Psychiatric Health Care Research Articles

Community Psychiatric Mental Health Nursing: Practice and Challenges

Due to the rising incidence of social risk incidents, the Mental Health Act was amended to provide community treatment and community support for patients with mental illness. Community mental health centers have added a public sector function to follow-up with the care of mentally ill patients using case management as an integrated service model. Under this amendment, the unique role and task of community psychiatric mental healthcare should be framed and developed. The National Health Research Institutes have advocated recovery-oriented case management as a mental health policy. Thus, in line with this policy, the authors developed a need-tailored recovery program led by nurses that has demonstrated significant effectiveness with regard to the recovery of mentally ill patients. Also, a mobile-care platform was subsequently developed to assess the care needs of community-dwelling patients with mental illness, implement recovery-oriented care, and evaluate its effectiveness, which may be incorporated into evidence-based community psychiatric mental healthcare guidelines. To improve the practice of community psychiatric mental health nursing, this article addresses key community nursing contexts, including: psychiatric home treatment and care, community mental health centers, the needs-tailored recovery-oriented case management model, and the roles and certification of community psychiatric mental health nurses promoted by the psychiatric mental health nurses association. Finally, future challenges and strategies are proposed to improve the quality of community psychiatric mental healthcare and to assist patients move from mental disorder to recovery.

Implementering av DBT i en rural kontekst

Background and purpose: Dialectical behaviour therapy (DBT) is a widespread evidence-based method of treating emotionally unstable personality disorder, but the method has barely been studied in a rural context. The purpose of this study is to identify rural challenges for the four treatment channels of DBT, to pinpoint implicit urban starting points in DBT, and to suggest possible adaptations of DBT in rural areas, based on Finnmark as a case. Method: The authors, who are clinicians with extensive experience in psychiatric healthcare in Finnmark, integrates findings from previous research of culturally adapted DBT for rural cultures with local clinical experience in accordance with the declaration of evidence-based psychological practice. Our methodical basis is traditional literary study, case study, autoethnography and theory generation. Results: DBT in its original format falls short in rural areas without adaptations. We found that key challenges for implementations of DBT in our local clinical practise are geographical distances, lack of personnel, difficulties in maintaining anonymity in group therapy, difficulties with group guidance and lack of continuity in treatment due to high turnover. Vi lay out possible adjustments, such as sectional skill training, short periodic admissions at DPS with intensive skill training, pragmatic use of phone consultations, digital treatment (and guidance) and inclusion of other departments in treatments. Conclusion: DBT is a principle-driven method which is originally designed for an urban setting, but which is possible to adapt to a rural context such as Finnmark. Possible challenges are geographical distance, lack of continuity, personnel shortage and lack of anonymity (group treatment). Keywords: rural, DBT, pragmatic psychology, geographical narcissism, urban bias

Practice and Niches of Advanced Practice Nurses (APNs) in Psychiatric and Mental Health Care

The current expansion in role responsibilities of advanced practice nurses (APNs) stems from the current change in public health needs. Advanced nursing education enables APNs to respond promptly to current health needs while expanding the scope of nursing practice. As a result, APNs have obtained recognition and acceptance from the public. The "clinical nurse specialist" in psychiatric care was a pioneering example of APNs in the United States. These specialists not only led the vigorous development of contemporary psychiatric nursing but also advanced the nursing profession as a whole. This article aims to elucidate the role practice of and future opportunities for advanced psychiatric mental health nurses. Using examples of "applying evidence-based care to solve complex practice issues", this article demonstrates the role functions of advanced psychiatric mental health nursing and outlines potential niche opportunities for this field.

Is it safe enough? A pilot feasibility study of an 8-day intensive treatment for severe PTSD.

