Hospital Psychiatric Unit Research Articles

EARLY ONSET AGGRESSIVE BEHAVIOR INDUCED BY PERAMPANEL IN THE TREATMENT OF CHRONIC INSOMNIA: A CASE REPORT

IntroductionChronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.ObjectivesTo draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.MethodsCase report and non-systematic literature review of the current data.ResultsA 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.ConclusionsPsychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.Disclosure of InterestNone Declared

Community, Hospital, and Patient Factors Contributing to Ethnoracial Disparities in Follow-Up After Psychiatric Hospitalization.

This study used an ecosocial perspective to examine ethnoracial disparities in timely outpatient follow-up care after psychiatric hospitalization in a cohort of Medicaid recipients. This retrospective analysis used 2012-2013 New York State Medicaid claims data for 17,488 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. Claims data were linked to other administrative data sets capturing key social conditions and determinants of mental health for non-Latinx White (White hereafter), non-Latinx Black (Black), Latinx, non-Latinx Asian/Pacific Islander (Asian/Pacific Islander), non-Latinx American Indian or Native Alaskan (American Indian or Native Alaskan), and other ethnoracial groups. Regression models were used to estimate the variations in disparities in timely follow-up care that were attributable to community, organization (i.e., hospital), and individual patient characteristics. Overall, 60.1% of patients attended an outpatient mental health visit within 30 days of discharge. Compared with the rate for White patients, the attendance rates were 9.5 percentage points lower for Black patients and 7.8 percentage points higher for Asian/Pacific Islander patients. No significant difference in attendance rates was found between Latinx and White patients. Community factors, specifically urban versus rural classification and county poverty status, accounted for the greatest variation in timely follow-up care in all comparisons. Efforts to increase connection to outpatient mental health follow-up care after psychiatric hospitalization should incorporate cultural and structural competencies to address social conditions and determinants of mental health that underly ethnoracial disparities.

Clinical and Sociodemographic Profile of Psychomotor Agitation in Mental Health Hospitalisation: A Multicentre Study.

Psychomotor agitation is characterised by an increase in psychomotor activity, restlessness and irritability. People with psychomotor agitation respond by over-reacting to both intrinsic and extrinsic stimuli, experiencing stress and/or altered cognition. The objective of this study is to assess the clinical and sociodemographic profile of psychomotor agitation in patients with severe mental disorders. The study was carried out in Spain by means of multicentre cross-sectional convenience sampling involving 140 patients who had been admitted to psychiatric hospital units and had experienced an episode of psychomotor agitation between 2018 and 2021.Corrigan's Agitated Behaviour Scale was used to assess psychomotor agitation. The results show that the predominant characteristic in psychomotor agitation is aggressiveness, which is also the most reported factor in patients with severe mental disorder. Patients who also have anxiety develop psychomotor agitation symptoms of moderate/severe intensity. The clinical and sociodemographic profile found in our study is consistent with other studies on the prevalence of psychomotor agitation.

Determinants of Treatment Outcome, Follow-Up, and Abstinence Rates Among Patients With Alcohol Use Disorder: A Prospective Study.

