Psychiatric Health Care Facilities Research Articles

Do Universities Improve Local Economic Resilience?

Abstract We use a novel identification strategy to investigate whether regional universities make their local economies more resilient. Our strategy is based on state governments using similar site-selection criteria to assign normal schools (to train teachers) and insane asylums between 1830 and 1930. Normal schools became larger regional universities while asylum properties mostly continue as small state-owned psychiatric health facilities. We find that a regional university roughly offsets the negative effects of manufacturing exposure. We show the resilience of regional public university spending is an important mechanism, and we show correlations consistent with bachelor’s degree share also playing a mediating role.

HYGIENIC ASPECTS OF ARCHITECTURAL AND PLANNING SOLUTIONS FOR THE CONSTRUCTION OF MENTAL HEALTH FACILITIES

In order to take into account the hygienic aspects of architectural and planning solutions in the construction of new mental health facilities (general hospitals, crisis units, hospices, psychological care centers, etc.), multidisciplinary groups should be involved – architectural and planning, urban planning units, the public, medical representatives of medical institutions, relatives, patients, to take into account all the necessary in-hospital factors. To conduct a hygienic assessment of architectural and planning solutions for buildings of psychiatric health care institutions in Ukraine that were built in the eighteenth and nineteenth centuries and to provide a comparative description of the hygienic standards of psychiatric health care institutions in different countries. The study was conducted on the basis of the analysis of the DBN B.2.2-10:2022 "Health Care Facilities", scientific sources of domestic and foreign scientists. A survey was conducted among chief physicians of psychiatric hospitals in Ukraine on safe sanitary and hygienic, anti-epidemic conditions of psychiatric health care facilities. There were 55 psychiatric hospitals in Ukraine before the outbreak of full-scale war: 28.6% of them were built in the eighteenth and nineteenth centuries (from 1786 to 1945), 28.6% after the Great Patriotic War (from 1945–1991), and 42.8% during the period of Ukraine's independence (from 1991–2013). Only 25% of psychiatric institutions have playgrounds for outdoor games equipped with tennis tables and volleyball nets (for table tennis and volleyball), 25% of hospitals have playgrounds for quiet recreation (chess, dominoes), and 12.5% have playgrounds for physical education and recreation (sports and play areas). At the same time, 41.6% of these sites are in satisfactory condition. Ukraine has adopted the State Construction Standards of Ukraine DBN B.2.2-10:2022 "Healthcare Facilities. Basic Provisions". It provides basic provisions for the design of health care facilities (buildings and structures of all types of health care facilities) during new construction and reconstruction or during major repairs in health care facilities. However, there is currently no formal sanitary legislation containing sanitary, epidemiological and hygienic requirements for the decoration, equipment and operation of health care facilities with inpatient units.

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

The prevalence of substance use disorders and associated characteristics among patients admitted to a psychiatric hospital in Botswana.

Substance use disorders (SUDs) have increased substantially across the globe, and has become one of the world's most significant public health and socioeconomic challenge. This study examined the prevalence and patterns of substance use disorders among patients admitted to the main psychiatric hospital in Botswana, the Sbrana Psychiatric Hospital. This was a cross-sectional study of patients admitted to a major psychiatric hospital in Botswana. SUDs were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) v13.0. Bivariate analysis was conducted to determine the association between socio-demographic characteristics and SUDs. Multivariate logistic regression was used to control for confounders. The final analysis involved 101 patients. Participants ranged in age from 18-60 years, and over half (59.4%) were male. The majority of participants (85.1%) had used potentially addicting substances at least once during their lifetime, with 63.4% having current substance use disorders. The most frequently used substances were tobacco, cannabis, alcohol, and cocaine at 58.4%, 42.6%, 34.7% and 12.8% respectively. SUDs were more common among participants who were male, ages 18-35 years, single, had a tertiary education, or were unemployed. There is a high prevalence of substance use and SUDs among psychiatric patients in Botswana. Screening for and interventions to manage SUDs should be part of routine care at psychiatric health care facilities in this country. Consideration should be given to the screening of all patients admitted to psychiatric hospitals in Botswana for SUDs using the ASSIST.

