Hospital Psychiatric Unit Research Articles

Enfermagem em unidade de internação psiquiátrica

Objetivo: Conhecer a opinião de trabalhadores da enfermagem e portadores de transtornos mentais sobre a assistência de enfermagem em unidade de internação psiquiátrica. Método: Estudo exploratório com 27/84 pacientes, 10/14 auxiliares de enfermagem e 6/6 enfermeiros de uma unidade psiquiátrica de hospital geral. Entrevistas individuais baseadas em questões norteadoras. Análise temática de conteúdo. Resultados: Pacientes: mulheres (66,7%); média etária 41,9 anos; primeira internação (44%). Profissionais: 68,8% mulheres, em média, formados há 9,8 anos. A enfermagem enfrenta dificuldades relacionadas aos pacientes (alucinações/delírios, crianças, isolamento, risco de suicídio, sintomas maníacos) e à rotina de trabalho (burocracia, omissão perante condutas inadequadas dos colegas, número insuficiente de profissionais, organização vertical do trabalho em equipe). Conclusão: Apesar da evolução da reforma psiquiátrica e dos avanços profissionais, a enfermagem ainda enfrenta dificuldades no cuidado aos pacientes internados. Identificálas, ajuda a refletir e aprimorar a prática profissional.

Five-Year Trend in Issuing Disability Certificates from a General Hospital Psychiatric Unit in South India.

Background:Mental disability is a common condition but is considered as an invisible disability. The disability certificate in psychiatry remains underexplored. Some reasons are issues of confidentiality, stigma, lack of awareness in the public, and the hesitancy in the mental health professionals. We aim to provide a brief profile of patients with mental illness issued disability certificates from a psychiatric unit over a five-year period (2013–2017).Methods:Our retrospective study is based on the data available from the copies of the issued disability certificates from a psychiatric unit that functions in a multispecialty tertiary care teaching government hospital in Southern India. Patients undergoing treatment in psychiatry apply for a disability certificate to the medical superintendent of the hospital. Each applicant undergoes a detailed workup to ascertain the diagnosis, and the mental disability is assessed using Indian Disability Evaluation and Assessment Scale (IDEAS). Those with intellectual developmental disorder (IDD) are assessed by a clinical psychologist for quantifying intelligence quotient, based on which the disability certificate is issued. Data were extracted and analyzed using SPSS. Descriptive statistics were used.Results:Over five years, 258 disability certificates were issued. A total of 218 were for mental illness and 40 were for IDD. Schizophrenia was the commonest primary diagnosis. There was no gender predominance, nor the influence of gender on different domains of IDEAS except on work domain dysfunction due to mental illness. The validity period was not mentioned in 81% of the issued certificates for mental illness.Conclusions:This descriptive study found a lower number of certificates issued from the psychiatric unit. Schizophrenia remains the main psychiatric diagnosis for which a disability certificate was issued. We did not assess the utilization pattern of the issued certificates.

Implementing Evidence-Based Treatments for Youth in Acute and Intensive Treatment Settings.

Evidence-based treatments (EBTs) have been well studied in outpatient and research settings to address a myriad of mental health concerns. Research studies have found benefits and challenges when implementing these interventions. However, less is known about the implementation of EBTs in acute and intensive treatment settings such as inpatient psychiatric hospitalization (IPH) units, partial hospitalization programs (PHPs), or intensive outpatient programs (IOPs). As a result, the specific benefits and challenges of providing EBTs in these settings are less clear. For example, challenges of implementing EBTs in IPHs, PHPs, and IOPs can include working within a multi-disciplinary team setting and sustaining trained staff. The current article provides an overview of implementing EBTs in IPHs PHPs, and IOPs. Current PHP, IOP, and IPH models of implementing evidence-based interventions along with strategies for engaging stakeholders, program development and implementation, and measurement are reviewed. Further considerations for sustainability and practice consideration are also provided.

Behavior Therapy for the Treatment of Tourette's Disorder in India: A Patient Series from an Indian General Hospital Psychiatric Unit.