Background The treatment of alcohol use problems needs to have a multidimensional approach for early recovery and better outcome. Objective The study aimed to study the socio-demographic, clinical, and psychological factors associated with the three-month clinical outcomes among patients with alcohol use disorder treated in a tertiary care general hospital psychiatric unit in southern India. Methods This is a prospective three-month follow-up study. Patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for alcohol use disorder were selected for the study. The baseline severity of alcohol use was assessed by the Severity of Alcohol Dependence Questionnaire, alcohol craving by Alcohol Craving Questionnaire (ACQ), impulsivity by Barratt Impulsiveness Scale, anxiety and depression by Hospital Anxiety and Depression Scale and personality traits by Personality inventory for DSM-5. Craving was assessed at 2, 4, 8 and 12 weeks post-discharge. Results A total of 110 patients participated in the study. After 3 months of follow-up, 75.5% of the patients remained abstinent throughout the follow-up period. The sample was divided into two groups based on the abstinent status at 12 weeks. Both the abstinent and relapsed users were compared based on socio-demographic, marital, family, illness-related, alcohol-usage, and psychological characteristics, the baseline and follow-up craving indices. There were no statistically significant differences between the two groups based on socio-demographic characteristics. Compared to the relapsed group, the abstinent individuals displayed increased adherence to follow-up visits and attended more frequent individual therapy sessions, however, there were no significant differences between the two groups in the number of group therapy sessions attended.Also, the abstinent group demonstrated lower subjective craving at both the baselineand during follow-up. The relapsed users had reported a significantly greater proportion of history of suicide in the family. Further correlational analyses were done to find the direction of associations between psychological characteristics and alcohol-usage characteristics. High attentional impulsivityand motor impulsivitywere associated with early age of first use. High attentional impulsivity, motor impulsivityand impulsive planningwere associated with early age of dependence. Early age of dependence was associated with increased levels of antagonism and psychoticism. Younger onset of alcohol use was associated with increased levels of craving at baseline. The baseline alcohol use severity and the baseline craving towards alcohol were positively correlated with follow-up craving indices as per ACQ and craving index (CI) scales. Conclusion The patients who were abstinent displayed reduced subjective craving towards alcohol at baseline and were more adherent in attending individual and group therapy sessions. Among the relapsed users, most relapsed before four weeks and had a family history of alcohol dependence, family history of psychosis, and suicide, which is indicative of high genetic loading of substance abuse leading to early initiation and early onset of alcohol dependence. The effects of genetic loading could be possibly mediated by traits of high impulsivity, psychoticism, and antagonism.

Clinical characteristics of admission for mental illness in a Regional Psychiatric Hospitalization Unit. Descriptive study 2008-2018

To describe the admissions of patients diagnosed with severe mental illness (SMI) and anxiety disorder in a regional hospital; to explore factors related to the patient’s referrer upon admission and prolonged stay. Cross-sectional study of episodes of admission to the regional Psychiatric Hospitalization Unit over a period of 11 years with ICD-10 diagnostic codesF20-29, F30-39, F60-69 and F40-48. The data was extracted through the Admissions Unit and the information from the electronic medical record. For the statistical treatment, descriptive or inferential tests were used with a confidence level of 95%. 961 patients were included (2,324 total discharges), aged 40.8±14.0 years. The most frequent reasons for admission were: positive symptoms (agitation, delusions and hallucinations), followed by suicidal ideation and attempt. The main remitting agent of the patients was the family itself. Approximately 1/5 of the cases were referred by the health system itself, and ¼ of those admitted had self-excluded themselves from specialized supervision for more than a year. The problems that caused the admission and its origin, as well as its lack of follow-up, can be considered as a clear opportunity for improvement in the follow-up of patients with severe mental illness. An orientation towards proactivity, acting before the decompensation, would contribute to improving the care and quality of life of patients with severe mental illness and their environment.

Disability in Patients With Bipolar Disorder in Full or Partial Remission: A Cross-Sectional Study.

Objective: To evaluate the level of disability and identify an association between sociodemographic and clinical variables and disability in patients with bipolar disorder (BD). Methods: This cross-sectional study was conducted in a tertiary care general hospital psychiatric unit with 100 patients with BD in partial or full remission (DSM-IV-TR criteria) from January 2017 to March 2018. Patients were assessed using a semistructured proforma, the Mini-International Neuropsychiatric Interview 5.0–Hindi version, the Hamilton Depression Rating Scale (HDRS) or the Young Mania Rating Scale (YMRS), and the Indian Disability Evaluation and Assessment Scale (IDEAS). Results: All patients with BD had at least mild disability. The mean ± SD IDEAS global score was 5.1 ± 2.59. Of the sample, 66% and 34% had mild or moderate, disability, respectively. The global score of disability was associated with the number of episodes, number of manic episodes, frequency of episodes in the past year, YMRS and HDRS scores, partial remission, and hospitalization. Categories of disability were associated with the type of last episode, type of remission, and treatment setting. Conclusions: Patients with BD had at least a mild level of disability even during remission. Disability worsened with the increasing number, frequency, and severity of episodes; number of manic episodes; partial remission; and hospitalization.