Hygienic assessment of new architectural and planning solutions of buildings of psychiatric health care facilities

Aim: to conduct a hygienic assessment of new architectural and planning solutions of psychiatric health care facility buildings in Ukraine and give a comparative description of the sanitary standards of the latter in the EU. The study was conducted based on the analysis of State Building Norms (SBN) B.2.2-10:2019 “Buildings and structures. Health care facilities” (draft, final revision), scientific sources of domestic and foreign scientists. A survey of the chief physicians of psychiatric hospitals of Ukraine concerning safe sanitary and hygienic, anti-epidemic conditions for the functioning of psychiatric health care facilities was conducted. We consider it necessary to present more carefully architectural and planning solutions in the relevant section of SBN B.2.2-10:2019 (draft, final revision) or to use the opportunity specified in the introduction to these Norms, and to supplement them with the Manual on the design of psychiatric health care facilities, taking into account the experience of the European Union. To create an appropriate “therapeutic environment” in new domestic mental health care facilities, it is necessary to implement European requirements in the design of these facilities with the involvement of multidisciplinary groups: (from architects to nurses, from construction contractors to patients) and supplement SBN B.2.2-10:2019 “Buildings and structures. Health care Facilities” of Ukraine with a guide for designing facilities of a new type of “Mental Health Centers” as in the Republic of Poland. We have developed and sent to the chief physicians of psychiatric hospitals of Ukraine «Questionnaire for scientific sanitary and epidemiological assessment of the conditions of placement of a psychiatric health care facility”. Based on the analysis of the block of questions on sanitary and antiepidemic and sanitary and hygienic parameters that characterize the buildings of domestic psychiatric hospitals, the location of medical structures and auxiliary units on the land plot, i.e. the design of buildings is determined. In particular, 50% of psychiatric hospitals are housed in combined buildings, 25% have a pavilion system (separate buildings), 12.5% each have a centralized system (all in one building) and a block system. The number of stories of psychiatric hospitals up to 2 is 50%, up to 3 – 37.5% and up to 5 stories in those which have been under construction since 1960 – 12.5%. Analysis of the questionnaire block on the conditions of stay, treatment, rehabilitation of the mentally ill revealed the possibility of organizing occupational therapy in 12.5% of psychiatric hospitals, where special workshops are equipped and patients can acquire professional skills. Physiotherapy rooms are equipped in 50% of psychiatric hospitals. Low provision of patients with furniture was revealed: 25% of patients partially have proper desk, 75% do not have it; 50% are provided with proper chairs; 62.8% use proper bedside tables and 25% – closets for storing personal clothes.

Stigmatization and discrimination towards human immunodeficiency virus seropositive patients in psychiatric and mental health facilities.

Stigmatization and discriminatory attitudes of nurses towards human immunodeficiency (HIV) patients have been reported in many countries. The current study was undertaken to assess the knowledge, attitudes and factors associated with stigmatizing attitudes and discrimination among psychiatric and mental health nurses and nurse interns towards patients diagnosed with the human immunodeficiency virus; utilizing a single-centre hospital-based survey design. Primary data were collected using a previously validated questionnaire in a large mental health care hospital in Riyadh, Saudi Arabia. Knowledge, attitudes, acts of discrimination and associated factors on the part of mental health nurses towards those diagnosed with the HIV were identified. The study described herein is in accordance with the STROBE guideline. A total of 241 psychiatric and mental health nurses completed the questionnaire, yielding a completion rate of 74.4%. Overall, more than half of the nurses demonstrated gaps in knowledge and reported higher stigmatizing attitudes and acts of discrimination. Factors associated with stigmatization and/or discrimination include higher exposure to seropositive patients, no formal HIV training, lower religiousness, lower awareness of HIV testing policy and lower level of knowledge about HIV infection. There is an urgent need to implement a training program that will help to reduce stigma among nurses caring for people diagnosed with this illness.