Reports on behavioral interventions for the treatment of Tourette’s disorder (TD) from India are limited. This patient series describes the usefulness and feasibility of conducting behavioral interventions for patients with TD from an Indian general hospital psychiatric unit. Behavioral treatments in these seven consecutively treated adult/adolescent patients with TD included all components of habit reversal treatment, comprehensive behavioral intervention for tics, and exposure with response prevention in some patients. Patients were predominantly male, with adolescent-onset severe TD, typical features and psychiatric comorbidities, and poor response to multiple medications prior to the institution of behavior therapy. In addition to long delays in diagnosis, none of the patients or their caregivers had been informed by the doctors they had consulted earlier about TD or the need for behavioral treatments before attending our center. Institution of behavioral treatments along with medications led to a 75% reduction in the severity of tics and reduction in comorbid symptoms. Patients and caregivers also reported similar rates of improvement as well as reductions in subjective distress and caregiver burden. Five patients have been followed up for seven months to seven years; apart from one patient, all others have had only minor exacerbations of tics during this period. This limited experience suggests that behavior therapies for TD can be successfully implemented in low-resource, non-specialized Indian settings. They are effective, and gains from such treatment are usually enduring.

Evaluation of oxidative stress biomarkers and liver and renal functional parameters in patients during treatment a mental health unit to treat alcohol dependence

Alcohol dependence is one of the main reasons for inpatient admission to psychiatric hospitals. The abuse of this chemical substance can cause modifications in our organism and among them, variations in the oxidative stress parameters. Therefore, the aim of this study is to evaluate patients admitted to a psychiatric hospital unit to treat alcohol dependence, comparing oxidative stress, renal and hepatic function parameters from the moment of admission to those obtained at discharge. Hepatic function was verified through gamma-glutamyl-transferase (GGT), alkaline-phosphatase (ALP), aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) activity measurements. Urea and creatinine serum levels were measured for kidney function evaluation. Oxidative stress was evaluated by superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), ferric reducing antioxidant power (FRAP) and malondialdehyde (MDA). Medications used during hospital stay were record and their influence over the measured parameters analyzed. Twenty-eight patients (82% male, 44 ± 13 years old) were included in this study. A significant increase in BMI of patients after the period of hospitalization could be observed. There were reductions in creatinine, AST, ALT, GGT and ALP serum levels. SOD levels were lower at discharge, while GPx and FRAP presented higher levels. Chlorpromazine use showed influence over some hepatic function markers (ALT, GGT and ALP) and oxidative stress parameters (CAT and GPx); while carbamazepine use influenced GGT and FRAP. Patients on alcohol dependence treatment had significant improvements of renal and hepatic function parameters and higher GPx and FRAP values after the hospitalization period, which indicates reversion of alcohol effects over oxidative stress parameters.

Changes in community mental health services availability and suicide mortality in the US: a retrospective study

BackgroundDespite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States.MethodsRetrospective analysis was performed using data from National Mental Health Services Survey (N-MHSS) and the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) (2014–2017). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (i.e., number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state.ResultsFrom 2014 to 2017, the number of CMHCs decreased by 14% nationally (from 3406 to 2920). Suicide increased by 9.7% (from 15.4 to 16.9 per 100,000) in the same time period. We find a small but negative association between the number of CMHCs and suicide deaths (− 0.52, 95% CI − 1.08 to 0.03; p = 0.066). Declines in the number of CMHCs from 2014 to 2017 may be associated with approximately 6% of the national increase in suicide, representing 263 additional suicide deaths.ConclusionsState governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts.

Observational Study of Complexity in a Psychiatric Hospital Unit

ABSTRACT
 Objectives: 1. Describe the possible variables that may be related to a psychiatric complex patient at the Acute Psychiatric Unit of Santa Creu i Sant Pau Hospital. 2. Determine the usefulness of the standard concept of chronic complex patient in a psychiatric patient.
 Methods: Cross sectional, observational, and quantitative study were conducted in Hospital Santa Creu i Sant Pau, Barcelona. 46 patients admitted at the Acute Psychiatric Ward from March to May 2018 were included in the study. The scales used were: PANSS, HDRS, YMRS, EEAG, FAST, CGI, EQ-VAS and Zarit Burden. The number of extended stays in health institutions, need for social assistance, previous admissions and duration of hospital stay were also evaluated.
 