Humanization of care in acute psychiatric hospitalization units: A scoping review.

INTRODUCTION: Humanization in Mental Health refers to give the same relevance to the clinical needs and to the social, emotional and psychological needs. To identify the published knowledge on current care models related to the humanization of care in acute psychiatric units. Scoping review based on the methodological model of Arksey and O'Malley, and PRISMA methodology. Database searches (Pubmed, Cinahl, Virtual Library, Cuiden, Academic Google and PsycInfo) with the terms: "Humanization," "Hospitals Psychiatric," "Emergency Psychiatric," "Psychiatric Service" and "Psychiatric intensive care units." Twenty-two articles met the inclusion criteria. Four thematic units were identified: aspects related to (i) patient perceptions; (ii) Government policies and hospitality organizational culture; (iii) external factors such as the environment, family or associations; and (iv) safety and security. Only one of the articles mentions the concept analysed, although all of them contribute with key aspects of healthcare humanization, such as the empowerment of the patient, the care model, the staff ratio, the therapeutic relationship, the nursing time of direct dedication to the patient, the therapeutic environment, safety and patient and staff perception of feeling safe. The present study can help to improve the care offered in acute mental health units.

Overactive, aggressive, disruptive and agitated behavior associated with the use of psychotropic medications in schizophrenia

BackgroundEvidence is limited for the associations between use of psychotropic medications and overactive, aggressive, disruptive or agitated behavior (OADA)11OADA: overactive, aggressive, disruptive or agitated behavior. in clinical practice. AimsTo investigate the associations between risk of readmission with OADA and use of antipsychotics, antidepressants, mood stabilizers and benzodiazepines in patients with schizophrenia. MethodA consecutive total cohort diagnosed with schizophrenia (N = 663) after admission to the Haukeland University Hospital psychiatric acute unit in Bergen, Norway, was followed from discharge over a 10-year period. At every following readmission, the level of OADA was assessed using the first item of the Health of the Nation Outcome Scale (HoNOS). Periods of use versus non-use of antipsychotics, antidepressants, mood stabilizers and benzodiazepines were recorded as time-dependent variables in each patient and compared using Cox multiple regression analyses. ResultsA total of 161 (24.3 %) patients were readmitted with OADA, and the mean (SD) and median times in years to readmission with OADA were 2.8 (2.6) and 2.1, respectively. We found that the risk of readmission with OADA was negatively associated with use of antipsychotics (adjusted hazard ratio (AHR) = 0.33, p < 0.01, CI: 0.24–0.46) and antidepressants (AHR = 0.57, p = 0.03, CI: 0.34–0.95), positively associated with use of benzodiazepines (AHR = 1.95, p < 0.01, CI: 1.31–2.90) and not significantly associated with use of mood stabilizers. ConclusionsUse of antipsychotics and antidepressants is associated with reduced risk of readmission with OADA whereas benzodiazepines are associated with an increased risk of readmission with OADA in patients with schizophrenia.

Pharmacist-led medication reconciliation on admission to an acute psychiatric hospital unit.