Strategies utilized to prevent and control SARS-CoV-2 transmission in two congregate, psychiatric healthcare settings during the pandemic

BackgroundThe COVID-19 pandemic has had a substantial effect on the delivery of psychiatric health care. Inpatient psychiatric health care facilities have experienced outbreaks of COVID-19, making these areas particularly vulnerable. MethodsOur facility used a multidisciplinary approach to implement enhanced infection prevention and control (IPC) interventions in our psychiatric health care areas. ResultsIn a 16-month period during the COVID-19 pandemic, our 2 facilities provided >29,000 patient days of care to 1,807 patients and identified only 47 COVID-19 positive psychiatric health inpatients (47/1,807, or 2.6%). We identified the majority of these cases by testing all patients at admission, preventing subsequent outbreaks. Twenty-one psychiatric health care personnel were identified as COVID+ during the same period, with 90% linked to an exposure other than a known positive case at work. DiscussionThe IPC interventions we implemented provided multiple layers of safety for our patients and our staff. Ultimately, this resulted in low SARS-CoV-2 infection rates within our facilities. ConclusionsPsychiatric health care facilities are uniquely vulnerable to COVID-19 outbreaks because they are congregate units that promote therapeutic interactions in shared spaces. IPC interventions used in acute medical care settings can also work effectively in psychiatric health care, but often require modifications to ensure staff and patient safety.

Psychiatric comorbidities in adolescents with substance-use disorder

Introduction Comorbidity between substance abuse and other psychiatric disorders has been excessively documented in adults while rarely been investigated in adolescents.Aim The study investigated the prevalence of psychiatric comorbidities among adolescent patients with substance-use disorder attending psychiatric health facilities in Suez Canal region.Patients and methods It was a cross-sectional study conducted on 120 adolescent patients aged 13–19 with substance-use disorder attending psychiatric health facilities in Suez Canal region. Data were collected using comprehensive psychiatric history, Mini-International Neuropsychiatric Interview, complete physical and neurological examination, and urine toxicology screen.Results Most of the study-sample participants were polysubstance abusers (89.1%). Cannabis was the commonest substance abused (90.8%). More than half of the patients (53.3%) had psychiatric comorbidity with onset before the abuse of the substance, 27.5% had psychiatric comorbidity after abusing the substance, and 19.2% had no psychiatric comorbidity. Major depressive disorder was the most prevalent disorder (40.8%) among the patients, followed by conduct disorder (38.3%).Conclusion Depression and conduct disorder are the most common psychiatric disorders among adolescent patients with substance-use disorder.

Attitude of health care workers in the field of mental health to their health

The article presents the results of theoretical and experimental studies of the degrees of value-motivational, cognitive, emotional, and behavioral components in health care workers of psychiatric health care facilities concerning their health. The degree of risk and value of the personal hygiene of health care workers is determined. The main components and factors that affect the attitude to personal health are revealed. The awareness of the own emotional and cognitive experiences by the medical staff of psychiatric hospitals regarding the preservation and strengthening of their hygiene is analyzed. According to research on the value-motivational component of the medical staff of psychiatric health care concerning the place of personal health in the hierarchy of values in life, it was found that own health is on the second place – 15.2% males, nursing staff (NS), 15.1% females, are psychiatrists and women NS, 14.8% are men psychiatrists. In case of a deterioration of own health both women (35,6%), and men (35,5%) psychiatrists are engaged in self-treatment, the similar tendency is among NS – women NS – 31,3%, men NS – 31, 5%), in 25.8% of cases female psychiatrists and in 23.1% of men NS do not pay attention to the disease at all, which leads to occupational diseases and chronic diseases. At the same time, occupational diseases among doctors and NS do not exceed 10% of the total number of occupational diseases in Ukraine due to self-medication and early treatment. Therefore, the statistics of occupational diseases of health workers in that field are underestimated compared to the actual ones.