Intensive treatments for posttraumatic stress disorder (PTSD) are gaining increased research support. Treatment models targeting Complex PTSD and previously treatment-resistant PTSD have shown a good effect. A pilot study was performed to assess the feasibility of an 8-day intensive treatment program for severe PTSD in a Swedish public healthcare setting. Eleven participants completed treatment, and overall, the reduction in PTSD symptoms was considerable. Also, loss of diagnosis at 3-month follow-up was 100%. No adverse events occurred, and no elevation of suicidal intentions was reported. Symptom exacerbation could not be observed in the data and dropout due to the intensity of the treatment format did not occur. Based on these positive results, it is recommended that further research with larger samples is conducted. If found safe and effective, the 8-day treatment program could be an important addition to psychiatric healthcare.

Peer workers to address discrimination against women in psychiatry and mental health

Compared to the general population and to males with mental health disorders, women with these disorders face more obstacles in psychiatric and mental health care settings. This strongly encourages mental health policies and psychiatric care to consider specific strategies that prevent gender bias in treatment among women with mental health issues. A growing body of research demonstrates the benefits of having peer workers–professionals with a lived experience of mental health issues who use their own experiences of mental distress to support others with comparable experiences–in mental health services. We postulate that peer support can become an important and integrated aspect of preventing and addressing discrimination against women in psychiatry and mental health care. First, women peer workers may combine their lived experiences as service users and as women to provide unique, experience- and gender-based support to women users who experience discrimination. Non-women or women peer workers who did not experience gender discrimination in psychiatric settings may nevertheless benefit from the integration of gender education in their curriculum and, in turn, bring a feminist lens to their work to achieve this mission. Second, using their experience as service users, peer workers have the credible ability to communicate and translate women patients’ needs to the medical staff, and thus facilitate concrete, need-based adjustments of services. Third, peer workers’ involvement as instructors in medical schools could provide early awareness of injustices experienced by women in psychiatry and mental health care. Further research is required to test the effectiveness of peer workers in addressing discrimination against women in real-world clinical settings. More broadly, from a diversity perspective, we believe that peer workers are one of the critical elements in the fight against discrimination in psychiatry and mental health.

A novel approach in psychiatric healthcare: co-designing a digital platform

Purpose This paper aims to focus on the involvement of mental healthcare professionals in a co-design process of a digital healthcare platform. Many people with severe mental disorders need constant support and monitoring, and with long waiting lists and scarce resources in mental healthcare, there is a dire need for innovative digital solutions to counteract those issues. This paper elaborates on a co-design process of a digital platform and mobile app designed for people with mental disorders. The platform primarily considers two perspectives: i) the patients and ii) the healthcare professionals. Design/methodology/approach This paper is based on canonical action research, where the co-design involvement with 13 healthcare professionals is analyzed and their interactions with three primary scenarios are focused. Findings The main contribution of this paper is three co-design principles: i) clarity and information accessibility regarding the patient's side, ii) efficiency and flexibility when it comes to the healthcare professional's side and iii) a notification function in the mobile application. Originality/value The theoretical contribution is the conceptualization of the three co-design principles that others can use when designing digital platforms in healthcare in general and psychiatric care in particular. The practical contributions are firstly outlined through the co-design process itself, where scenarios to guide the work are used, and secondly, the improvements made in the digital platform derived from the results of the co-design process.

Real-World Evidence of Aripiprazole Tablets with Sensor: Treatment Patterns and Impacts on Psychiatric Healthcare Resource Utilization.