Background:Therapy management in patients suffering from mental health disorders is complex and the risks derived from changes or interruptions of treatment should not be ignored. Medication reconciliation in psychiatry may reduce medication errors and promote patient safety during transitions of care.Objective:To identify the influence of complementary information sources in the construction of the best possible medication history, and to ascertain the potential clinical impact of discrepancies identified in a medication reconciliation service.Methods:An observational study was conducted in an acute mental hospital unit, with a further validation in an internal medicine unit. Adult patients taking at least one medicine admitted in the unit were included. Patients/caregivers were interviewed upon admission and the information gathered was compared with hospital medical and shared electronic medical records. Once the best possible medication history was gathered, therapeutic information was reconciled against the prescription on admission to identify discrepancies. Potential clinical impact of medication errors was classified using the International Safety Classification.Results:During the study period, 148 patients were admitted, 50.7% females, mean age 54.6 years (SD=16.3). Collaboration of a caregiver was a needed in 74% of the interviews. In total, 1,147 drugs were considered to obtain patients’ best possible medication history. After reconciliation, 560 clinically sound intentional discrepancies were identified and 359 discrepancies required further clarification from prescribers: 84.12% “drug omission”, 5.57% “drug substitution”, 6.96% “dose change”, and 3.34% “dosage frequency change”. Potential clinical impact of these medication discrepancies was classified as: 95 mild, 100 moderate, and 29 severe medication errors.Conclusion:About 1 in three intentional discrepancies observed in a pharmacists-led medication reconciliation service required further clarification from prescribers, being 80% of them unintentional discrepancies. Results highlight the importance of the caregiver as source of information for the psychiatric patient, the relevance of analyzing shared electronic health records until 6 months before, and the need to use hospital medical records efficiently. Additionally, 29 discrepancies were classified as errors with potentially severe clinical impact. A medication reconciliation service is concluded to be feasible and necessary in a mental health unit.

Clinical experience with the new double aripiprazole depot regime in a psychiatric hospitalization unit

IntroductionNowadays, relapses are typical in patients with schizophrenia and may have serious implications due to most of them are caused by a lack of adherence to treatment.Therefore, numerous long-acting injectable antipsychotics (LAI) have been developed as aripiprazole depot who need a proper oral supplementation. Since November 2020, FDA approved a new treatment indication with a double injection start and a single dose of 20mg of oral aripiprazole, with the aim of avoiding oral supplementation during the next 14 days.ObjectivesThe purpose of our study is to expose our experience with the new double injection start with aripiprazole LAI, regarding the rehospitalization rate.MethodsA prospective study (n=17 patients) has been developed between November 2020 and October 2021 with the purpose of studying the rehospitalization and antipsychotic adherence after the new guideline of aripiprazoleResultsAfter an 11-month-follow-up, it is noticed a 65% non-rehospitalization rate and a 76% proper treatment persistence rate. The 94% did not present any kind of side effects, only one patient had a case report of bullous pemphigoid. Regarding the concomitant use of other antipsychotics, 82% of the patients remained in monotherapia. The average stay time was shortened (11 days) regarding the standard dose (14 days).ConclusionsThe new LAI regimen is well tolerated in our patients obtaining a high treatment persistence after several months of hospital discharge. It was already possible to shorten the time of rehospitalization, not having to add oral aripiprazole for 14 days. Most patients were discharged are on antipsychotic monotherapy and have not been rehospitalized in the short term.DisclosureNo significant relationships.

“Let’s face it… it’s futile”: Experiences of futility among nurses who provide care to patients with borderline personality disorder

IntroductionResearch studies suggest that mental health nurses hold negative attitudes towards patients diagnosed with borderline personality disorder (BPD).ObjectivesThe aim of this study was to explore mental health nurses’ experiences and attitudes towards BPD patients in Greece, using a qualitative approach.MethodsData were collected through two audio-recorded focus group discussions. The participants were twelve nurses who work in two General Hospital Psychiatric Units –one in Athens and one regional– and have direct clinical experience with BPD patients. The audio recordings were transcribed verbatim and analysed using thematic analysis in the context of grounded theory.ResultsOne overarching theme and three main themes were identified. The overarching theme that emerged was: “Futility”, which refers to feelings that the provision of nursing care to BPD patients is devoid of purpose and meaning. The main themes were: “Uncertainty”, which refers to the absence of valid causal explanations for mental disorders and on the perplexity of the BPD psychopathology; “Frustration”, which refers to challenges and barriers to providing care to BPD patients; “Unsupportiveness”, which refers to a complex mental health system, where there is a lack of guidance and goal orientation. Of significance are the nurses’ feelings of frustration and futility creating a sense of being burdened and leading to negative attitudes and behaviours towards BPD patients.ConclusionsUnderstanding treatment goals from the recovery model perspective and developing guidelines to help nurses revisit the concept of medical futility, may improve care to BPD patients.DisclosureNo significant relationships.