 Results: There is no difference in the need for social assistance between chronic complex patient (11%) and non-chronic complex patient (18.9%). Also, no difference was noted among the scales FAST, CGI, EEAG, EQ-VAS and Zarit Burden. Upon analysis of the variables, the result of the quality of life is correlated with: 1. PANSS_N (p<0.0044) 2. FAST finances (p<0.0027) 3. FAST cognitive (p<0.0018).
 
 Conclusion: The standard definition of a Chronic Complex Patient does not fit the needs of complexity in a psychiatric patient.
 
 DeCS: quality of life, multimorbidity, caregiver, psychiatric

Study of referrals to department of psychiatry in tertiary care general hospital setting

Background: Study of referral pattern to psychiatry helps us to understand the type of patients and the rate of referral from individual departments. It also helps us to understand the need for consultation liaison services (CLP) thereby strengthening the General Hospital Psychiatric Units (GHPU). Aim: To study the referral pattern to psychiatry in a tertiary care teaching hospital. Materials and Methods: All referrals to the department of psychiatry for a period of two months were included in the study. Sociodemographic details, reasons for referral and the department from which referred were noted. The Psychiatric diagnosis was made according to the ICD -10 criteria. The overall referral rate to psychiatry and referral from individual departments was noted and descriptive statistics was applied to represent the same. Results: The overall referral rate to psychiatry was found to be 1.17% with majority being from medical specialities (62%). The most common reasons for referral have been suicidal attempts and most common psychiatric disorder diagnosed among referred has been delirium. Conclusion: The low levels of referrals to psychiatry emphasize the need for better consultation liaison services. Keywords: Referrals, Consulatation-liasion, General hospital psychiatric units.

Rehabilitation needs of patients with schizophrenia attending the general hospital psychiatric unit of a tertiary care hospital in South India.

Context:Schizophrenia is a major psychiatric illness that is stressful for both patients and their families. Along with clinical improvement with medications, psychosocial rehabilitation is an essential part of treatment to improve functioning and quality of life.Aims:This study aims to assess the rehabilitation needs of patients with schizophrenia and to identify the association of these needs with demographic and clinical variables.Settings and Design:A cross-sectional descriptive design was used. The study was conducted in a general hospital psychiatric unit (GHPU) of a tertiary care teaching hospital.Subjects and Methods:The sample included 770 subjects (385 patients and 385 caregivers). A standardized self-administered questionnaire, the Rehabilitation Needs Assessment Schedule was used to assess the patients' rehabilitation needs.Statistical Analysis Used:Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed in terms of mean with standard deviation or median with an interquartile range. The association between different rehabilitation needs was analyzed using the Chi-square test or Fisher's exact test.Results:The most common requirement was skill training rehabilitation needs (93.8%), followed by psychosocial modification rehabilitation needs (88%) and help for family members (87%). There were significant associations (P < 0.05) between age at onset of illness with employment, current living status with overall needs, and help needed by the family.Conclusion:The study found that 76.9% of the patients required help in at least one rehabilitation domain. The findings of the study have implications in planning and implementing rehabilitation programs.

Nursing process implantation in mental health: a convergent-care research.

to understand the perception of nurses and their needs regarding Nursing Process implantation in a long-term psychiatric hospitalization unit. a convergent care research, carried out in a psychiatric institute in Rio de Janeiro, with 13 nurses. Data were produced between May/2016 and August/2017, with observation in a field diary, semi-structured interviews and groups. Data were analyzed regarding content, theme and by the software NVivo. three thematic categories were developed: Knowledge and practices of participants on Systematization of Nursing Care, Nursing Process and classification system; Convergence points: Nursing Process in practice and research; Challenges of Nursing Process implantation in mental health. Final considerations: implantation was perceived by nurses as a way to be constructed: in the stages of Nursing Process, in handling classifications, but mainly in articulation with the Brazilian National Mental Health Policy.