Maintaining adherence to antipsychotic (AP) medication is often challenging. Aripiprazole tablets with sensor (AS) contain an ingestible event marker and communicate with wearable patches and a smartphone app to provide objective medication ingestion data. This study evaluated real-world treatment patterns of AS usage and its impact on psychiatric healthcare resource utilization (HCRU). This retrospective, observational cohort study identified individuals who initiated AS between 1/1/2019 and 6/30/2020 with 3 months baseline and 6 months of follow-up data using a commercial medical and pharmacy claims database (Clarivate). Controls were propensity score-matched (4:1) to AS initiators based on age (±2 years), sex, diagnosis (major depressive disorder [MDD], schizophrenia, bipolar I disorder [BP-I], other), insurance, and baseline oral AP use (yes/no). Days of AP supply were evaluated using a general regression model. The frequency of psychiatric HCRU during follow-up was compared between groups using a zero-inflated regression model. Most AS initiators were diagnosed with MDD (61.2%) and were women (61.2%); mean age was 37.7 years (standard deviation: 14.1). Most AS initiators (53.1%) continued treatment for >60 days (mean days of supply = 77). After adjusting for covariates, AS initiators had 41% more days of AP supply during follow-up compared with controls (P <0.0001) and significantly lower adjusted odds ratios (ORs) for psychiatric outpatient visits (adjusted OR = 0.80; P <0.05), emergency department visits (adjusted OR = 0.11; P <0.05), inpatient visits (adjusted OR = 0.42; P <0.05), and other medical services (adjusted OR = 0.25; P <0.05). Participants who implemented AS had significantly more days of AP supply and fewer psychiatric care visits. These preliminary results suggest AS usage can help build regular medication-taking habits and holds promise for reducing psychiatric HCRU. Additional studies with larger sample sizes are warranted to inform clinical practice and coverage decisions.

0686 High prevalence of sleep apnea in mental disorders – a need for use of sleep evaluation tools in psychiatric health care

Abstract Introduction Sleep apnea is a prevalent disorder but it is frequently overlooked in diagnosing mental disorders. The aim of the present study was to screen for sleep apnea in a group of patients referred for diagnosing mental disorders or non-restorative sleep and to assess the accuracy with which such testing can be replaced with commonly used screening questionnaires for sleep apnea. Methods 104 patients were investigated – 58 with mental disorders (26 with affective disorders, 26 with schizophrenia spectrum disorders, 3 with anxiety disorders, 3 with neurocognitive disorders; mean age 37.5±9.5 years, 24% females, BMI 32.8±6.5 kg/m2) and 46 with non-restorative sleep (mean age 41.2±14.6, 39% females, BMI 26.3±4.8 kg/m2). The patients were screened for sleep apnea with a home sleep apnea test (HSAT) based on peripheral arterial tonometry (PAT) and were asked to fill in the Sleep Apnea Scale from Sleep Disorders Questionnaire (SDQ-SA), the STOP-BANG and the Berlin questionnaires (BQ), and the Epworth Sleepiness Scale (ESS). Results Apnea-Hypopnea Index of &amp;gt; 5/h was found in 57 (55%) patients: 36 (62%) patients with mental disorders and 21 (45%) patients with non-restorative sleep. An increased risk for sleep apnea was found in 45 patients (43.3%) using SDQ-SA, 64 (61.5%) using BQ, 80 (76.9%) patients using STOP-BANG with the cut-off of 3 points and 30 (28.8%) with the cut-off of 5 points. Positive predictive values were: 65.9% for SDQ-SA, 71.0% for BQ, 68.8% for STOP-BANG with the cut-off of 3 point and 75.9% with the cut-off of 5 points. Negative predictive values were 49.1%, 63.0%, 83.3% and 51.4% respectively. Diagnostic accuracy was highest for STOP-BANG with the cut-off of 3 points – 72.3% and lowest for SDQ-SA – 56.6%. Excessive Daytime Sleepiness was found in 44 (42.3%) of patients. Three patients (2.9%) refused or did not complete the HSAT. Conclusion Inclusion of HSAT in the diagnostic process revealed high prevalence of sleep apnea in patients with mental disorders. Psychiatrists should be encouraged to include HSAT in evaluation of patients. Such testing is patient-friendly and using only screening questionnaires does not provide high enough diagnostic accuracy. Support (if any)

Online training of Covid-19 infection prevention and control for healthcare workers in psychiatric institutes

