Psychiatric Hospitals In Switzerland Research Articles

Voluntary sport programs for individuals with mental health disorders: The trainer’s and participant’s view

Introduction
 There is strong evidence that physical activities are important in increasing and maintaining mental health as well as in preventing relapse after mental health disorders (Schulz et al., 2011). Physical activity is an integral part of the treatment program in psychiatric hospitals in Switzerland (CH; Brand et al., 2016). However, after discharge from the hospital in CH, there are insufficient opportunities to engage in physical activity for individuals with mental health disorders (IMHD). To close this gap, voluntary sports groups (VSG) for IMHD have been growing in Switzerland since 2016, mainly organized by the PluSport Umbrella Organization of Swiss Disabled Sports (Kiselev & Loosli, 2019). Yet, little is known about these VSG and their training settings. The perspectives of IMHD and trainers of these groups as well as the perceived barriers and facilitators for participating for IMHD have neither been assessed nor included in the design of sports programs. Therefore, two studies aimed to explore the point of view of the IMHD (first study) and the trainers of these groups (second study) on challenges, barriers, and facilitators for IMHD regarding participation in VSG for IMHD. Additionally, given the crucial role of the trainers in the training process and the importance of their interpersonal characteristics, both studies aimed to identify reasons/motivations and proper personality characteristics of the VSG trainers from the interviewees’ perspective.
 Methods
 Both studies consisted of 15 semi-structured interviews each (with participants (1st study) and with trainers (2nd study) of VSG for IMHD). The results were analyzed using thematic analysis using Nvivo (Guest et al., 2012).
 Results
 Several training facilitators and trainers’ characteristics supporting the participation of the IMHD in VSG for IMHD were named by interviewees (e.g., offer-specific, emotional, rational motives, social skills of the trainers, and ability to set boundaries). At the same time, respondents reported several barriers as possible inhibitors for the participation of IMHD in VSG for IMHD (e.g., intrapersonal, structural, offer-specific, interpersonal and socio-cultural). Within the interviews, IMHD described predominantly positive perceived outcomes from participating in VSG for IMHD. On the other side, trainers of VSG for IMHD highlighted the satisfaction of doing sports with IMHD and of the contribution to improving the physical activity habits of IMHD as the main factors for their commitment as coaches (Baumberger et al., under review; Epiney et al., 2023).
 Discussion/Conclusion
 IMHD benefit socially, physically, and psychologically from participating in VSG for IMHD. However, participation is associated with barriers that need to be minimized in the future to make participation more accessible. Furthermore, the findings suggest improving the recruitment of future trainers of VSG for IMHD by focusing on assessing the appropriate personality characteristics of trainers and their motives. Additionally, findings should be integrated into the educational materials of Swiss disabled sports systems to ensure the proper upskilling of the new and present trainers of VSG for IMHD and ensure the quality and attractiveness of these groups for the target population . Finally, a large-scale survey is necessary to validate the results among the population.
 References
 Baumberger, C., Wieber, F., Pauli, C., Loosli, D., Kleim, B., & Kiselev, N. (under review). Active bodies - Active minds? A deep dive into the voluntary sports programs for individuals with psychiatric disorders in Switzerland: Participants view. BMC Public Health.
 Brand, S., Colledge, F., Beeler, N., Pühse, U., Kalak, N., Sadeghi Bahmani, D., Mikoteit, T., Holsboer-Trachsler, E., & Gerber, M. (2016). The current state of physical activity and exercise programs in German-speaking, Swiss psychiatric hospitals: Results from a brief online survey. Neuropsychiatric Disease and Treatment, 12, 1309-1317. https://doi.org/10.2147/NDT.S107313
 Epiney, F., Wieber, F., Loosli, D., Znoj, H., & Kiselev, N. (2023). Voluntary sports programs for individuals with mental health disorders: The trainer’s view. Plos one, 18(10), Article e0290404. https://doi.org/10.1371/journal.pone.0290404
 Guest, G., MacQueen, K., & Namey, E. (2012). Applied Thematic Analysis. SAGE. https://doi.org/10.4135/9781483384436
 Kiselev, N., & Loosli, D. (2019). Kann ich mitmachen? Behinderten- und Rollstuhlsportclubs in der Schweiz und der Zugang zum Behinderten- und Rollstuhlsport [Disabled and wheelchair sports clubs in Switzerland and access to disabled and wheelchair sports]. Schweizerische Zeitschrift für Heilpädagogik, 25(5-6), 13-20.
 Schulz, K. H., Meyer, A., & Langguth, N. (2011). Körperliche Aktivität und psychische Gesundheit [Physical activity and mental health]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 55(1), 55-65. https://doi.org/10.1007/s00103-011-1387-x

