Inpatient Psychiatric Treatment Research Articles

Social-ecological barriers and facilitators to seeking inpatient psychiatric care among transgender and nonbinary people: A qualitative descriptive study.

To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people. Qualitative interview study. Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study. Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options. Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care. Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care. The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery. Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.

Emotional awareness for self and others and empathic abilities in clinical depression during acute illness and recovery

BackgroundThe present longitudinal investigation had two major goals. First, we intended to clarify whether depressed patients are characterized by impairments of emotional awareness for the self and the other during acute illness and whether these impairments diminish in the course of an inpatient psychiatric treatment program. Previous research based on the performance measure Levels of Emotional Awareness Scale (LEAS) provided inconsistent findings concerning emotional self-awareness in clinical depression. Second, we investigated whether cognitive and affective empathic abilities change from acute illness to recovery in depressed patients.MethodsFifty-eight depressed patients were tested on admission and after 6–8 weeks of inpatient psychiatric treatment. A sample of fifty-three healthy individuals were also examined twice at an interval of 6–8 weeks. The LEAS and the Interpersonal Reactivity Index (IRI) were administered to assess emotional awareness and empathic abilities. Written texts were digitalized and then analyzed using the electronic scoring program geLEAS, the German electronic Levels of Emotional Awareness Scale.ResultsDepressed patients reported more depressive symptoms than healthy controls and less severe depressive symptomatology at time 2 compared to time 1. Independent of time, depressed individuals tended to show lower geLEAS self scores and had lower geLEAS other scores than healthy individuals. Depressed patients showed higher personal distress scores than healthy individuals at both measurement times. No group differences were observed for the cognitive empathy scales of the IRI (perspective taking and fantasy) and empathic concern, but empathic concern decreased significantly in depressed patients from time 1 to time 2. Empathic abilities as assessed by the IRI were not significantly correlated with emotional awareness for others, neither in the whole sample, nor in the patient and control subsample.ConclusionsDepressed patients seem to be characterized by impairments in emotional awareness of others during acute illness and recovery, but they also tend to show deficits in emotional self-awareness compared to healthy individuals. Self-reported cognitive empathic abilities seem to be at normal levels in depressed patients, but their heightened self-focused affective empathy may represent a vulnerability factor for depressive disorders.

Involuntary psychiatric hospitalisation – differences and similarities between patients detained under the mental health act and according to the legal guardianship legislation

BackgroundInvoluntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL.MethodsWe conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care.ResultsCases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low.ConclusionWe found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field.

Heart rate vARiability and physical activity in inpatient treatMent of burnOut and DepressIon (HARMODI): protocol of a cross-sectional study with up to 8-week follow up

IntroductionChronic stress can cause an imbalance within the autonomic nervous system, thereby affecting cardiovascular and mental health. Physical activity (PA) may have a positive effect on the autonomic nervous system...

Comparison of 8-vs-12 weeks, adapted dialectical behavioral therapy (DBT) for borderline personality disorder in routine psychiatric inpatient treatment—A naturalistic study

Dialectical behavior therapy (DBT) is widely acknowledged as an effective treatment for individuals with borderline personality disorder (BPD). However, the optimal treatment duration within DBT remains a topic of investigation. This retrospective, naturalistic non-randomized study aimed to compare the efficacy of 8 week and 12 week DBT interventions with equivalent content, focusing on the change of BPD-specific symptomatology as the primary outcome and depressive symptoms as the secondary outcome. Overall, 175 patients who participated in DBT and received either 8 week or 12 week intervention were included in the analysis. Routine inpatient treatment was adapted from standard DBT with the modules: skill training, interpersonal skills, dealing with feelings, and mindfulness. Measurements were taken at baseline, mid-point, and endpoint. The borderline symptom list-23 (BSL-23) was used for the assessment of borderline-specific symptoms, while the Beck depression inventory-II (BDI-II) was used for the assessment of depressive symptoms. Statistical analysis was conducted using linear mixed models. Effect sizes were calculated for both measures. The results of the analysis indicated an improvement in both groups over time. Effect sizes were d = 1.29 for BSL-23 and d = 1.79 for BDI-II in the 8 week group, and d = 1.16 for BSL-23 and d = 1.58 for BDI-II in the 12 week group. However, there were no differences in the change of BPD-specific symptoms or the severity of depressive symptoms between the 8 week and 12 week treatment duration groups. Based on these findings, shorter treatment durations, like 8 weeks, could be a viable alternative, offering comparable therapeutic benefits, potential cost reduction, and improved accessibility. However, further research is needed to explore factors influencing treatment outcomes and evaluate the long-term effects of different treatment durations in DBT for BPD.Trial registration: drks.de (DRKS00030939) registered 19/12/2022.