Substantiation of the sanitary-epidemiological component to the new edition of the state-building norms of Ukraine “Health care institutions” concerning designing of psychiatric hospitals, taking into account the international experience

Annotation. The aim of the work was to evaluate the design decisions of new psychiatric health care facilities in Ukraine and their comparative characteristics with EU institutions. An analysis of the requirements for the design of domestic new psychiatric wards, day hospitals in outpatient psychiatric wards in general hospitals according to paragraph 8.2.15 SBN B.2.2-10: 2019. State building codes of Ukraine “Buildings and structures. Healthcare facilities” (draft, final version) and European facilities of the same type based on the study of literature data. The method of theoretical analysis is used. It was found that conditions of the location of inpatient departments, their zoning, composition, and area of premises, requirements to ensure a safe stay of patients in wards, toilets, and bathrooms are regulating in the new SBN B.2.2-10: 2019. This essentially repeats the sanitary and hygienic requirements of the previous document SBN B .2.2-10: 2001 “Healthcare facilities”, ie no changes are aiming at creating an ecological environment and comfortable conditions for patients and medical staff of psychiatric healthcare facilities. In this normative document, there is no clear understanding of the location of medical facilities and the next post of a nurse in inpatient departments of psychiatric hospitals; there is no area for a private stay of patients with mental disorders in the middle of the department and outside it; the regulations of life support systems for nurses and patients in the inpatient department (lighting, noise, air exchange, etc.) of psychiatric hospitals are not standardized. In European psychiatric clinics, the “therapeutic environment” provides for the presence of single and double wards (coincides with domestic building codes); area of 37.7 m2 per patient under foreign law, while the project DBN B.2.2-10: 2019 – the zone per patient is 12 m2, which is three times less; separate bathrooms and toilets, common areas, individual access to the garden, where the conditions of privacy of patients are creating (not provided by Ukrainian regulations); location of most patient rooms around the central work area for medical staff (according to national legislation – a corridor-type system); creation of visual supervision over the doors of bedrooms, showers, toilets, kitchens, garden gazebos, as well as the selection of colours for painting the walls of wards and corridors of offices (not provided by Ukrainian regulations). To create a proper “therapeutic/healing environment” in new domestic mental health facilities (psychiatric wards, day hospitals in outpatient psychiatric wards in general hospitals, mental health centres), it is necessary to implement European requirements in the design of these facilities with the involvement of multidisciplinary groups: from architects to nurses, from construction contractors to patients and supplement SBN B.2.2-10: 2019 “Buildings and structures. Health Facilities” is a guide to designing psychiatric health facilities.

Issues of stigmatization to mental patients from medical students and medical staff of psychiatric institutions and measures for its minimization

Annotation. The aim of the study was to identify the presence of stigmatization among students of medical educational institutions and medical stuff of psychiatric institutions toward mental patients, to establish the causes and develop measures to minimize it. Methods were used in the work: bibliosemantic, historical, content analysis, as well as a questionnaire method using a specially designed questionnaire. Using Telegram, Microsoft Excel 2003 software, 1062 students were interviewed anonymously of 4–5 courses of medical institutions of higher education of Ukraine. The average age of students ranged from 20 to 22 years – 913 (85.9 %); from 23 to 24 years old – 119 (11.3 %) and from 25 to 26 years old – 30 (2.8 %). It was found that 93.8% of respondents from the total number of students surveyed are convinced that people with mental illness need special treatment; 87.9 % – were convinced that people who have mental illness pose a threat to society; 17.3 % respondents witnessed the humiliation of mental patients by working medical personnel in the presence of medical students. It is a fact, but in 2.1 % of cases, future doctors allowed themselves to offend patients who were hospitalized in psychiatric healthcare facilities during training. Thus, the inheritance of the Soviet system of medical education in the field of training young specialists for the mental health sector in Ukraine, which, unfortunately, has not experienced significant structural changes, is reflected in the behavior of the working medical personnel of psychiatric hospitals and the views of future doctors. Stigmatization of mental patients was carried out by every fourth medical worker (24.5 %) in psychiatric institutions in Odessa and every fifth medical worker in psychiatric institutions in Poltava (21.4 %) and Chernivtsi (20.9 %), which is violation of the moral and ethical principles of the doctor's behavior and unacceptable. The stigmatization of the mentally ill by medical students of medical schools is 2.1 %, which indicates that students use the negative example of the medical personnel of psychiatric institutions for their future medical activities.