Exploring Patients’ Feeling of Being Coerced During Psychiatric Hospital Admission: A Qualitative Study

Various coercive measures can be used to legally compel a person suffering from psychiatric disorder to undergo treatment. However, evidence suggests that patients’ feeling of being coerced is not determined solely by their being submitted to formal coercion. This study aimed to explore voluntary and involuntary patients’ experience of coercion during psychiatric hospitalisation and to identify which factors, from their perspective, most affected it. We chose a qualitative design inspired by a hermeneutic-phenomenological approach. Participants were purposively selected from six psychiatric hospitals in Switzerland. Maximum variation sampling was used to ensure the inclusion of patients with different levels of perceived coercion and different admission statuses. In-depth, semi-structured interviews were co-conducted by a research psychologist and a service-user researcher. The transcribed data underwent thematic analysis. All twelve interviewed patients described the hospitalisation as an experience of loss of control over their life due to either external or internal pressures. During the process, perceptions of these pressures varied and sometimes overlapped, leading some patients to describe their admission as a form of simultaneous protection and violation. The balance between these two contradictory feelings was affected by a variety of contextual and relational factors, as well as by the meaningfulness of the experience and the patient’s subsequent satisfaction with it. Increasing policy-makers’ and clinicians’ awareness about the main factors influencing patients’ experience of loss of control is of paramount importance in order to develop skills and strategies able to address them, reinforcing patients’ empowerment, reducing their feeling of coercion and improving their well-being.

Psychometric assessment of the German version of the Questionnaire about the Process of Recovery.

Personal recovery is important for mental health services and service users; moreover, valid and reliable assessment instruments are necessary for measuring personal recovery. Therefore, this study aimed to evaluate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. The study was conducted using a cross-sectional design with a convenience sample. The questionnaire was completed by 200 patients of outpatient services of two psychiatric hospitals in Switzerland. A confirmatory factor analysis was conducted to validate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. Cronbach's alpha was calculated to assess the internal consistency. The results showed an overall acceptable model fit (χ2 =134.188, df=90, P=0.002; RMSEA=0.050, 90% CI: 0.031-0.067; CFI=0.937; TLI=0.927) and excellent internal consistency (Cronbach's α=0.91). These results are consistent with those of studies that have examined the Questionnaire about the Process of Recovery in other languages. This study provides preliminary evidence that the German version of the Questionnaire about the Process of Recovery is a reliable assessment instrument for measuring personal recovery among people with mental illness experiences. However, it is necessary to conduct further psychometric tests to verify the validity and reliability of the instrument. The German version of the Questionnaire about the Process of Recovery can be applied to both research and clinical practice, especially as a means of facilitating communication during the planning and evaluation of treatment goals.

Analysis of Patient Characteristics in the Inpatient Treatment of Behavioural Addictions: an Exploratory Study

Clinical research on the treatment of behavioral addictions is still scarce. The current study aims to analyze the therapy model for behavioral addictions implemented at the Privatklinik Meiringen, a psychiatric hospital in Switzerland. Patient characteristics over a period of two years were analyzed, documenting abnormalities and changes in their psychological state. A total of 49 individuals between the ages of 18 and 64 were included from the inpatient setting. The patient characteristics were presented with descriptive statistics. Using validated measuring instruments, the psychological state of the patients at the time of admission and discharge was recorded and analyzed. All study participants suffered from psychological comorbidities besides the diagnosis of behavioral addiction. Depression constituted the most common comorbidity, whereas the distribution and incidence of comorbidities varied depending on specific behavioral addiction present in the patient. A clear improvement in psychological distress between the first and the last surveys could be demonstrated. The study provides an exploratory insight into the peculiarities of characteristics of patients suffering from behavioral addiction in an inpatient setting and an overview of their comorbidity spectrum. The retrospective nature of the study prevents an assessment of the effectiveness of the therapy.

