makers so that paternalism does not trump principles of primum non-nocere (first, do no harm), autonomy and reciprocity.

Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial.

The impact of light exposure on mental health is increasingly recognised. Modifying inpatient evening light exposure may be a low-intensity intervention for mental disorders, but few randomised controlled trials (RCTs) exist. We report a large-scale pragmatic effectiveness RCT exploring whether individuals with acute psychiatric illnesses experience additional benefits from admission to an inpatient ward where changes in the evening light exposure are integrated into the therapeutic environment. From 10/25/2018 to 03/29/2019, and 10/01/2019 to 11/15/2019, all adults (≥18 years of age) admitted for acute inpatient psychiatric care in Trondheim, Norway, were randomly allocated to a ward with a blue-depleted evening light environment or a ward with a standard light environment. Baseline and outcome data for individuals who provided deferred informed consent were used. The primary outcome measure was the mean duration of admission in days per individual. Secondary outcomes were estimated mean differences in key clinical outcomes: Improvement during admission (The Clinical Global Impressions Scale-Improvement, CGI-I) and illness severity at discharge (CGI-S), aggressive behaviour during admission (Broset Violence Checklist, BVC), violent incidents (Staff Observation Aggression Scale-Revised, SOAS-R), side effects and patient satisfaction, probabilities of suicidality, need for supervision due to suicidality, and change from involuntary to voluntary admission. The Intent to Treat sample comprised 476 individuals (mean age 37 (standard deviation (SD) 13.3); 193 (41%) were male, 283 (59%) were female). There were no differences in the mean duration of admission (7.1 days for inpatients exposed to the blue-depleted evening light environment versus 6.7 days for patients exposed to the standard evening light environment; estimated mean difference: 0.4 days (95% confidence interval (CI) [-0.9, 1.9]; p = 0.523). Inpatients exposed to the blue-depleted evening light showed higher improvement during admission (CGI-I difference 0.28 (95% CI [0.02, 0.54]; p = 0.035), Number Needed to Treat for clinically meaningful improvement (NNT): 12); lower illness severity at discharge (CGI-S difference -0.18 (95% CI [-0.34, -0.02]; p = 0.029), NNT for mild severity at discharge: 7); and lower levels of aggressive behaviour (difference in BVC predicted serious events per 100 days: -2.98 (95% CI [-4.98, -0.99]; p = 0.003), NNT: 9). There were no differences in other secondary outcomes. The nature of this study meant it was impossible to blind patients or clinical staff to the lighting condition. Modifying the evening light environment in acute psychiatric hospitals according to chronobiological principles does not change duration of admissions but can have clinically significant benefits without increasing side effects, reducing patient satisfaction or requiring additional clinical staff. Clinicaltrials.gov NCT03788993; 2018 (CRISTIN ID 602154).

Role of turnover, downsizing, overtime and night shifts on workplace violence against healthcare workers: a seven-year ecological study

BackgroundAbout one-third of workers identify organisational factors as contributors to workplace violence (WPV), but the associations between these factors and WPV have primarily been explored retrospectively and with measures of perceived organisational constraints, hence providing limited information for prevention. Therefore, we assessed whether objectively measured ward-level indicators of turnover, downsizing, overtime, and night shifts are associated with the occurrence of WPV and whether these associations vary by ward type.MethodsWe conducted an ecological study at a university hospital in northern Italy from 2016 to 2022, using wards as statistical unit (average: 230 wards per year). Active surveillance of WPV was based on an in-hospital incident reporting procedure, updated in November 2021 based on Health Regional Administration guidelines; 2021 was therefore excluded as a transition year. Individual-level administrative data were used to compute ward-level yearly indicators of turnover, downsizing, overtime and night shifts per active worker. Using generalised linear models, we estimated rate ratios (RRs) for yearly WPV counts per 1 SD increase in the indicators, controlling for study period, ward type (emergency department [ED], psychiatric ward, other) and ward sociodemographic composition.ResultsA total of 337 WPV episodes occurred in the 1381 ward-year observations. The WPV rates per 100 active workers per year increased from 1.40 (95%CI: 1.23–1.60) during 2016–2020 to 3.48 (2.90–4.17) in 2022. Higher turnover (RR, 95%CI: 1.47, 1.23–1.75) and downsizing (1.12, 1.00-1.24) were associated with a greater occurrence of WPV across all wards; these associations were consistent across the study periods. In wards with night shift scheduling, turnover (1.64, 1.40–1.92), downsizing (1.21, 1.04–1.40) and the mean number of night shifts (2.50, 1.37–4.56) were associated with WPV. The association between night shifts and WPV was greater in psychiatric wards (RR = 8.73; interaction p-value = 0.02), whereas the role of downsizing was greater in EDs (RR = 1.42, interaction p-value = 0.09) and the role of turnover was greater in the other wards (RR = 1.34, interaction p-value = 0.16).ConclusionWork organisational factors are associated with the occurrence of WPV episodes against healthcare workers. Ward type-tailored priorities should be given to minimising turnover and downsizing and promoting a fairer allocation of night shifts to decrease WPV occurrence.