In-Hospital Substance Use and Possession: A Study of Events From 38 Acute Care Hospitals in Pennsylvania

Patients’ substance use and possession at acute care hospitals is an understudied topic. To learn more about this topic, we queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) for events that occurred during calendar year 2018. We identified 106 reports from 38 acute care hospitals (excluding psychiatric, detox, and behavioral health units and facilities) where a patient possessed and/or misused a substance (e.g., heroin, oxycodone, liquor). We analyzed these reports to better understand how hospital personnel attempt to prevent in-hospital substance use and manage patients who are at risk for using a substance. We explored a range of variables, including antecedent conditions and hospital personnel’s actions post- detection of a patient’s substance use or possession. We found that a relatively low percentage of patients (26%) were identified as having a prior history of substance use, despite later using or being in possession of a substance in hospital. In our sample, patients frequently acquired the substances from visitors, more than half of the substances were consumed intravenously, and opioids were the most common substance. The most prevalent actions taken by hospital personnel were conducting searches for substances and paraphernalia, use of a patient sitter or video monitor, moving patients to a different room, and implementing visitor restrictions. Based on our findings and previous research, hospitals should consider increasing their use of substance use disorder (SUD) screening tools, pharmacotherapy, and referring patients to treatment. Overall, our results can help personnel better understand the nature of and strategies that may reduce the likelihood of in-hospital substance use. Keywords: substance use, paraphernalia, substance use disorder, in-hospital, addiction, opioid, risk mitigation, patient safety

Changes in voluntary admission and restraint use after a comprehensive tobacco-free policy in inpatient psychiatric health facilities

Background: Cardiovascular and respiratory diseases, predominantly due to tobacco use, are the leading causes of death among individuals with serious and persistent mental illness. However, many psychiatric health facilities do not routinely treat tobacco use disorder. The purpose of the current study was to examine the impact of implementing a tobacco-free policy in inpatient psychiatric health facilities in a large, urban setting on behavioral problems, treatment access, and tobacco treatment. Methods: Data on seclusion and restraint incidents, voluntary commitment at admission for each hospitalization episode, and nicotine replacement therapy (NRT) prescriptions were collected through secondary analysis of Medicaid administrative records from baseline in January 2015 (n = 8983) to follow-up in December 2016 (n = 9685) at 14 inpatient psychiatric health facilities. Results: There were no significant changes from baseline to follow-up in odds of seclusion and restraint incidents or voluntary admission status. There was a significant increase in the odds of NRT prescriptions at both 30 and 180 days post discharge (odds ratio [OR] range = 1.58–2.09, P < .01). Conclusions: In a large, urban setting among Medicaid enrollees, implementation of a tobacco-free policy in inpatient psychiatric health facilities had no negative impact on behavioral problems or treatment access and improved access to NRT, although overall NRT use remained low. This study challenges perceptions among some providers that addressing tobacco use disorder will negatively impact treatment outcomes in individuals with serious mental illness. These findings support tobacco-free policies in psychiatric health facilities and the role of psychiatric health providers in treating tobacco use in this population, which is at high risk for tobacco-related mortality.

Dysproporcja pomiędzy częstością występowania zaburzeń lękowych i depresyjnych w populacji mieszkańców powiatu żywieckiego a korzystaniem z psychiatrycznej opieki zdrowotnej

Introduction: The aim of the article is to estimate the disproportion between the incidence of anxiety disorders and depression in adult population of the Żywiec Poviat and the use of mental health care. Material and methods: An anonymous survey was conducted in a randomly selected group of adults living in the Żywiec Poviat. 1659 completed questionnaires were obtained. The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool. The data were compared with the number of outpatient and hospitalized people in psychiatric health care facilities in the poviat. Results: The study released a significant disproportion between the occurrence of anxiety disordes and treatment for this reason. In outpatient settings 1.23% of people suffering from anxiety used medical care, 0.06% were hospitalized. A similar situation applies to the disproportion between the occurrence of depression and treatment for this reason. Among people whose symptoms implement the criteria of depressive episode, 1.11% used outpatient treatment and 0.14% were hospitalized. Conclusion: Prevelence of anxiety disorders and depression and related to this health needs in examinated population significantly exceeds the real use of psychiatric healthcare. Constant underestimation of health needs in the field of psychiatry can be a result and one of the causes of this phenomenon. For better planning of activities in the field of health policy, it is necessary to perform epidemiological studies that reveal scale of the problem.