Seclusion as a coercive measure in suicidality – daily routine or exception?

BackgroundCoercive measures continue to be an important topic in psychiatry. However, there is no proof of the effectiveness of the use of coercive measures, especially with suicidal people. For many years, attempts have been made to replace such measures with alternative noncoercive intervention options. This paper aims to clarify the situation of coercive measures, more precisely seclusions, in a general psychiatric hospital in Switzerland. It focuses on compulsory measures in patients with suicidal tendencies.MethodIn this single-centre retrospective cohort study, we used routinely collected medical data and performed qualitative analyses of medical histories to examine whether alternative measures to seclusion had been offered and/or provided to patients who had been secluded solely because of suicidality. Patients were aged 18–65 years and had received inpatient treatment at one of five adult acute care units at a general psychiatric hospital in Switzerland between September 2016 and December 2019.ResultsThere were 5,935 inpatient treatment cases during the study period. Suicidality was rated as “acute” or “very high” at least once during the hospitalization in 219 (3.7%) cases. Of these, 60 were excluded from further analyses as they involved seclusion, but suicidality was not the exclusive indication for this measure. Coercive seclusion was imposed exclusively due to suicidality in 53 (33.3%) of the remaining 159 cases, whereas 106 (66.7%) cases were not secluded. The rates of seclusion among suicidal patients varied considerably between the hospital wards (13.0% to 55.3%). Suicidal patients with non-Swiss residence status and/or lacking language skills were particularly prone to be secluded. Additionally, alternative interventions were offered and provided significantly more frequently in the nonsecluded patients.ConclusionsTo avoid seclusion due to suicidal tendencies, it is necessary to have a general attitude of avoiding coercive measures at all costs. It is also important for qualified staff to be able to deal with challenging sociodemographic characteristics of patients such as foreign-language, which may require translators and intercultural interpreters.

A two-center pilot study on the effects of clinical ethics support on coercive measures in psychiatry

BackgroundThe use of formal coercion such as seclusion, mechanical restraint, and forced medication is one of the most challenging and complex issues in mental health care, on the clinical, the legal, and the ethical level. Clinical ethics support aims at assisting healthcare practitioners in determining the morally most justifiable course of action in these situations. However, the effectiveness of clinical ethics support has hardly been studied so far.MethodsMonthly moral case deliberation (MCD) was implemented in two acute wards of two different psychiatric hospitals in Switzerland. Frequency and intensity of coercion was measured on ward level (npatients = 405), and the Moral Attentiveness Scale, Knowledge on Coercion Scale, and Staff Attitudes towards Coercion Scale were applied on healthcare practitioner level (nHP = 46). Pre-post-comparisons were conducted using multi-level modeling where appropriate.ResultsAfter implementation of MCD, formal coercion was less frequent (particularly seclusion, small effect size; 9.6 vs. 16.7%, p = .034, Cramér’s V = .105) and less intense (particularly mechanical restraint, large effect size; 86.8 ± 45.3 vs. 14.5 ± 12.1 h, exact p = .019, r = -.74), and approval for coercive measures among healthcare practitioners was lower when controlling for the number of MCD sessions attended.ConclusionsClinical ethics support such as MCD may be a hitherto underutilized service for the reduction of coercion, complementing existing strategies and programs. Implementing clinical ethics support may help improve quality of care for persons suffering from severe mental illness.

Shared Decision Making in the Psychiatric Inpatient Setting: An Ethnographic Study about Interprofessional Psychiatric Consultations.

Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a better understanding of how psychiatric inpatients and the interprofessional care team interact during regular interprofessional psychiatric consultations. Data were collected through participant observation on two different psychiatric wards in a large psychiatric hospital in Switzerland. The observation focused on the contextual aspects of interprofessional patient consultations, the communication and interaction as well as the extent to which patients were involved in decision making. Participants included patients, psychiatrists, junior physicians, nurses, psychologists, social workers and therapists. We observed 71 interprofessional psychiatric consultations and they differed substantially in both wards in terms of context (place and form) and culture (way of interacting). On the contrary, results showed that the level of patient involvement in decision making was comparable and depended on individual factors, such as the health care professionals’ communication style as well as the patients’ personal initiative to be engaged. The main topics discussed with the patients related to pharmacotherapy and patient reported symptoms. Health care professionals in both wards used a rather unidirectional communication style. Therefore, in order to promote patient involvement in the psychiatric inpatient setting, rather than to focus on contextual factors, consultations should follow a specific agenda and promoting a bidirectional communication style for all parties involved is strongly recommended.

