Psychiatric Health Care System Research Articles

New precursors of ill mental health and the “at risk” adolescent brain: Implication for prevention

Precursors are evoked upstream of the Capgras’ syndrome. Then, an analogy is suggested between the need for prognostic classification linked to the saturation of the asylum population at the dawn of the 20th century, and the current overflow of the psychiatric healthcare system. The contemporary situation justifies the search for information useful to mitigate ill mental health in at-risk adolescents. The article presents recent research reports on adolescents at-risk of emotional dysregulation, stemming from a longitudinal cohort database of European adolescents. The database analyses have revealed new brain and psychometric predictors of emotional dysregulation in adolescents. New early indicators were derived from easy-to-administer questionnaires, exploring emotions, affective symptoms and traits, sleep, early adversity and stress, puberty. Findings suggest that the physiology and stages of brain development could be taken into account for decisions regarding Mental Health. Studies on adolescent brain development have implications for public health, in terms of the age of protection for adolescents, and targeted prevention upstream of care.

Cigarette smoking is associated with Herpesviruses in persons with and without serious mental illness.

Herpesviruses are recognized as major causes of human diseases. Following initial infection, Herpesviruses can undergo cycles of reactivation controlled largely by the immune system. Cigarette smoking is an important modulator of the immune system particularly in individuals with serious mental illness where smoking is associated with increased rates of cardiopulmonary diseases and mortality. However, the effect of smoking on Herpesviruses has not been extensively studied. In this nested cohort study, cigarette smoking was assessed in 1323 persons with serious mental illness or without a psychiatric disorder ascertained in a psychiatric health care system and the adjacent community. Participants provided a blood sample from which were measured IgG class antibodies to five human Herpesviruses: Cytomegalovirus (CMV), Epstein Barr Virus (EBV), Herpes Simplex Virus-Type 1 (HSV-1); Varicella Zoster Virus (VZV); and Human Herpes Virus-Type 6 (HHV-6). The associations between smoking variables and antibody levels to the Herpesviruses were analyzed among diagnostic groups in multiple regression models adjusted for age, sex, and race. Current smoking was significantly associated with higher levels of antibodies to CMV (coefficient .183, 95% CI .049, .317, p<.001, q<.007) and the three EBV proteins (EBV NA -(coefficient .088, 95% CI .032, .143, p = .002, q<.014; EBV Virion - coefficient .100, 95% CI .037, .163, p = .002, q<.014; and EBV VCA - coefficient .119, 95% CI .061, .177, p = .00004, q<.0016). The amount of cigarettes smoked was also correlated with higher levels of antibodies to the three EBV proteins. Interaction analyses indicated that the association between cigarette smoking and levels of antibodies to CMV and EBV was independent of diagnostic group. Cigarette smoking was not significantly associated with the level of antibodies to HSV-1, VZV, or HHV-6. Individuals who smoke cigarettes have increased levels of IgG antibodies to CMV and EBV. Cigarette smoking may be a contributory factor in the relationship between CMV, EBV and chronic somatic disorders associated with these viruses.

Monitoring of coercive measures and compulsory treatment in Germany

Epidemiological registers on the burden of disease and adverse events (deaths, serious side effects, etc.) play an important role in the management, evaluation, and improvement of healthcare treatment for the population. This also applies to coercive measures in the psychiatric healthcare system. Such registers only became feasible on abroad basis due to the availability of electronic medical records and steadily increasing computing capacities; however, in most German states, registers have not been implemented. Data protection problems must be taken into account in the collation of person-related data but can be solved by appropriate pseudonymization procedures taking the prerequisites of data parsimony into account. Extensive data are now available from the Baden-Wuerttemberg register for coercive measures, which has been in existence since 2015 and which enabled, for instance, evaluating the consequences of the changes to the law following the 2018 ruling of the Federal Constitutional Court on mechanical restraint and the consequences of the coronavirus pandemic. In the meantime, there are also state-wide data collections in some other German states; however, unlike in Baden-Wuerttemberg, these registers do not include measures under guardianship law. Anationwide register for coercive measures, compulsory treatment and involuntary detention has justifiably repeatedly been demanded for a long time. Amajor obstacle is the historically developed separation between the responsibility of the German states for the detention regulated by public law and the Federal State for the scope of application of the guardianship law.