Psicosis and suicide risk: who, when and why

IntroductionSuicide rates in people diagnosed with a psychotic disorder can be up to 50 times higher than in the general population, with the lethality of attempts being significantly higher in this group, compared to people diagnosed with other psychiatric disorders. Furthermore, it is known that being male is associated with more serious suicide attempts and higher rates of completed suicides.ObjectivesTo reflect on the increased risk of suicide associated with psychotic disorders.MethodsCase report and literature review.ResultsCase report 40-year-old male, recently diagnosed with Schizophreniform Disorder and currently with persistent positive symptoms. He was admitted to our psychiatric hospitalization unit due to a voluntary overdose of almost 100 tablets (antihypertensives, antiarrhythmics, and benzodiazepines) and alcohol. He admits taking the pills with the aim of committing suicide. Literature review: - Around 10% of people diagnosed with schizophrenia commit suicide. - In young patients diagnosed with schizophrenia, suicide is the leading cause of death. - Between 15 and 65% of patients diagnosed with schizophrenia have depressive symptoms such as hopelessness. - Depressive symptoms in these patients seem to be directly proportionally with awareness of the disease (stigma, awareness of its severity and a sudden decrease in quality of life and social integration). - The risk of suicide increases especially in the first 10 years of the disease.ConclusionsPsychosis is an important risk factor of suicide and active preventive measures should be carried out in these patients.DisclosureNo significant relationships.

Covid-19 pandemic and suicidal risk among adolescents

IntroductionThe Covid-19 pandemic has had a significant impact on the mental health of adolescents. Several descriptive studies and systematic reviews have shown an increase in suicide rates in this age group.Objectives- To present a literary review on the impact of the Covid-19 pandemic on the mental health and suicidal behavior of adolescents around the world. - To present data on admission rates due to suicidal behavior during the first year of the Covid-19 pandemic in a Spanish child-adolescent psychiatric hospitalization unit.Methods- We will present a literature review and a retrospective cross-sectional study on admission rates for suicidal behavior in a child-adolescent psychiatric hospitalization unit. - Admission rates for suicidal behavior during the year prior to the pandemic will be compared with rates relative to the first year of the pandemic.Results- We have found a significant increase in admission rates for suicidal behavior during the year of the pandemic. Similar results have been found in different studies and meta-analyzes. - The socio-demographic characteristics of the patients are quite similar in the two periods of time analyzed, but the reference to intra-family problems has been more frequent in the year of the pandemic.ConclusionsOur data is in line with other studies suggesting that the Covid-19 pandemic has had a strong impact on teenage suicidal behavior.DisclosureNo significant relationships.

0339 A possible role for the circadian system in aggression in dementia

Abstract Introduction Growing evidence suggest a bidirectional relationship between circadian and sleep regulation, and the pathology and progression of dementia. Behavioral and psychological symptoms of dementia (BPSD) are very prevalent, and lead to an enormous disease burden in patients, families and caregivers. Indications for a possible disruption of circadian regulation of emotions and behavior in dementia, can be found in the phenomenon known as ‘sundowning’, exacerbation of neuropsychiatric symptoms during the late afternoon and early evening. Aggression in particular can be a very debilitating symptom of dementia, and previous animal and human studies point to a possible role of the circadian rhythm in the propensity for aggressive behavior. Therefore, we examine here the timing of aggression in a dementia cohort. Methods We studied the timing of aggression incidents on a university psychiatric hospital unit treating patients with dementia and additional behavioral problems. During a 6-month period (November 2020 - April 2021) 84 patients were admitted to the ward. Data of these patients were retrospectively analyzed. During this period 335 individual incidents of aggression (verbal and/or physical) were reported by the nursing staff. Results Among the 84 subjects, 42 (50%) had at least one aggression incident during hospital admission. 41% of all incidents occurred between 4-10pm. (5-9pm (36.4%), 9pm-1am (11.6%), 1-5am (5.7%), 5-9am (22.7%), 9am-1pm (10.7%), 1-5pm (12.8%)). In every investigated month, a peak in number of incidents could be seen between 7 and 8pm. Aggression incidents were most likely to occur in Alzheimer’s dementia (OR: 3.75). Patients who exhibited aggression had worse cognitive impairment (difference in mean MMSE: 4.57 ± 2.1 , p=0.034). Conclusion Aggression incidents were most prevalent during the late afternoon and evening. Furthermore, the severity of cognitive impairment and type of dementia negatively impacted the prevalence of aggression.Our study thus confirms a possible role of the circadian rhythm in aggression. The role of the circadian rhythm in the pathophysiology of neurodegenerative disorders, and specifically in their neuropsychiatric symptoms, warrants further research. Support (If Any) Supported by the Funds Malou Malou, Perano, Georgette Paulus, JMJS Breugelmans and Gabrielle, François and Christian De Mesmaeker, Managed by the King Baudouin Foundation of Belgium, No. 2021-J1990130-222081.

Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes.

ObjectivesTo investigate differences in behavioral and psychological symptoms of dementia (BPSD) and caregiver distress caused between older adults with dementia living in the community and in nursing homes.DesignA comparative cross-sectional study.Setting and ParticipantsParticipants were recruited from outpatient clinics of a tertiary psychiatric hospital and dementia units of a nursing home in Guangzhou, China.MethodsNeuropsychiatric Inventory was used to assess symptoms and caregiver distress. Dementia severity was determined using the Clinical Dementia Rating.ResultsThis study included 157 community and 112 nursing home residents with dementia. Clinically significant symptoms (item score ≥ 4) were found in 88.5% of the former and 75% of the latter. Caregivers of 79.6% of the former and 26.8% of the latter reported that at least one of these caused them moderate-to-severe distress (distress score ≥ 3). Among the community patients, anxiety was the most frequent “very severe” symptom, while sleep disorders and agitation caused the most frequent “very severe” caregiver distress. After controlling for dementia severity and medication use, family caregiving remained an independent risk predictor for clinically significant symptoms and moderate-to-severe caregiver distress. The prediction of caregiver distress based on symptom scores varied across caregiver types and individual symptoms (R2 0.36–0.82). Group differences in clinically significant symptoms and moderate-to-severe caregiver distress showed at the stage of moderate-to-severe dementia.Conclusions and ImplicationsTailored management strategies to relieve family caregivers’ BPSD-induced distress are needed, especially at the stage of moderate-to-severe dementia. An effective service system should be established for supporting family caregivers to cope with BPSD.

Overview of practice of Consultation-Liaison Psychiatry.

Overview of practice of Consultation-Liaison Psychiatry.

Are patients improving during and after a psychiatric hospitalisation? Continuity of care outcomes of compulsory and voluntary admissions to an Italian psychiatric ward.

Background: To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients’ outcomes improved during hospitalisation and followup in mental health services (MHS) based on community continuity of care.Design and methods: Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed-up for six-months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman χ2 and Mann-Whitney tests for outcomes’ improvement.Results: Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes’ improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug’s efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2.Conclusions: CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that communitybased MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients’ subjective experiences and assessing long-term improvement in those who received personcentred interventions. Significance for public health This study demonstrates that patients voluntarily or involuntarily admitted to an inpatient psychiatric service improve to a same extent during hospitalisation, and this improvement is maintained during a six-month follow-up by outpatient mental health services. Moreover, the greatest improvement after discharge from hospital is observed in social functioning. To our knowledge, this is also the first study analysing psychiatric patients’ outcomes in a longitudinal continuity of care model, allowing preliminary scientific evidences valuable for mental health policy. The study also shed a light on the hypothesis that a mental health system strongly community-based and applying a whole-system continuity of care approach might achieve recovery in a long-term perspective, particularly with regard to psychosocial outcomes in more severely-ill patients.