Use of Long-Acting Injectable Antipsychotics in Inpatients with Schizophrenia Spectrum Disorder in an Academic Psychiatric Hospital in Switzerland.

Long-acting injectable antipsychotics (LAIs) offer many benefits to patients with schizophrenia spectrum disorder (SSD). They are used with very different frequencies due to questions of eligibility or patients and prescribers’ attitudes towards LAI use. We assessed the prescribing rates of LAIs in a large academic psychiatric hospital with a public service mandate in Switzerland and compared them with other countries and health care systems. To our knowledge, this study is the first to investigate inpatient LAI use in Europe. Medical records of all patients diagnosed with SSD discharged from the Clinic of Adult Psychiatry of the University Hospital of Psychiatry Zurich over a 12 month period from January to December 2019 were evaluated regarding the prescribed antipsychotics at the time of discharge. The rates of use of LAIs among all patients and among patients receiving LAI-eligible antipsychotic substances were assessed retrospectively. We assessed records of 885 patients with SSD. Among all cases, 13.9% received an LAI. Among patients who received antipsychotic medication that was eligible for LAI use (n = 434), 28.1% received an agent as an LAI. LAI use included paliperidone palmitate (69.9%), aripiprazole monohydrate (14.6%), risperidone (4.9%) and first-generation LAIs (9.8%). Compared to international frequencies of LAI administration, the prescription rate of LAIs in SSD patients was low. Further studies will evaluate patient- and prescriber-related reasons for this low rate.

"What's the best way to document information concerning psychiatric patients? I just don't know"-A qualitative study about recording psychiatric patients notes in the era of electronic health records.

This paper reports the results of a qualitative study regarding the main attitudes and concerns of Swiss psychiatrists related to the utility, usability and acceptability of EHR and how they address the pitfalls of sharing sensitive information with other parties. A total of 20 semi-structured interviews were carried out. Applied thematic analysis was used to identify themes with regard to participation. Three main themes were identified: 1) strengths of the use of EHR in the clinical context; 2) limitations of EHR; and 3) recommendations on preserving confidentiality in health records. The study shows variable practices of EHR use in psychiatric hospitals in Switzerland and a lack of standards on how to document sensitive information in EHR.

Impact of language proficiency on mental health service use, treatment and outcomes: "Lost in Translation"

BackgroundMastery of a language is bound to place of origin; low language proficiency is thus related to migration and cultural differences, all of which influence access to mental health care, treatment and outcomes. Switzerland, being multilingual, allows the disentangling of language proficiency from migration and, to some extent, culture. This study uses propensity score matching to explore how language proficiency relates to help-seeking behaviour, service use, treatment and outcomes in patients with mental health disorders. MethodsWe used the first admission of patients admitted to and discharged from an academic psychiatric hospital in Switzerland between January 1st, 2013 and December 31st, 2019, with an observation period of one-year post-discharge (until December 31st, 2020). We paired 2101 patients with low language proficiency to 2101 language proficient patients, balancing baseline sociodemographic and clinical characteristics using propensity score matching. ResultsPatients with low language proficiency had a higher probability of compulsory admission (OR: 1.79, 99%CI: 1.60–2.02); which remained after adjustment for confounders (OR: 1.51; 99%CI: 1.21–1.89). Whilst in treatment, they had higher rates of compulsory medication (OR: 1.73, 99%CI: 1.16–2.59) and seclusion/restraint (OR: 1.87, 99%CI: 1.25–2.79). Furthermore, patients initially admitted voluntarily had a higher probability of being compulsorily retained (OR: 1.74, 99%CI: 1.24–2.46). Both groups showed similar clinical improvement rates and service use parameters. ConclusionsOur results demonstrate that low language proficiency constitutes a risk factor for coercive measures throughout hospitalisation. The results demonstrate the need for an increase in language sensitivity in psychiatric care.