Health care partnership to deliver inpatient care to children

An innovative psychiatric health care system and top‐rated children's hospital, both Minnesota‐based, last week announced a new partnership that will deliver inpatient mental health services to patients as young as 6 years old. Health leaders say the move is intended to address the urgent mental health needs of vulnerable children and adolescents and provide them with age‐appropriate, personalized care.

The mental distress of our youth in the context of the COVID-19 pandemic.

Epidemiological evidence from population-based surveys suggest that the psychological well-being of adolescents has been severely affected by the COVID-19 pandemic itself, as well as by the safety measures implemented. The rationale of the study was to investigate the influence of the pandemic on psychiatric emergency service use, psychiatric admissions rates, emotional well-being, suicidality and self-harm behaviour in help-seeking children and adolescents. Retrospective cohort study of electronic patient records before and during the COVID-19 pandemic from the emergency out-patient facility of the department of child and adolescent psychiatry and psychotherapy of the Psychiatric University Hospital Zürich. The frequency of all emergency service contacts from 1 January 2019 to 31 June 2021 were described and the frequency of records compared in half-year intervals. Emotional well-being, behavioural problems, suicidality and self-harm were estimated based on the mental state examination notes of electronic patient records from the 1 March to the 30 April for the years 2019, 2020 and 2021. After an initial decline in emergency contacts at the beginning of the first lockdown, the use of the centralised emergency service increased during the subsequent months and has since stabilised at a significantly higher level than before the pandemic. Comparison of emergency contacts in the first half of 2019 with the first half of 2021 shows that the number of emergency phone contacts nearly doubled, emergency outpatient assessments increased by 40%, emergency bridging interventions increased by 230%, and inpatient admissions of minors to adult psychiatric inpatient units more than doubled because of lack of service capacity in child and adolescent psychiatry. The proportion of adolescents who reported suicidal ideation increased significantly by 15%, from 69% to 84%, and the proportion of adolescents who reported self-harm behaviour increased by 17%, from 31% to 48%. We found a significant increase in psychiatric service use, as well as in reported serious mental health symptoms such as suicidality and self-harm behaviour in help-seeking children and adolescents in the course of the pandemic. The child and adolescent psychiatric healthcare system is overburdened and down-referral of adolescents in need of ongoing therapy is becoming increasingly difficult. We recommend prioritising preventive and therapeutic measures to support the mental health of our children and adolescents alongside the somatic management of the COVID-19 pandemic.

Community Psychiatry Care: An Urgent Need in Nigeria.

Nigeria’s mental health policy was formulated in 1991, but it did not make adequate provision for community-based psychiatric care. Since there are only seven government-owned psychiatry facilities in Nigeria and these are always overwhelmed, there is the need to overhaul the existing policy and emphasise the urgency of a shift from inpatient psychiatric mental healthcare towards a community-based multidisciplinary psychiatric healthcare system.

Rural community attitude towards mental healthcare: a mixed-method study in Khurda district of Odisha, India

BackgroundMental health is a global concern due to its hasty escalation. The shifting social dynamics in rural India intensify care-seeking behaviors, which means immediate action is required. Mental illness, however, is seen as a neglected disorder. This study examined the attitude of rural people towards mental health care in rural Odisha, India. An explanatory mixed-method study was conducted among 395 participants age between 18 to 65 years in two rural blocks of Khurdha district, Odisha. A total of 16 in-depth interviews were conducted among the caretakers of the patients.ResultsThe educational level, religion, age, and gender (p < 0.05) had significantly associated with attitudes towards mental healthcare facilities; female having lower-education had more negative attitudes towards mental healthcare facilities. The major barriers for the mental healthcare were the rejection of mental illness by patients due to fear of societal stigma, faith on religious healers, and lack of availability of mental health services.ConclusionsPerspective of people should be considered along with their location, gender, and education when strategizing the psychiatric healthcare system as their perception/attitude serves as facilitators/barriers for achieving mental healthcare goals and psychiatric hospital goals.