Psychiatric hospitalization of alcoholists from rural areas in a general hospital: expectations of families.

to know the expectations of family members of alcoholics living in rural areas under treatment in a Psychiatric Hospitalization Unit. qualitative research, through interviews with 15 relatives of alcoholics living in rural areas and hospitalized in a Psychiatric Unit. Information was interpreted in the light of Phenomenological Sociology. two concrete categories emerged: Expectations that the family member quits using alcohol and Projects of family members for the alcoholic after discharge. Relatives expected the alcoholic to maintain abstinence and planned post-discharge care, which involved everything from welcoming them to projects with a prospect of control or even fear of not being able to care for the alcoholic. most participants have positive expectations regarding psychiatric hospitalization, but some relatives are not confident about caring for the alcoholic and mentioned alternatives such as hiring a caregiver or nursing homes.

P.028 Evaluation of the effectiveness of a psychiatric home hospitalization unit in Barcelona

In this article we describe two cases that presented with persistent fever and a hyperinflammatory state in association with severe acute respiratory syndrome-coronavirus-2 infection with various negative reverse transcription-polymerase chain reaction results. These cases subsequently developed myocarditis with cardiogenic shock that required vasoactive drugs and had a good response to corticosteroid treatment. All cases met criteria for a definitive case of multisystemic inflammatory syndrome in adults, a recently described entity associated with coronavirus disease 2019, which has a good response to immunomodulators and a good prognosis in most cases.<Learning objective: Multisystemic inflammatory syndrome in adults is a severe disease with predominantly cardiac involvement, associated with severe acute respiratory syndrome-coronavirus-2 infection. The presentation of these two cases shows the importance of early recognition, especially in this coronavirus 2019 pandemic scenario in which almost anyone is susceptible to have had contact with the virus. It usually has a good therapeutic response to corticosteroids and invasive diagnostic tests, such as endomyocardial biopsy, could be avoided.>

Estudo comparativo do perfil de idosos atendidos em um hospital terciário: ambulatório de psiquiatria geriátrica e unidade de internação psiquiátrica

AIMS: To verify the profile of the elderly and their main diagnoses in the geriatrics psychiatric outpatient clinic and the psychiatric hospitalization unit of a tertiary hospital. METHODS: A cross-sectional study of population-based was performed in a tertiary referral hospital, with individuals aged ≥55 years attending the geriatric psychiatric outpatient clinic and psychiatric hospitalization, from 2014 to 2018. Data were collected through interviews. The studied variables were sociodemographic and clinical aspects. RESULTS: A total of 497 individuals were evaluated, 269 from the psychiatric outpatient clinic and 228 from the psychiatric hospital. The mean age was 69.34±8.87 years. Most of the patients were female (75.8%), had no partner (56.3%), had primary education (50.3%), lived in Porto Alegre (75.6%) and were retired (66.5%). According to the clinical variables studied, 89.6% of the individuals had some morbidity, 36.9% had already been admitted to the psychiatric ward, the most common diagnosis was depression (40.8%), followed by bipolar disorder (19%) and anxiety (14.1%). CONCLUSIONS: With the population aging, it is expected to increase morbidity and mental disorders, requiring more specific diagnostic tools and better treatment approaches. There are still no consistent data on the management of mood disorders in the elderly, so our study can guide a better care for elderly and aging individuals, improving the planning of health services and policies.

Percepção, satisfação e resistências relatadas por profissionais de enfermagem na atuação em psiquiatria

Objetivo: identificar a percepção, a satisfação e as resistências dos profissionais de enfermagem na atuação profissional em psiquiatria. Método: realizado estudo exploratório com 16 profissionais de enfermagem de uma unidade de internação psiquiátrica do interior paulista. Entrevistas com questões norteadoras sobre o início da carreira em psiquiatria e como se sentem, atualmente, trabalhando na área. Análise temática de conteúdo. Resultados: dos 16 profissionais participantes, 68,8% eram mulheres com média etária 35,7 anos. 87,5% dos profissionais resistiram em trabalhar em psiquiatria. Os motivos da resistência foram a falta de preparo (100%), preconceito (43,7%), receio de desenvolver transtornos mentais (30%). Hoje, 50% sentem medo dos pacientes, porém não gostariam de mudar de setor. Estão satisfeitos com seu trabalho porque se sentem importantes para a recuperação dos pacientes. Conclusão: muitos profissionais de enfermagem começaram a trabalhar em psiquiatria devido à falta de oportunidades para seu primeiro emprego. O preconceito em relação à psiquiatria, o ensino insuficiente de enfermagem psiquiátrica e o receio de desenvolverem transtornos mentais predispõem esses profissionais a considerarem negativamente a carreira de enfermagem psiquiátrica.