Community health workers’ attitude towards people with mental illness: potential challenge of maternal mental health services in a selected health centre, Ruhengeri Hospital in Rwanda

Introduction: Integration of mental health services into non psychiatric health care facilities from community level was recommended by the world health organization (WHO) in 1984 to improve the quality of mental health services provided to the local population. Community Health Workers (CHWs) have an important role to play for the implementation of WHO recommendation of integration especially at the community level. Research objectives were to: Describe attitude among CHWstowards people with a mental illness and explore relationships between socio-demographic variables and CHWs’ attitude towards people with mental illness in Muhoza health center/Ruhengeri hospital in Rwanda.Methods: In this study, a quantitative descriptive cross-sectional design was used to conduct a research among CHWs operating under Muhoza health centre/ Ruhengeri hospital in Rwanda. A selfreport questionnaire was used to collect data on a sample of 138. Questionnaire consisted of sociodemographic variables and two sections that include level of contact (LOC) and the Community Attitude towards Mental Illness-Swedish version (CAMI-S). The statistical package for social sciences (SPSS) version 22 was used to analyze data.Results: Findings showed negative attitude among community health workers in regards to people with mental illness (MI). The participants’ total score on the CAMI-S was ranging between 25% and 87%. This study revealed that participants with lower level of education and less experienced as CHWs reflected higher negative attitude in regards of people with mental illness than participants with higher level education and more experienced. Also, results from this study indicated that increase in LOC correlates with decrease in fear and avoidance towards people with mental illness.Conclusion: Community health workers in a selected Health Centre/ Ruhengeri Hospital, in Rwanda hold negative attitudes towards people mentally ill. Also, there is association between negative stereotypes towards people mentally ill and the level of education and experience. Familiarity has a mediating effect on negative attitudes hold by community health workers in regards to people mentally ill.Keywords: Community health workers, mental illness, health centre, negative attitude

Major findings from the 4th Evaluation of the National Healthcare Improvement Initiative

Objective To carry out the 4th round of third-party evaluation on the implementation and effect of the 1st year of the 2nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015. Methods The 4th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations. Results The 4th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction. Key words: Healthcare Improvement Initiative; Third party evaluation; Hospital Survey; Doctor-patient satisfaction

Effect of Brief Admission to Hospital by Self-referral for Individuals Who Self-harm and Are at Risk of Suicide

To our knowledge, there is no consensus regarding when individuals who repeatedly self-harm and are at risk of suicide should be hospitalized. To evaluate a new alternative, we examined the effects of brief admission (BA) to hospital by self-referral. To determine the effects of BA on inpatient service use and on secondary outcomes of daily life functioning, nonsuicidal self-injuries, and attempted suicide among individuals who self-harm and are at risk of suicide. The single-masked Brief Admission Skåne Randomized Clinical Trial was conducted from September 2015 to June 2018 at 4 psychiatric health care facilities in southern Sweden. Data were collected 6 months retrospectively at baseline and at 6-month and 12-month follow-ups. Participants were randomized to either BA and treatment as usual (BA group) or treatment as usual (control group). The sample was a referral population, with the most important inclusion criteria being current episodes of self-harm and/or recurrent suicidality, at least 3 diagnostic criteria for borderline personality disorder, and hospitalization in the last 6 months. Self-referred BA was offered for 12 months, with standard limits for duration and frequency, after the negotiation of a contract outlining the intervention. Prespecified main outcome measures were days admitted to the hospital, including voluntary admission, BA, and compulsory admission. The 125 participants had a mean (SD) age of 32.0 (9.4) years, 106 (84.8%) were women, and 63 were randomized to the BA group and 62 to the control group. No significant advantage was observed in the number of days in the hospital for the BA group compared with the control group. Within-group analyses demonstrated significant decreases in both groups regarding days admitted to the hospital (BA group: χ2 = 22.71; P < .001; control group: χ2 = 23.01; P < .001) and visits to the emergency department (BA group: χ2 = 13.95; P < .001; control group: χ2 = 21.61; P < .001), but only the BA group showed a reduction in days with compulsory admission (χ2 = 7.67; P = .02) and nonsuicidal self-injuries (χ2 = 6.13; P = .047). The BA group showed significantly greater improvements in the mobility domain of daily life functioning (z = -2.39; P = .02) and significant within-group improvements in 3 other domains (cognition: F = 9.02; P < .001; domestic responsibilities: F = 3.23; P = .049; and participation: F = 3.79; P = .03). Brief admission appears no more efficacious in reducing use of inpatient services than usual care for individuals who self-harm and are at risk of suicide. Future studies should explore other possible beneficial effects. ClinicalTrials.gov identifier: NCT02985047.