Quality of cognitive-behavioural therapy in routine psychiatric care: therapist adherence and competence, and patient outcomes for depression and anxiety disorders

BackgroundQuality of care is essential for the dissemination of evidence-based practices, yet therapist adherence and competence are seldom assessed. We examined the quality of delivery of cognitive-behavioural therapy (CBT) in routine psychiatric care for depression and anxiety disorders, considering therapist adherence and competence, and therapy effectiveness, as well as their associations.MethodsTwenty-nine therapists recruited 85 patients with a principal diagnosis of depression or anxiety disorder from two routine psychiatric outpatient clinics in Stockholm, Sweden. Therapist adherence was assessed mid-CBT by observers and post-CBT by patients and therapists, respectively, using an instrument developed as part of the present study. Therapist competence was assessed using role-plays with a standardised patient. Patients rated symptoms, functional impairment, and global health pre- and post-CBT. Linear mixed models were used to analyse associations.ResultsTherapist adherence was high according to patients, moderate to high according to therapists, and moderate according to observers. Most therapists demonstrated competence in CBT, as assessed using the Cognitive Therapy Scale-Revised (M = 40.5, SD = 6.5; 76% passed the ≥ 36 points competence threshold). Patients improved significantly from pre- to post-CBT across outcome measures (Cohen’s ds = 0.80 – 1.36). Neither therapist adherence nor competence was associated with patient outcomes.ConclusionsIn routine psychiatric care, therapists delivered CBT with adherence, competence, and improvements for patients with depression and anxiety disorders, on par with previous research results in controlled settings. The implications for quality assessment and improvement are discussed.Trial registrationClinicalTrials.gov NCT03625024 10/08/2018.

Theta power reduction and theta–gamma coupling desynchronization are associated with working memory interference and anxiety symptoms in panic disorder: a retrospective study

BackgroundTheta-gamma coupling (TGC) describes the modulation of gamma oscillations by the theta phasic activity, which is crucial for processes such as the ordering of information during working memory (WM) performance. The mental arithmetic (MA), which involves performing calculations with numbers, is a crucial tool for evaluating and understanding the sensory processing and management abilities of WM. Evaluating TGC may provide greater insight into the neural mechanisms mediating WM deficits in panic disorder (PD).MethodsMedical and electroencephalography (EEG) records of psychiatric outpatient clinic between 1 March 2020 and 30 September 2023 were retrospectively reviewed. A total of 34 PD patients and 34 age- and sex-matched healthy controls (HCs) underwent EEG to assess the overall functional interaction of the brain using multi-channel EEG analysis, focusing on specific brain regions including the frontal, temporal, parietal, and occipital lobes. EEG recordings were conducted during two sessions: a 5-min eyes-closed resting-state (RS) and a subsequent 5-min eyes-closed MA. The TGC and the spectral power of the theta and gamma frequency bands, which are well known to be associated with WM, were analysed.ResultsCompared to those in HCs, TGC and theta power were significantly attenuated in PD patients. When analysing both HCs and PD patients together, RS TGC and relative theta power were negatively correlated with state anxiety and perceived stress scores, respectively. In contrast, TGC and relative theta power during the MA condition were positively correlated with the MA performance. Specifically, in PD patients, RS theta power across all electrodes was significantly negatively correlated with the Hamilton Anxiety Scale (HAMA) score. Linear regression analysis revealed that theta power in the T5 channel remained negatively correlated with pathological anxiety as measured by the HAMA score, even after controlling for other confounding factors.ConclusionsThis study highlights significant alterations in TGC and theta power in PD patients. PD patients exhibit reduced TGC and theta power compared to HCs, indicating deficits in the neural mechanisms underlying anxiety and/or WM in PD. These insights contribute to a better understanding of the neural basis of WM deficits in PD and suggest potential avenues for targeted therapeutic interventions.

Aggressivity in Schizophrenia: The Risk and Confounders in a Romanian Setting

&lt;p dir="ltr"&gt;&lt;span&gt;There is an increased stigma in Romania regarding schizophrenia patients, who are thought to be violent and dangerous. However, there is little research on this topic that analyzes the exact risk of aggressive behavior, especially considering the high prevalence of alcohol and substance abuse, conditions also associated with a potential risk of violent behavior. The objectives of this study were to compare aggressivity levels between patients with schizophrenia admitted to an emergency hospital and healthy individuals and to find possible risk factors. This case-control study, matched for age and gender included 50 patients hospitalized for schizophrenia and 50 healthy participants from an emergency psychiatric facility in Romania. We collected demographic data and screened for major mental disorders using the Mini International Neuropsychiatric Interview (MINI). Aggressivity levels were measured with the Buss-Perry Aggression Questionnaire (BPAQ). The CAGE questionnaire and the Drug Abuse Screening Test (DAST-10) were used to screen for alcohol and substance use disorder. The results highlighted a 3.93 times increase in aggressivity in the schizophrenia group, with the involvement of specific violent domains. Younger men with alcohol abuse had a higher risk of violent acts. Schizophrenia patients appear to present an increased risk of violence, but this must be carefully assessed and confounders considered. Public health programs are needed to increase treatment compliance and decrease alcohol and other psychoactive substances consumption. &lt;/span&gt;&lt;/p&gt;

Assessment of Administrative Services in State Mental Health Hospitals Among Muslim Patients in the Kingdom of Saudi Arabia: A Descriptive Study

Kingdom of Saudi Arabia (KSA) leads mental health research in the Arabic world, addressing challenges for Muslim patients seeking treatment at hospitals. This study aims to evaluate the quality of administrative services at public mental health hospitals, as perceived by Muslim recipients in the KSA. This descriptive quantitative study used a self-reported questionnaire to collect data from 200 public mental health service recipients in the KSA from 4 January 2022 to 4 March 2022. More than 95% of participants were optimistic about the entry process procedures. Approximately 88% of the participants accepted the policies for booking an appointment with a doctor. The study’s findings highlight the need to streamline and improve the communication of administrative procedures to provide recipients with optimal clarity and convenience. By addressing the moderately reported issues with policy transparency related to visit cancellations, referrals, and treatment completion, patient satisfaction and compliance could be improved, leading to a more efficient and patient-centred healthcare experience. These findings underscore the importance of streamlining administrative procedures to enhance clarity and convenience for Muslim patients, ultimately contributing to a more patient-centred healthcare experience in mental health hospitals in the KSA.