Matching Registered Nurse Services With Changing Care Demands in Psychiatric Hospitals: Protocol for a Multicenter Observational Study (MatchRN Psychiatry Study).

BackgroundThe quality of care is often poorly assessed in mental health settings, and accurate evaluation requires the monitoring and comparison of not only the outcomes but also the structures and processes. The resulting data allow hospital administrators to compare their patient outcome data against those reported nationally. As Swiss psychiatric hospitals are planned and coordinated at the cantonal level, they vary considerably. In addition, nursing care structures and processes, such as nurse staffing, are only reported and aggregated at the national level, whereas nurse outcomes, such as job satisfaction or intention to leave, have yet to be assessed in Swiss psychiatric hospitals. Because they lack these key figures, psychiatric hospitals’ quality of care cannot be reasonably described.ObjectiveThis study’s purpose is to describe health care quality by exploring hospital structures such as nurse staffing and the work environment; processes such as the rationing of care; nurse outcomes, including job satisfaction and work-life balance; and patients’ symptom burden.MethodsMatchRN Psychiatry is a multicenter observational study of Swiss psychiatric hospitals. The sample for this study included approximately 1300 nurses from 113 units of 13 psychiatric hospitals in Switzerland’s German-speaking region. In addition, routine patient assessment data from each participating hospital were included. The nurse survey consisted of 164 items covering three dimensions—work environment, patient safety climate, and the rationing of care. The unit-level questionnaire included 57 items, including the number of beds, number of nurses, and nurses’ education levels. Routine patient data included items such as main diagnosis, the number and duration of freedom-restrictive measures, and symptom burden at admission and discharge. Data were collected between September 2019 and June 2021. The data will be analyzed descriptively by using multilevel regression linear mixed models and generalized linear mixed models to explore associations between variables of interest.ResultsThe response rate from the nurse survey was 71.49% (1209/1691). All data are currently being checked for consistency and plausibility. The MatchRN Psychiatry study is funded by the participating psychiatric hospitals and the Swiss Psychiatric Nursing Leaders Association (Vereinigung Pflegekader Psychiatrie Schweiz).ConclusionsFor the first time, the MatchRN Psychiatry study will systematically evaluate the quality of care in psychiatric hospitals in Switzerland in terms of organizational structures, processes, and patient and nurse outcomes. The participating psychiatric hospitals will benefit from findings that are relevant to the future planning of nurse staffing. The findings of this study will contribute to improvement strategies for nurses’ work environments and patient experiences in Swiss psychiatric hospitals.International Registered Report Identifier (IRRID)DERR1-10.2196/26700

Psychometric evaluation of the German version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC)

BackgroundHealthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the German language version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a self-report measure of stigmatizing attitudes.MethodsStaff (n = 392) on general psychiatric inpatient wards (excluding child, forensic and geriatric psychiatry) at five psychiatric hospitals in Switzerland (n = 3) and Germany (n = 2) participated in the study. The internal consistency of the OMS-HC was examined as well as its factor structure using exploratory and confirmatory factor analyses. To assess the scale’s concurrent validity, we used the Social Distance Scale.ResultsInternal consistency for the OMS-HC total score was good (α = 0.74), acceptable for the subscales Attitudes (α = 0.62) and Social Distance (α = 0.69), and poor for the Disclosure subscale (α = 0.55). The original three-factor structure fit our data well. The OMS-HC total score and the Social Distance subscale score were significantly correlated with the Social Distance Scale, supporting concurrent validity.ConclusionThe German version of the OMS-HC demonstrated satisfactory psychometric properties and can be recommended for future research and intervention evaluation.

Knowledge and attitude towards home treatment among referring healthcare professionals and self-referring patients to a psychiatric hospital: Better information is needed.