Differences between psychiatric disorders in the clinical and functional effectiveness of an acute psychiatric day hospital, for acutely ill psychiatric patients.

Intensive treatment in acute day-care psychiatric units may represent an efficient alternative to inpatient care. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder. The primary aim of this study was to explore differences between main psychiatric diagnostic groups, in the effectiveness of an acute partial hospitalization program. And, to identify predictors of treatment response. The study was conducted at an acute psychiatric day hospital. Clinical severity was assessed using BPRS, CGI, and the HoNOS scales. Main socio-demographic variables were also recorded. Patients were clustered into 4wide diagnostic groups (i.e.: non-affective psychosis; bipolar; depressive; and personality disorders) to facilitate statistical analyses. A total of 331 participants were recruited, 115 of whom (34.7%) were diagnosed with non-affective psychosis, 97 (28.3%) with bipolar disorder, 92 (27.8%) with affective disorder, and 27 (8.2%) with personality disorder. Patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F=5.30; P=0.001) and CGI (F=8.78; P<0.001) than those suffering from psychosis or depressive disorder. Longer length of stay in the day-hospital, and greater baseline BPRS severity, were identified as predictors of good clinical response. Thirty-day readmission rate was 3%; at long-term (6 months after discharge) only 11.8% (N=39) of patients were re-admitted to a psychiatric hospitalization unit, and no differences were observed between diagnostic groups. Intensive care in an acute psychiatric day hospital is feasible and effective for patients suffering from an acute mental disorder. However, this effectiveness differs between diagnostic groups.

Mentally disordered offenders discharged from designated hospital facilities under the medical treatment and supervision act in Japan: Reoffending and readmission.

Current Japanese forensic mental health legislation (Medical Treatment and Supervision Act [MTSA]) was enacted in 2003. Little is known, however, about the actual outcomes for the offender patients detained within hospitals under this provision. This study aimed to quantify reoffending and readmission following patients' discharge from forensic psychiatric hospital units across Japan and explore related risk factors. We followed up 526 offenders with mental disorder who had been detained under the MTSA and who were subsequently discharged from any of the 28 hospitals nationwide between 2007 and 2015. The total cumulative reoffence rate was found to be 2.5% (1.1-3.9%) after 1 year and 7.5% (4.6-10.4%) after 3 years. The rate of serious reoffending was 0.4% (-0.18% to 0.99%) after 1 year and 2.0% (0.4-3.6%) after 3 years. The cumulative admission rate to local psychiatric hospitals following a discharge was 21.8% after 6 months and 37.6% after 1 year. Patients who had been discharged from their MTSA order but transferred to a general psychiatric hospital before open community residence-because it was necessary to build community supports-were more likely to reoffend than those discharged directly to the community. Patients who had been diagnosed with a substance use disorder (F10-F19) and had one subsequent admission were at higher risk of further readmissions. The low reoffending rates could be attributed to the intensive treatment and care plans required by the MTSA. The high rate of readmission to psychiatric hospitals may indicate shortcomings in community mental health services in Japan.