TBM-Crise : intervention hospitalière brève basée sur la mentalisation

Contexte Notre équipe travaille dans une unité hospitalière psychiatrique de crise aux Hôpitaux universitaires de Genève (Suisse). Nous y accueillons pour 7 jours des personnes en situation de crise qui présentent des idées ou un comportement suicidaire. Comme facteurs précipitant la crise suicidaire, ces personnes traversent des évènements de vie s’accompagnant d’intenses difficultés interpersonnelles et menaçant l’image qu’ils ont d’eux-mêmes. Il y a dans notre population clinique environ 35 % de patients souffrant de trouble de personnalité limite (TPL). Chez ces patients, les crises à répétition et les comportements suicidaires engendrent des ruptures relationnelles et thérapeutiques fréquentes et dommageables. Notre objectif est de développer une approche spécifique à cette problématique clinique. Intervention Nous avons développé une intervention psychologique brève focalisée sur la mentalisation en 4 temps : accueil, mentalisation affective des éléments de crise, formulation de la problématique, travail sur la sortie et la suite de soins ambulatoires. Cette intervention est adaptée à une équipe médicosoignantes. Du point de vue de la thérapie basée sur la mentalisation (TBM), la phase d’accueil est principalement consacrée à un mirroring et à une régulation affective afin de réduire l’intensité de la désorganisation psychique. Il s’agit ensuite d’activer la capacité à mentaliser, à savoir la curiosité au sujet des états mentaux, au travers d’un travail sur la narrative de crise avec un focus affectif. Nous travaillons ensuite à construire avec les personnes une formulation de sa problématique dans laquelle elle a peut assumer un rôle. Il s’agit de les rendre « agents » de leurs crises. Alors nous pouvons terminer l’intervention en travaillant tant la séparation qu’une projection dans le futur immédiat. Le but est alors de prolonger le travail psychologique entamé au niveau d’un réseau ambulatoire. Cette dernière phase voit se réactiver le système d’attachement et réapparaître les difficultés jusque-là extérieures à l’espace thérapeutique. Implications cliniques La TBM est efficace pour le TPL notamment sur la réduction des gestes suicidaires et du nombre d’hospitalisations. Nous avons ajusté son dispositif théorique et clinique pour des individus hospitalisés en raison d’une crise suicidaire et qui présentent des profils psychopathologiques divers et comorbides. La TBM permet l’adaptation et l’évaluation d’outils psychothérapeutiques empiriquement fondés à différents contextes cliniques, mais aussi à différentes populations cliniques.

Clinical and functional characteristics of schizophrenic patients admitted to a psychiatric home hospitalization unit

Clinical and functional characteristics of schizophrenic patients admitted to a psychiatric home hospitalization unit

Psychiatric comorbidity and quality of life in patients with bipolar disorder

Psychiatric comorbidity in patients with bipolar disorder (BD) has been associated with an earlier onset, rapid cycling, worsening severity and outcome, and increased suicidality. Patients with BD have been reported to have poor quality of life (QOL) even during remission. Estimate the prevalence of psychiatric comorbidity and assess the QOL in patients with BD, and find the associated sociodemographic and clinical variables. This cross-sectional study was done in a general hospital psychiatric unit on 100 patients (both inpatients and outpatients) with DSM-IV-TR BD in partial or complete remission. Patients were assessed using a semi-structured pro forma, Mini International Neuropsychiatric Interview 6.0 - Hindi version, Hamilton Rating Scale for Depression or Young Mania Rating Scale and World Health Organization QOL instrument, short-form (WHOQOL-BREF), Hindi Version. Sixty-one percent of the sample had at least one psychiatric comorbidity, and the commonest comorbid disorders were substance use disorders (SUD) (30%) and anxiety disorders (AD) (28%). Male gender was identified as a predictor for comorbidity in BD. The mean QOL-BREF score was 85.96 ± 14.35. Poor QOL was associated with older age at onset of comorbidity, multiple comorbidities, mixed episodes, rapid cycling, partial remission, and increased severity of depression while patients with current hypomanic symptoms were found to have better QOL. BD with comorbidity had worse QOL than those without comorbidity. The majority of patients with BD had at least one comorbidity. SUD were the most common comorbid disorders. QOL, already poor in BD patients, was poorer in cases with comorbidity.