Home treatment (HT) is a patient-centred and cost-effective alternative to acute psychiatric inpatient care. However, the progress of its implementation and utilisation in routine care is slow. The aim of this study was to examine the knowledge and attitude towards HT among healthcare professionals. This observational study included telephone-based semi-structured interviews of 140 referring healthcare professionals including 35 self-referring patients to a large psychiatric hospital in Switzerland during 6 months in 2020. We assessed their knowledge, attitude and experience with HT along with sociodemographic characteristics, professional background and the intention for the referral. We completed the interviews with routine medical data of the referred patients such as diagnoses or symptom severity. Regarding referrals for inpatient treatment (involuntary and voluntary), half of the referring healthcare professionals and 80% of the self-referring patients had no prior experience or knowledge of HT. Knowledge of HT differed in the order of the participants' working places. We found that most participants were uncertain about the inclusion/exclusion criteria for HT. Despite the low levels of knowledge, attitudes towards HT were overall positive. Our results indicate that a proportion of the patients referred for inpatient treatment might have been eligible for HT too. The referring healthcare professionals' and patients' unfamiliarity and uncertainty with HT seems to be an important reason that home-based treatment approaches are still underused, although they are viewed very positively. Besides providing more information to potential referring health professionals, psychiatric hospitals should always carry out a standardized evaluation if HT is an option in patients who are referred for inpatient treatment.

Hospital-based bereavement care provision: A cross-sectional survey with health professionals

Background: An in-hospital death is a profound experience for those left behind and has been associated with family members’ psychological morbidity. Supporting bereaved family members is an essential part of end-of-life care and includes attentive presence, information-giving, and emotional and practical support. The actual adoption of hospital-based bereavement care, however, remains little understood. Aim: To investigate hospital-based bereavement care provision and associated barriers. Design: Cross-sectional survey using an online questionnaire. Setting/participants: Health professionals (n = 196) from two University-affiliated acute and psychiatric hospitals in Switzerland. Results: The most frequent bereavement services (⩾40%) were viewing the deceased, giving information on available support, and making referrals; the most often named barriers were lack of time and organizational support. Acute care health professionals faced statistically significant more structural barriers (55.1% vs 21.4% lack of time, 47.8% vs 25.9% lack of organizational support) and felt insufficiently trained (38.4% vs 20.7%) compared to mental health professionals (p ⩽ 0.05). Nurses provided more immediate services compared to physicians, such as viewing the deceased (71.3% vs 49.0%) and sending sympathy cards (37.4% vs 16.3%) (p ⩽ 0.01). In contrast, physicians screened more often for complex bereavement disorders (10.2% vs 2.6%) and appraised bereavement care as beyond their role (26.5% vs 7.8%) (p ⩽ 0.05). Conclusion: The study indicates that many barriers to bereavement care exist in hospitals. More research is required to better understand enabling and limiting factors to bereavement care provision. A guideline-driven approach to hospital-based bereavement care that defines best practice and required organizational support seems necessary to ensure needs-based bereavement care.

Attitudinal variance among patients, next of kin and health care professionals towards the use of containment measures in three psychiatric hospitals in Switzerland

BackgroundIn psychiatric treatment containment measures are used to de-escalate high-risk situations. These measures can be characterized by their immanent amount of coercion. Previous research could show that the attitudes towards different containment measures vary throughout countries. The aim of this study was to compare the attitudes towards containment measures between three study sites in Switzerland which differ in their clinic traditions and policies and their actual usage of these measures.MethodsWe used the Attitude to Containment Measures Questionnaire (ACMQ) in three psychiatric hospitals in Switzerland (Zurich, Muensingen and Monthey) in patients, their next of kin (NOK) and health care professionals (HCP). Furthermore, we assessed the cultural specifics and rates of coercive measures for these three hospitals.ResultsWe found substantial differences in the usage of and the attitudes towards some containment measures between the three study sites. The study site accounted for a variance of nearly zero in as needed medication to 15% in seclusion. The differences between study sites were bigger in the HCPs’ attitudes (up to 50% of the variance), compared to NOK and patients. In the latter the study site accounted for up to 6% of the variance. The usage/personal experience of containment measures in general was associated with higher agreement.ConclusionsAlthough being situated in the same country, there are substantial differences in the rates of containment measures between the three study sites. We showed that the HCP’s attitudes are more associated with the clinic traditions and policies compared to patients’ and their NOKs’ attitudes. One can conclude that patients’ preferences depend less on clinic traditions and policies. Therefore, it is important to adapt treatment to the individual patients’ attitudes.Trial registrationThe study was reviewed and approved by the Cantonal Ethics Commission of Zurich, Switzerland (Ref.-No. EK: 2016–01526, decision on 28.09.2016) and the Cantonal Ethics Commission of Bern, Switzerland (Ref.-Nr. KEK-BE: 2015–00074).This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The permission for conduction of the study was granted by the medical directors at the three study sites. The authors informed the respondents (patients, NOK, HCP) of their rights in the study in an oral presentation and/or a cover letter. They assured the participants of the confidentiality and anonymity of the data, and the voluntariness of participation. Patients were given an information sheet with the possibility to consent in the conduction of the study. Return of the completed questionnaires from HCP and NOK was constituted as confirmation of their consent. No identifying factors were collected to ensure privacy.This article does not contain any studies with animals performed by any of the authors.