BackgroundThis study aimed to develop a unique online infection prevention and control (IPC) training on Covid-19 for healthcare workers in psychiatric institutes in Japan and to examine its efficacy based on its impact on the knowledge, attitude, and confidence about IPC for Covid-19 among the healthcare workers.MethodThis quasi-experimental study was conducted using online training on Covid-19 IPC for healthcare workers in various psychiatric institutes from April 2021 to March 2022. An online training video on Covid-19 IPC was developed. Voluntary healthcare workers in psychiatric institutes located in five prefectures in Japan were recruited to participate in this training. The participants then completed 30 min of online training and surveys about knowledge, attitude, and confidence were conducted pre, post, and three months after the training. The video training and surveys were contextually validated by the experts, but not by any previous study.ResultsA total of 224 participants were included, of which 108 (54.0%) were men. The mean (standard deviation (SD)) age and the mean occupational experience were 47.4 (9.5) and 18.0 (12.6) years, respectively. Among the participants, 190 (84.8%) completed the post-training, and 131 (58.5%) completed the three-month-later training surveys. The total score on the quizzes in the post-training (+ 31.1%, SD 15.7, p-value < 0.01) and three-month-later training (+ 14.9%, SD 16.8, p-value < 0.01) surveys had significantly increased from that in the pre-training survey. In contrast, the total score in the three-month-later training had significantly decreased from that in the post-training survey (-16.1%, SD 16.7, p-value < 0.01).ConclusionThirty minutes of online training about IPC for Covid-19 had improved knowledge, confidence, and attitude among psychiatric healthcare workers. Regular online training would help in preventing the transmission or formation of clusters of Covid-19 in psychiatric healthcare institutes.

Psychiatric Inpatient Healthcare Resource Utilization and Treatment Patterns Among Patients With Predominant Negative Symptoms in Schizophrenia

AbstractIntroductionCurrently approved treatments for schizophrenia (antipsychotics) have demonstrated effectiveness for treating positive symptoms; however, these agents are largely ineffective in treating other domains. Negative symptoms, including avolition, alogia, blunted affect, and asociality, are difficult to treat, and often persist despite adequate control of positive symptoms. Additionally, some patients experience “predominant” (moderate-to-severe negative symptoms that have greater relative severity than co-occurring positive symptoms) or “prominent” (severity of negative symptoms [moderate-to-severe] without any reference to positive symptoms) negative symptoms. These symptoms are known to have great impact on patient social functioning and quality of life, and are associated with poorer clinical course and outcomes for patients. Here, we examined inpatient healthcare resource utilization in patients with schizophrenia experiencing predominantly negative symptoms (PNS).MethodsDe-identified data were extracted from electronic health records in the NeuroBlu Database across 25 US mental healthcare providers. Positive and negative symptom data were derived from free-text records using natural language processing. PNS was defined as the presence of three or more negative symptoms and three or fewer positive symptoms at first clinical contact following schizophrenia diagnosis. Groups were balanced for baseline demographic and clinical characteristics by minimizing the generalized Mahalanobis distance and compared using chi-square and t-tests. Treatment patterns were visualized using Sankey diagrams.ResultsA total of 4444 patients with schizophrenia were identified and 8% were classified as PNS. A balanced cohort of 720 patients (50% PNS) was generated. Patients with PNS were more likely to be hospitalized in the 12 months following diagnosis (PNS: 76%, non-PNS: 60%, χ2: 22.5, p &lt; 0.001) and were switched to a second-line antipsychotic after a shorter first-line treatment duration. The most frequently prescribed antipsychotics differed between groups (PNS: risperidone, aripiprazole, haloperidol; non-PNS: risperidone, olanzapine, other atypical).DiscussionThis study demonstrates that negative symptoms in schizophrenia may be associated with worse illness course and higher healthcare resource utilization. There remains a need for new treatment options for patients with persistent, prominent, or predominant negative symptoms which specifically improve this historically hard-to-treat and assess symptom domain.FundingSunovion Pharmaceuticals, Inc.

Psychosocial Burden of Pediatric and Adult Patients With Congenital Versus Traumatic Facial Differences: Assessment of Psychiatric Distress and Healthcare Utilization in the United States From 2004 to 2012.