Modern going near creation of in-hospital comfort for patients and medical personnel in psychiatric establishments of health protection

Today requires an important focus on providing psychological comfort both for health care professionals in preventing emotional burnout syndrome and inpatient comfort for patients in these settings. The purpose of the work is to carry out a comparative analysis of European experience on the principles of functional and aesthetic organization of interiors and decoration materials of premises of psychiatric health care institutions, to determine the characteristics of the influence of natural and artificial lighting on the psychophysiological state of the body of patients and medical professionals. The material of the study was Form № 18 of the Ministry of Health of Ukraine "Report on work on control of environmental factors affecting the state of health of the population" of the State Institution "Vinnytsia Regional Laboratory Center of the Ministry of Health of Ukraine" for the period 2016-2019. Content analysis of domestic and foreign scientific sources, as well as bibliosemantic, theoretical and analytical methods of research were used in the work. The statistical processing of the study results was performed in a licensed standardized package "Statistica 6.1 for Windows". As a result of studying the experience of European countries on the creation of in- hospital comfort for patients and medical staff of psychiatric health care institutions, the following has been established: taking into account the sanitary and hygienic requirements in the design and arrangement of facilities for mentally ill persons should correspond to the therapeutic environment and promote the establishment of security regimen, improving treatment and prevention work, preventing hospital-acquired infections and therefore being one and the same priorities reform of mental health in Ukraine. According to the results of studying foreign experience on the basis of a systematic and ergo design approach to the re-profiling and reconstruction of existing psychoneurological hospitals in Ukraine, it is determined that its main purpose is to provide comfortable conditions for patients stay and create conditions for conducting psychosocial therapy and rehabilitation of persons with mental disorders. Therefore, the adaptation of hygiene requirements during the design and arrangement of the premises of psychiatric health care facilities should be aimed at ensuring the optimal individual and psychological status of patients and the appropriate parameters of the hospital environment and its sanitary and hygienic characteristics, which must correspond to the latest technology in providing high quality medical care using a biopsychosocial approach that will facilitate the transition to European standards.

Lack of Insight in Psychiatric Illness: A Critical Appraisal.