A comparative survey between the levels of personal and perceived stigma among professionals working in the psychiatric care system

Background: In Romania there are very few national studies of the stigma associated with depression1. The psychiatric health care system is mainly concentrated on psychiatric hospitals with few ambulatory services offering very limited services, approximately 80% of the psychiatric staff is working in the psychiatric hospital. Coming from a 45-year period during which the psychiatry was only biological the Romanian population has started to discover and use the psychotherapeutic services provided by psychologists, a profession that was forbidden for a 20- year period during the communist time. This study seeks to compare the nature and extent of stigma among the professionals working in the psychiatric care system namely psychiatric hospital. Methods: A survey was conducted in professionals' group using the depression stigma questionnaire. The study comprised of a survey of 139 persons aged over 18 years, psychiatric staff working in the psychiatric hospital: psychiatrists, psychologists, nurses, carers and other professions (represented by social workers). The respondents reported their personal attitudes (personal stigma) and perceptions of the attitudes of others (perceived stigma) in the community they work. Results: Personal stigma is lowest among the highest trained professionals (psychiatrists and psychologists) and highest among the lowest specialized personnel (carers and other professions). Perceived stigma is greater than personal stigma among all the professionals working in the psychiatric care system, the highest trained professionals have highest levels of perceived stigma and the lowest trained professionals have the lowest levels of perceived stigma. Conclusion: Stigmatizing attitudes are common to all professionals, the results suggest that there is a need to train better the staff according to its needs and to make more public awareness interventions tailored to the targeted groups. The current results provide a baseline for future interventions in order to decrease the stigma levels of professionals.

Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers.

Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice. Between 1 January 1996 and 30 June 2012, 3.5% of the refugee children accessed psychiatric healthcare services compared to 7.7% of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95% CI 0.40-0.45) among refugee boys and 0.35 (95% CI 0.33-0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.

Update on adolescent mental health

Adolescence is a period of significant physical, social and emotional change and therefore a vulnerable period for the development of mental illness. Many psychiatric disorders have their onset during adolescence. Approximately 20% of children have a mental health disorder, but the majority of disorders are not detected and treated. Risk factors for mental illness include: genetic vulnerability, neurobiological factors and psychosocial stressors. Common mental disorders during this period are mood, anxiety and substance related, with adolescents often presenting with comorbidity. Healthcare practitioners should screen for adolescent mental illness and associated suicide risk. Brief screening tools such as the Strengths and Difficulties Questionnaire are useful in detecting mood and anxiety disorders in primary care settings. While there is increasing evidence for the efficacy of psychotropic medications in adolescents, more research is still required. Management of adolescent mental health problems generally requires a combination of psychotropic medication and psychosocial interventions. Early intervention and support in an integrated medical and psychiatric healthcare system is required.

Patient experienced continuity of care in the psychiatric healthcare system-a study including immigrants, refugees and ethnic danes.

Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

EPA-0698 – ADHD in adults: a nationwide study from 1995–2012

Introduction The incidence of different psychiatric diagnoses in Danish Psychiatric Hospitals are characterized by fluctuations. This phonemena could be due to changes in true incidence, changes in the entry into the health care system, changes in the diagnostic practices and the possibilities of treatment for a given disease, or due to changes in the attention towards the disease within the population, the profesionals or the medias. Nowadays there is a notable increase of the number of new ADHD diagnoses among children and adults. Objectives There is a need for epidemiological measures in ADHD in The Danish Psychiatric Health Care System. Aims To investige treated incidence in ADHD in adults in Denmark through the period of 1995–2012, and to investigate psychiatric comorbidity, latency from the first contact to the ADHD diagnosis and mortality. Methods From The Danish Psychiatric Central Research Register all patients with following diagnoses given for the first time ever after their 18th birthday were identified: ICD-10: F.90.0, F90.1, F90.8, F90.9, F98.8. These data are used to make an age standardized incidence rate throughout the period differentiated with gender and possible existence of previous childhood psychiatric diagnosis. We will also analyze for psychiatric comorbidity after their primary ADHD diagnosis. Results The statistical analysis are still in progress. Conclusions There is a marked increase in treated incidence in adult ADHD from the introduction of ICD-10 to 2012. Further results about psychiatric comorbidity and mortality will be presented.

Continuity of care in the psychiatric health care system - a patient persepctive of immigrants, refugees and ethnic Danes

Background Immigrants and refugees have been found to be vulnerable to the development of certain types of psychiatric illness and are more frequently subjected to coercion. A large part of patients with psychiatric illness experience lengthy courses of treatment and a combination of inpatient and outpatient care. Therefore, the aim of this study is to investigate continuity of care through the entire course of treatment from the perspective of patients including vulnerable …

Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

ObjectiveThere has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression. MethodRefugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion. ResultsBoth NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers. ConclusionsThe study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups. ClinicalTrials.gov registry numberNCT00218959.