Psychiatric distress and its effects on healthcare utilization in pediatric patients with congenital and traumatic facial differences remain poorly understood. This study analyzes the psychosocial burden along with mental health and reconstructive surgery services utilization of this patient population in comparison with adult patients with such facial differences. The 2004-2012 Medical Expenditures Panel Survey was queried for all patients with facial differences. Socioeconomic variables, Patient Health Questionnaire 2 and Kessler 6 scores, responses from validated screening surveys, and utilization of mental health and reconstructive surgery (ie, plastic surgery and otolaryngology) services were compared between pediatric and adult patients with congenital and traumatic facial differences. Children ages 5 to 12 years were more likely to be affected by facial trauma, whereas adolescents aged 13 to 17 years were more affected by congenital facial conditions. Pediatric patients with congenital facial conditions had higher rates of medical care, education, and special therapy utilization ( P < 0.0001), although their facial trauma counterparts used mental health services more often ( P < 0.0001). In adults, more facial trauma patients reported poorer perceived mental health status ( P = 0.01). Among patients with any facial difference, distressed adult patients were less likely to see a reconstructive surgeon even when controlling for socioeconomic variables (0.55 [0.31-0.97], P = 0.04). In the pediatric population, psychosocial considerations should include both age and etiology of facial differences to best optimize care. Among adults with facial trauma, poor mental health may contribute to lower rates of surgical follow-up, highlighting a potential benefit for provision of mental health services earlier for these patient populations.

Effects of geography on risk for suicidal ideation and suicide attempts among commercially insured children and youth in the US

IntroductionTo study the effects of geography on risk for suicidal ideation and suicide attempts among commercially insured children and youth in the USEffects of geography on risk for suicidal ideation and suicide attempts among commercially insured children and youth in the USObjectivesFew studies have examined the impact of geography on risk factors for suicidal ideation (SI) and suicide attempts (SA). This study used a national representative sample to study how geography may influence the relationships of risk factors for SI and SA in commercially insured children and youth.MethodsThe sample was a nationwide retrospective cohort study of 124,424 patients &lt;25 years using commercial claims from four major insurance companies (Aetna, Humana, Kaiser Permanente, and UnitedHealthcare) in the US. The index visit was a mental health or substance use (MH/SUD) outpatient encounter between January 2014 and June 2015. SI and SA were defined by having an ICD-9 diagnosis code within one year after the index visit. Risk factors in the models were demographic and clinical risk factors, including prior psychiatric diagnoses, prescriptions, and healthcare services utilization. Patients’ geographic regions were assigned to one of the nine divisions defined by the US Census Bureau. We used survival analysis to evaluate the effects of geography on risk factors for SI and SA.ResultsAt each follow-up time period (post 7-, 30-, 90-, 180-, and 365-day), rates of SI and SA varied by geographic division (p&lt;0.001). The Mountain Division consistently had the highest rates for both SI and SA (5.44%-10.26% for SI; 0.70%-2.82% for SA). Having MH emergency department (ED) visits in the past year increased the hazard ratio of SI by 28%-65% for children and youth residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p&lt;0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (HRs=0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (HR=1.46).ConclusionsChildren and youth residing in the Mountain Division had the highest prevalence of SI and SA and the highest risk of SI after having MH ED visits. Studies of indicators of access to MH ED care and other social determinants of health may clarify the reasons for SI and SA geographic differences.Disclosure of InterestNone Declared

Challenges for psychiatric health care for adults in Lower Silesia.

The authors, in their study, refer to the changes taking place in Polish psychiatry under the National Mental Health Program (NMHP). They present their thoughts on the restructuring of psychiatric health care for adults in Lower Silesia. They refer to the European experiences described in the book Better Mental Health Care by G. Thornicroft and M. Tansella, and in the practical and scientific dimension - to the substantive premises, derived from demographic analyzes, epidemiological indicators obtained in the EZOP study, from Maps of Health Needs and other official statistics. Lower Silesia is the fifth voivodeship in Poland in terms of population, with four psychiatric hospitals in need of restructuring, a lower than the national rate of beds per 100,000 population and a relatively high rate of the so-called common mental disorders should be included in a targeted pilot project under the NMHP. In conclusion, the authors strongly support the fastest possible implementation of the community model of psychiatric services in Lower Silesia, indicating the methodology that should accompany the transformation process, the risks that may occur, but most of all, making people aware of the benefits that society should achieve in a human and economic sense.