Characteristics of Psychiatric Emergency Situations and the Decision-Making Process Leading to Involuntary Admission

Introduction: Involuntary admissions to psychiatric hospitals, regardless of their beneficial effects, violate the patients' autonomy. To keep such measures at a minimum and develop less restricting and coercive alternatives, a better understanding of the psychiatric emergency situations which end up in involuntary admissions is needed. This descriptive and exploratory study investigates the consultations leading to involuntary admission and the decision-making process of the referring physicians.Methods: We developed an online questionnaire to collect data on the characteristics of the consultation leading to an involuntary admission, including influencing factors from the referring physicians‘ perspective, as well as their professional background. We included 107 physicians who completed the questionnaire after they had referred patients for involuntary admission to one major psychiatric hospital in Switzerland.Results: The referring physicians were heterogeneous regarding their medical background and experience with psychiatric emergency situations. The consultations were time consuming and took place in various locations. Clinical findings, third-party anamnesis and a known psychiatric diagnosis contributed strongest to the decision to admit involuntarily. “Protection from danger to self” was named most frequently as purpose of the admission.Discussion: This study emphasizes the variety of psychiatric emergency situations leading to involuntary admissions. In most cases, several parties are involved and influence the decision together with medical and social factors. To reduce the number of involuntary admissions, alternatives for patients with a high symptom load and at risk of harming themselves are needed. Possible approaches to achieve that reduction and recommendations for further research are provided.

Age and adverse drug reactions from psychopharmacological treatment: Data from the AMSP drug surveillance programme in Switzerland

The frequency of severe adverse drug reactions (ADRs) from psychotropic drugs was investigated in hospitalised psychiatric patients in relation to their age. Specifically, the incidence of ADRs in patients up to 60 years was compared to that of patients older than 60 years. Prescription rates of psychotropic drugs and reports of severe ADRs were collected in psychiatric hospitals in Switzerland between 2001 and 2010. The data stem from the drug surveillance programme AMSP. A total of 699 patients exhibited severe ADRs: 517 out of 28,282 patients up to 60 years (1.8%); 182 out of 11,446 elderly patients (1.6%, ns). Logistic regression analyses showed a significantly negative relationship between the incidence of ADRs and patients' age in general and in particular for weight gain, extrapyramidal motor system (EPMS) symptoms, increased liver enzymes and galactorrhoea. A significantly negative relationship was observed for age and the dosages of olanzapine, quetiapine, risperidone, valproic acid and lamotrigine. When comparing age groups, frequency of ADRs was lower in general for antipsychotic drugs and anticonvulsants, in particular for valproic acid in the elderly. Weight gain was found to be lower in the elderly for antipsychotic drugs, in particular for olanzapine. For the group of mood-stabilising anticonvulsants (carbamazepine, lamotrigine and valproic acid) the elderly exhibited a lower incidence of reported allergic skin reactions. The results suggest that for psychiatric inpatients the incidence of common severe ADRs (e.g., weight gain or EPMS symptoms) arising from psychotropic medication decreases with the age of patients.