Occupational status and hospitalisation for mental disorders: findings from Friuli Venezia Giulia region, Italy, 2008–2017

Purpose: To investigate to which extent occupational status, and job titles, were associated with types of hospitalisations and psychiatric diagnoses among inpatients of Friuli Venezia Giulia Region, Italy.Methods: Cross-sectional study based on 10 years register data (2008–2017) on 2929 subjects hospitalised in General Hospital Psychiatric Units. Odds ratios (OR) of hospitalisations and psychiatric diagnoses for occupational status and job titles were calculated by logistic regression analysis.Results: Employed were at lower risk of urgent and involuntary hospitalisation. The risk of urgent hospitalisation was higher for affective, organic or other disorders, while all psychiatric diagnoses were at lower risk of involuntary hospitalisation than psychosis. Using white collars as reference category, army showed a higher risk for urgent hospitalisation (OR = 2.3) and affective disorders (OR = 1.9). A higher risk for affective disorders was found in managers (OR = 2.0). Blue collars were at higher risk for alcohol and substance abuse (OR = 1.7).Conclusions: Employment was protective for urgent and involuntary hospitalisations and severe diagnoses. Hospitalisation for affective disorders was more likely in managers, army, and for substances abuse in blue collars. More research is needed to assess the association between specific occupational groups and involuntary hospitalisation.KeypointsEmployment was shown to be a protective factor for both urgent and involuntary hospitalisations and diagnosis of severe mental disorder.Managers, police and military forces were at higher risk of being hospitalised for affective disorders, while blue collars were at higher risk of hospitalisation for alcohol and substances abuse.Future research would benefit from a better analysis on the association between more specific occupational groups and hospitalisation for psychiatric disorders, with a particular focus on involuntary treatment.Further research is needed to compare the risk of hospitalisation for mental disorders in temporary or permanent position, according to recent international changes in labour market and its impact on mental health.

The Rise and Demise of America’s Psychiatric Hospitals: a Tale of Dollars Trumping Sense

The Rise and Demise of America’s Psychiatric Hospitals: a Tale of Dollars Trumping Sense

Animal-assisted activity improves social behaviors in psychiatrically hospitalized youth with autism.

There is preliminary research suggesting that animal-assisted activities can improve social interactions of children with autism spectrum disorder. This pilot study sought to investigate the benefits of animal-assisted activities with dogs and psychiatrically hospitalized youth with autism spectrum disorder. Participants were recruited from a specialized inpatient psychiatric hospital unit for youth with autism spectrum disorder and other developmental disabilities. Utilizing a crossover design, participants served as their own control by engaging in two 10-min conditions: an experimental dog and handler interaction (animal-assisted activities) and a novel toy and handler control (control). Of the 142 youth aged 6--8 years screened for participation, 47 completed both conditions. Participants' behavioral data were captured via video and coded using the Observation of Human-Animal Interaction for Research, a tool specifically developed to capture human behavioral interactions in the presence of animals. Overall, social-communication behaviors significantly improved in the animal-assisted activities experimental condition compared to the control condition (p = 0.0001). Specifically, participants in the animal-assisted activities experimental condition displayed more positive emotional facial expressions (p ⩽ 0.0001), talking (p = 0.0408), use of gestures (p = 0.032), and looking at both adults and peers (p ⩽ 0.0001). In addition, a higher frequency of constant motion (p = 0.003) was observed in the animal-assisted activities experimental condition. Results suggest that animal-assisted activities with a dog may promote social-communication behaviors in psychiatrically hospitalized youth with autism spectrum disorder. Given the fact that social and communication behaviors can facilitate treatment engagement for this population, we recommend future studies examine how such improvements can positively affect the psychiatric treatment of this population.

New Hampshire Senate addresses psychiatric boarding bill

A proposal aimed at preventing mental health patients from languishing in emergency rooms won preliminary approval Jan. 31 in the New Hampshire Senate, The Associated Press reported. The bill sent to the Senate Finance Committee would spend $6 million of the state surplus to encourage the construction of hospital psychiatric units by doubling the state's reimbursement rate for designated receiving beds and subsidizing hospital renovation costs. The 16–8 vote, with two Republicans joining Democrats to advance the bill, came after the Senate rejected an amendment that would have spent significantly less on so‐called designated receiving beds but would have added money for mobile crisis teams that could help patients avoid emergency rooms. The average number of adults waiting in emergency departments for inpatient psychiatric admission each day has quadrupled to more than 40 in the last six years. On Jan. 31, there were 43 adults and seven children waiting around the state, according to the state chapter of the National Alliance on Mental Illness.