Provision of HIV services to psychiatric inpatients in Botswana: Challenges and recommendations.

The high prevalence of HIV among psychiatric inpatients is well-documented, yet little is known about the provision of HIV services for these patients. This qualitative study aimed to explore and understand healthcare providers' challenges with providing HIV services to psychiatric inpatients. This study was conducted at the national psychiatric referral hospital in Botswana. The authors conducted in-depth interviews with 25 healthcare providers serving HIV-positive psychiatric inpatients. Data analysis was performed using a thematic analysis approach. Healthcare providers reported challenges with transporting patients to access off-site HIV services, longer waiting periods for antiretroviral therapy (ART) initiation, patient confidentiality, fragmented services for treatment of comorbidities, and a lack of patient data integration between the national psychiatric referral hospital and other facilities such as the Infectious Diseases Care Clinic (IDCC) at the nearby district hospital. Providers' recommendations for addressing these challenges included the establishment of an IDCC at the national psychiatric referral hospital, connecting the psychiatric facility to the patient data management system to ensure integration of patient data, and provision of HIV-related in-service training to nurses. Psychiatric healthcare providers advocated for on-site integration of care for psychiatric illness and HIV among inpatients to address the challenges of ART provision. The findings suggest the need to improve the provision of HIV services in the psychiatric hospitals in order to ensure better outcomes for this often-overlooked population. These findings are useful in improving clinical practice for HIV in psychiatric settings.

Diverse Geriatric Workforce Education History, Needs, and Opportunities: Focus on Psychiatric Advanced Practice Nurses

Primary TopicAdvanced Practice Nursing History and Current State of Education Update Secondary TopicExploration of opportunities for filling educational gaps for subspecialty geriatric psychiatry training in Diverse WorkforceThis symposium is sponsored by the AAGP IDEA Committee.Advanced practice nurses are continuing to grow as partners of care for the geriatric psychiatry patient population. With increasing specialty workplace shortages across acute, ambulatory, and long-term care settings and growing numbers of geriatric psychiatrists retiring and less coming into the field, there is need to increase interprofessional collaboration with advanced practice nurses. The variety of advanced practice nurses practicing in the field has led to understandable confusion surrounding educational standards and experience from physician colleagues.Advanced nursing education has evolved over decades adapting to the needs of the ever-changing healthcare system and patient needs. Advanced practice nurses came in existence to assist in providing care to the underserved and often rural populations that struggled to maintain physician employment. The first advanced practice nurse specializing in the field of psychiatry was the certified nurse specialist. This role originally encompassed a larger focus on psychotherapy. Over decades and changes in healthcare, there was a larger call for psychiatric prescribers due to psychiatrist shortage, leading to the development of the psychiatric nurse practitioner role. Psychiatric nurse practitioners are board certified to provide psychiatric healthcare across the lifespan but are considered generalists until provided experience and training in specialty areas. Psychiatric nurse practitioners specializing in geriatric psychiatry do not currently have any additional academic institution driven training, but become specialists through mentorship from geriatric psychiatrists, nurse practitioners, or physician assistants within depth knowledge in geriatric mental healthcare. They also engage with continuing medical education, professional organization involvement, and gain clinical experience at bedside and in advanced practice nursing. Some advanced practice psychiatric nurses come into geriatric psychiatry practice from a calling and passion for this population, while others find their career gravitates towards this population as a response to a call from the community in need of care. There is desire and need for increased standardized educational opportunities for advanced practice nurses who are passionate about caring for the mental health needs of older people, and a hope that geriatric psychiatrists may offer assistance and guidance with the interprofessional united goal to improve access to quality care to our geriatric patients.