682 – Age and adverse effects of psychopharmacological treatment. data from the drug surveillance program amsp in switzerland

Objectives and aims The frequency of severe adverse drug reactions (ADR) of psychotropic drugs in relation to age is investigated and especially the incidence in hospitalized patients aged up to 60 years is compared with patients aged above 60 years. Methods The data - prescription rates of psychotropic drugs, reports of severe ADR - are taken from psychiatric hospitals in Switzerland between 2001 to 2010 and stem from the drug surveillance program AMSP. Results 699 patients exhibited severe ADR: 517 out of 28282 patients up to 60 years (1.8%); 182 out of 11446 elderly patients (1.6%, ns). Linear regression analyses show a significantly decreasing relationship between the incidence of ADR and patients’ age in general and in particular for weight gain, EPMS symptoms, increased liver enzymes and galactorrhoea. Delirium increases with age. A significantly decreasing relationship was observed for age and the dosages of olanzapine, quetiapine, risperidone, valproic acid and lamotrigine. Comparing age groups, lower frequency of ADR in general was found for antipsychotic drugs and anticonvulsants, in particular also for valproic acid in the elderly. Weight gain was found to be lower in the eldery for antipsychotic drugs, in particular also for olanzapine. For the group of mood stabilizing anticonvulsants (carbamazepine, lamotrigine and valproic acid) the elderly exhibited a lower incidence of reported allergic skin reactions. Conclusion The results suggest that in hospitalized patients the incidence of common severe adverse effects such as weight gain and EPMS symptoms as a consequence to psychotropic medication decreases with age.

Sequelae of Sexual Trauma in Women Treated for Non–Trauma-Related Psychiatric Disorders in a Psychiatric Hospital in Switzerland

We sought to explore the impact of sexual trauma on symptom severity, sense of coherence, and control orientation in female psychiatric inpatients diagnosed with and admitted for non-trauma-related mental disorders. A sample of 31 female inpatients with a reported history of sexual trauma (two thirds abused in childhood, one third raped in adulthood) were compared with 31 female inpatients with similar sociodemographic backgrounds, matched for age and psychiatric diagnosis. Compared with the sexually nontraumatized patients, the patients with a reported history of sexual trauma were neither more symptomatic nor did they have a more severe course of illness. No significant differences were found between the two groups with regard to sense of coherence and control orientation. Patients who had been raped in adulthood rated lower than all other patients in the Meaningfulness subscale of the Sense of Coherence Scale, indicating that their belief that there is good reason to care about what happens has been affected. Based on the dimensions assessed, female psychiatric inpatients with a reported history of sexual trauma were not found to be significantly different from female inpatients without such a history. The burden of a mental disorder ensuing from the severity of illness symptoms and illness course is probably so high that the potential impact of a sexual trauma cannot manifest.

Individuelle Lebensqualität von drogenabhängigen Patienten in einem Entzugsprogramm: Selbstbeurteilung in einer Drogenentzugs- und Übergangsstation für Erwachsene

The aim of this study was twofold: to examine the individual quality of life of drug addicted patients after being admitted to a drug withdrawal programme in a psychiatric hospital in Switzerland, and to check whether the individual quality of life changes over a period of three weeks. Within three days following admission, thirty patients (23 men, 7 women) were interviewed, using the half structured instrument Schedule for the Evaluation of Individual Quality of Life: a Direct Weighting Procedure for Quality of Life Domains (SEIQoL-DW). Three weeks later, 16 patients (who were still participating in the drug withdrawal programme) were interviewed for a second time. The 46 interviews were analysed by means of qualitative content analysis according to Morse and Field (1998). In the 30 interviews that were conducted within the first three days following hospital admission, 269 individual quality of life domains (QLD) were described, from which 37 categories of QLD could be derived, which in turn were classified into nine main themes. In the second round of interviews conducted after three weeks in hospital, the QLD categories and the main themes remained nearly identical to those derived from the first round. Only one new category of QLD, <<structural conditions>>, could be identified and was assigned to the main QLD "distress factors". The rankings of some QLDs changed. The median of the Global Quality of Life (GLQ) index of all 30 patients amounted to 48.5 out of 100 points. The initial value for 16 patients who were interviewed for a second time was 57.7 while the value for the 14 drop outs amounted to 39.9. After three weeks, the median of the GLQ of the remaining 16 patients increased from 57.7 to 63.1. Compared to a healthy population, drug addicts have a lower quality of life, while compared to other psychiatric groups similar quality of life can be observed. The SEIQoL-DW method was well accepted among patients without distressing them. This study shows that the quality of life of drug addicts is individual, multi-dimensional, dynamic and complex.