Byline: M. Reddy Setting the Stage for Discussion: Evolution of The Concept and Importance The concept of insight in psychiatric discourse has evolved through various stages. Psychiatrists or 'the doctors of the soul' have sincetimes immemorial been curious about the attitudes and perspectives of persons with mental illness towards their disturbed minds/selves. Though discussed by alienists in the mid-19th century and few psychopathologists in the early 20th century, the concept has seen a great progress in its understanding over the last 25 years. The concept has progressed through the following stages: *Insight into illness as present or absent dichotomy (e.g., IPSS)[sup][1],[2] *One dimensional grading of Insight[sup][3] from Complete Denial (grade 1) to True Emotional Insight (grade 6). This model incorporated understanding of causation as due to internal or external factors. *Multidimensional models[sup][4],[5] which are referred to as 'biomedical models' by their anthropological critics. *The socio-cultural modifications of multidimensional models[sup][6] and the concept of Narrative Insight.[sup][7] The reason so much of global discussion and research is going into this one topic is its clinical, administrative and legal importance. The clinical practice of covert (or surreptitious) medication and involuntary admission into a psychiatric health facility are very difficult things to come to terms with. Not only is the practice of involuntary treatment/admission a clinical concern, it is also an administrative concern for the psychiatric health facility. Issues like use of physical restraints and involuntary treatment/admission usually go against the liberal understanding of Human Rights. Apart from the clinical and administrative concerns, even the legal concerns of criminal responsibility, capacity for informed consent and validity of a will depend upon the understanding of the concept of insight (or the related issues of personal, social and moral judgment) of the person suffering with a mental illness. So, the establishment of the lack of insight in a person suffering from mental illness is of utmost importance for the clinical, administrative and legal reasons. Difficulty in The Clarity and Utility of The Concept of Insight The concept of lack of insight, because of its importance needs clear conceptualization. Clarity in its conceptualization and its utility remain as major problems for four reasons: *Lack of insight means different things in different psychiatric conditions. For example lack of insight means various things in the following conditions: psychosis, depression, obsessive-compulsive disorder, personality disorder, paraphiliac disorders, substance addictions etc. *Criteria or definitions used even for a particular condition like Schizophrenia are different when used by different researchers. Some of which seem very utopian and almost unachievable when applied in routine clinical practice (example: Karl Jaspers' need for a 'completely objective attitude'[sup][8] or Amador & David's need for meeting the five criteria in a fullest sense).[sup][5] Some like Aubrey Lewis' definition[sup][9] are broad and vague. *Different schools of psychiatry ascribe different etiological reasons or reformulations of the concept of lack of insight. The understanding of causation and treatment vary among various schools of psychiatry whereby if one school considers that the person who takes western medical treatment is the one with optimal insight, the other school thinks that use of non-medical treatment is also a correct attitude towards treatment. Cultural psychiatrists[sup][7],[10],[11] discuss the lack of insight as only a coping strategy (or as just a way of explaining the disorder to oneself) without taking neurobiology of disorder into consideration. *The ontological nature of the Human Insight into subjective experiences or lack of it is very complex. …

Symptoms and signs in interpreting Gamma-hydroxybutyrate (GHB) intoxication - an explorative study

BackgroundAcute poisoning with gamma-hydroxybutyrate (GHB) has been a serious medical and social problem in different parts of the world including Sweden. GHB is a drug of abuse which acts primarily as central nervous system (CNS) depressants. GHB has serious toxicity, although many young users do not recognise GHB as a dangerous drug. The aim of this pilot study was to explore how symptoms with risk of failure in vital functions would be valued among professionals that encounter GHB intoxication in the emergency phase.MethodsA web-based survey focusing on the assessment of vital clinical signs for possible GHB intoxication using a numeric scale was carried out during April and May 2011. The participants, n 105, are all professionals who encounter GHB intoxicated in the emergency phase, but have different levels of training in GHB intoxication, mainly Registered Nurses (RNs) in southwest Sweden, employed in pre-hospital or emergency departments at somatic and most psychiatric health care facilities, as well as police officers who in their work come into contact with drug users. Responses in the survey were scored according to risk of GHB intoxication with serious failure of vital functions. The score value was then referred to a so-called evidence based priority (EBP) scale and analysed using descriptive statistics and Fisher's exact test.ResultsCardiac arrest, coma, hypoxia, general convulsions, slow respiratory and heart rate and pale skin are symptoms with the highest risk of serious failure in vital physical functions and were predominantly recognised as such.ConclusionDespite the professionals' different levels of training in GHB intoxication, all of them were relatively well aware of and in accordance regarding the most risky symptoms. The interpretation score for the less risky symptoms and signs of GHB intoxication varied depending on their degree of training. The results should be viewed cautiously, as the size of the professional groups and their general knowledge of critical symptoms of GHB poisoning varied.