Associations between post-traumatic stress symptoms and quality of life among psychiatric healthcare personnel in China during the COVID-19 pandemic: A network approach.

Post-traumatic stress symptoms (PTSS) are commonly reported by psychiatric healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic and negatively affect quality of life (QOL). However, associations between PTSS and QOL at symptom level are not clear. This study examined the network structure of PTSS and its connection with QOL in psychiatric healthcare personnel during the COVID-19 pandemic. This cross-sectional study was carried out between March 15 and March 20, 2020 based on convenience sampling. Self-report measures including the 17-item Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) and World Health Organization Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were used to measure PTSS and global QOL, respectively. Network analysis was used to investigate the central symptoms of PTSS and pattern of connections between PTSS and QOL. An undirected network was constructed using an extended Bayesian Information Criterion (EBIC) model, while a directed network was established based on the Triangulated Maximally Filtered Graph (TMFG) method. Altogether, 10,516 psychiatric healthcare personnel completed the assessment. "Avoidance of thoughts" (PTSS-6), "Avoidance of reminders" (PTSS-7), and "emotionally numb" (PTSS-11) were the most central symptoms in the PTSS community, all of which were in the Avoidance and Numbing domain. Key bridge symptoms connecting PTSS and QOL were "Sleep disturbances" (PTSS-13), "Irritability" (PTSS-14) and "Difficulty concentrating" (PTSS-15), all of which were within the Hyperarousal domain. In this sample, the most prominent PTSS symptoms reflected avoidance while symptoms of hyper-arousal had the strongest links with QOL. As such, these symptom clusters are potentially useful targets for interventions to improve PTSS and QOL among healthcare personnel at work under pandemic conditions.

Identifying Military Service Status in Electronic Healthcare Records from Psychiatric Secondary Healthcare Services: A Validation Exercise Using the Military Service Identification Tool.

Electronic healthcare records (EHRs) are a rich source of information with a range of uses in secondary research. In the United Kingdom, there is no pan-national or nationally accepted marker indicating veteran status across all healthcare services. This presents significant obstacles to determining the healthcare needs of veterans using EHRs. To address this issue, we developed the Military Service Identification Tool (MSIT), using an iterative two-staged approach. In the first stage, a Structured Query Language approach was developed to identify veterans using a keyword rule-based approach. This informed the second stage, which was the development of the MSIT using machine learning, which, when tested, obtained an accuracy of 0.97, a positive predictive value of 0.90, a sensitivity of 0.91, and a negative predictive value of 0.98. To further validate the performance of the MSIT, the present study sought to verify the accuracy of the EHRs that trained the MSIT models. To achieve this, we surveyed 902 patients of a local specialist mental healthcare service, with 146 (16.2%) being asked if they had or had not served in the Armed Forces. In total 112 (76.7%) reported that they had not served, and 34 (23.3%) reported that they had served in the Armed Forces (accuracy: 0.84, sensitivity: 0.82, specificity: 0.91). The MSIT has the potential to be used for identifying veterans in the UK from free-text clinical documents and future use should be explored.

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.

Associations between outpatient treatment and the use of intensive psychiatric healthcare services.

The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.

Hermeneutical injustice and unworlding in Psychopathology

ABSTRACT The rich literature in phenomenological psychopathology regards the communicative difficulties accompanying psychiatric illness as a product of ‘unworlding‘: the experience of a drastic change in one’s habitual field of experience. This paper argues that the relationship between speech expression and unworlding in psychiatric illness is more complex than previously assumed. Not only does unworlding cause a breakdown in speech expression, but a breakdown in speech expression can perpetuate, and even exacerbate, the experience of unworlding characteristic of psychiatric illness. In other words, I identify a two-way relationship between unworlding and the communication breakdown in psychiatric illness. Merleau-Ponty’s phenomenology of speech expression is drawn upon to demonstrate how hermeneutical injustice in psychiatric healthcare can elicit unworlding for the person with a psychiatric illness.