Prisons: the psychiatric institution of last resort?

The World Health Organization declared in 1948 that the enjoyment of the highest individual attainment of health for any person is a fundamental human right. Australia, the U.K. and the United States all legally ratified this declaration as becoming signatories to their founding treatise with the United Nations. Despite this, there are many conspicuous examples of inequities of public health as found within these nations. One of the more disparate and outrageous examples of inequities in public health has been an insidious trend towards criminalizing mental illness, and the largely unjust treatment of many mentally ill persons. This change has resulted in untold numbers of mentally ill persons being over-represented within the criminal justice system, experiencing higher morbidity, co-morbidity and mortality rates, and having difficulty in surviving in a society frequently dealing with their illness in a persecutory manner. Questions must be raised: that although over the passage of time medical science and technology has changed, but has western societies' attitudes to health equity kept pace?

Relatives’ Experiences of Care and Caregivers in a Psychiatric Caring Context

Reform of psychiatric care in Sweden, meant to improve support and coordination of care for people with mental illness, has passed much of the rehabilitation and daily care of these people on to their families. This study explores the psychiatric health care system as experienced by family members of people with mental illness. We conducted 18 tape-recorded interviews with close relatives of people with mental illness in the health care district in northem Sweden. The results show that they feel guilty about not providing enough support for their relatives, they are unsure of where to go for support and answers to their questions about their relative's diagnosis, prognosis, proposed date of discharge from hospital, and rehabilitation requirements. Most also feel the need of professional therapy for themselves. Serious criticism was levelled against the current reforms to psychiatric care in Sweden, which family members experienced as discontinuous and inconsistent between the different levels of municipal, county, and national health care and social services.

From Asylum to Hospital to Psychiatric Health Care System

From Asylum to Hospital to Psychiatric Health Care System

From Asylum to Hospital to Psychiatric Health Care System

From Asylum to Hospital to Psychiatric Health Care System

Der niedergelassene Psychiater und die psychiatrische Klinik

Against the background of the problematic interface between outpatient and inpatient care in the German psychiatric health care system, the role of psychiatrists in private practice concerning the pathways of psychiatric inpatients before and after their hospital stay should be evaluated. Based on data of the psychiatric basic documentation (DGPPN-BADO) of 4905 patients admitted to the psychiatric hospital in 2003, predictors of the type of referral as well as the outpatient aftercare were analysed by means of logistic regression analyses. 9.8 % of patients were referred by psychiatrists in private practice. Patients sent by psychiatrists more seldom had an addiction disorder, more often were residents of sheltered homes, showed a present episode lasting more than three months and had a psychopharmacological pre-treatment with an atypical antipsychotic or SSRI. At discharge, outpatient aftercare by psychiatrists in private practice was recommended to 32.1 % of inpatients. Referral by a psychiatrist in private practice as well as the diagnosis of schizophrenia or affective disorder led more often to an outpatient aftercare by a psychiatrist. Due to the small number of patients referred by psychiatrists, the cooperation between psychiatric hospital and psychiatrists in private practice has to be focused by the quality management of the hospital.

Gender differences in subtypes of late-onset depression and mania

It is currently not known whether elderly men and women present with different subtypes of depression and mania/bipolar disorder. The aim of this study was to compare the prevalence of subtypes of a single depressive episode and mania/bipolar disorder according to the ICD-10 for elderly men and women in a nationwide sample of all out- and inpatients in psychiatric settings. All patients older than 65 years who received a diagnosis of a single depressive episode and mania/bipolar disorder in the period from 1994 to 2002 at the end of their first outpatient treatment or at their first discharge from psychiatric hospitalization in Denmark were identified in a nationwide register. A total of 9837 patients aged more than 65 years received a diagnosis of a single depressive episode (69.9% were women) and 443 a diagnosis of mania/bipolar disorder (61.6% were women) at the end of their first contact with psychiatric health care. Slightly more women than men received a diagnosis of mild (70.8%) or moderate depression (67.4%) compared to severe depression (65.9%). Men more often presented with a single depressive episode with comorbid substance abuse or comorbid somatic illness. No gender differences were found in the prevalence of depression with or without melancholic or psychotic symptoms. Men more often presented with mania/bipolar disorder with comorbid substance abuse. The distributions of the subtypes of a single depressive episode or mania/bipolar disorder are remarkably similar for male and female patients aged over 65 years with first contact with the psychiatric health-care system.