The Mental Health Toll of the COVID-19 Pandemic on Adolescents Receiving Inpatient Psychiatric Treatment.

Objective: During the COVID-19 pandemic, the prevalence of depression and anxiety among children and adolescents significantly increased, along with the number of visits to emergency departments due to suicidality and/or suicide attempts. Relatedly, health care workers experienced significant burnout and symptoms of anxiety, depression, and posttraumatic stress disorder during this time. However, the corresponding impact on psychiatric inpatient treatment has not yet been researched. We hypothesized that during the pandemic, adolescents hospitalized in an acute care psychiatric inpatient unit had increased incidents of suicide attempts and nonsuicidal self-injurious behaviors and of aggressive behaviors toward others, resulting in greater use of constant observation and restraints. Method: This study was a retrospective chart review based on electronic medical record data examining use of restraints and constant observation one year before the pandemic (March 2019 to February 2020) and 1 year following the onset of the pandemic (March 2020 to February 2021) in an acute-care adolescent (12 to 17 years old) psychiatric inpatient unit. Results: There were 571 admissions during the year before the pandemic and 500 admissions during the pandemic. The number of patients who were restrained (χ2 = 7.86, p = 0.005), number of patients who were placed on constant observation (χ2 = 13.41, p < 0.001), and number of constant observation orders per patient (χ2 = 91.90, p < 0.001) were all significantly greater during the pandemic. Conclusion: Psychiatrically hospitalized adolescents during the pandemic received more intensive interventions such as restraints and constant observation. Severe patient psychopathology and staff shortages, as well as limitations of and decreases to the dialectical behavior therapy program, may have been the contributing factor.

Racial disparities with PRN medication usage in inpatient psychiatric treatment

Racial disparities in psychiatric diagnoses and treatment have significant public health implications, contributing to inequities in healthcare outcomes. We specifically examined racial disparities regarding pro re nata (PRN), or as needed, medications. Data from 14,616 encounters across 2019–2020 within Community Health Network’s inpatient psychiatric setting in Indianapolis, Indiana were included in this study. Due to the demographic sample size, analyses were narrowed to Black and White patients. Primary outcomes included comparisons across race for all PRN administrations and PRN administrations of antipsychotics vs. non-antipsychotics. Logistic regression was used to examine associations between race and PRN administrations by medication category, including all antipsychotics vs. non-antipsychotics overall, hydroxyzine, and lorazepam, independently. Significant differences in the percentage of administrations between Black and White patients were observed. Black patients received more PRN medications overall (71.0%) compared to White patients (67.7%) (p < 0.01). Further, while 17.7% of Black patients were administered PRN antipsychotics, this was true for only 8.2% of White patients (p < 0.001). When comparing antipsychotic PRNs with non-antipsychotic, hydroxyzine, and lorazepam PRNs, independently, Black patients were 58% (OR 1.58, p < 0.001), 109% (OR 2.09, p < 0.001), and 32% (OR 1.32, p < 0.001), more likely to receive antipsychotic PRNs, respectively, than White patients, controlling for sex, age, length of stay, and psychotic disorder diagnosis. Our study identifies yet another area of medical care with significant racial disparities. In this analysis of PRN medications during psychiatric admission, we identified significant differences in medication utilization by race. This information provides a basis for further investigation of disparities in patient-centered data.

Impact of the emotional development approach on psychotropic medication in adults with intellectual and developmental disabilities: a retrospective clinical analysis.

Compared with the general population, adults with an intellectual developmental disorder (IDD) are more likely to develop mental health problems and to receive high levels of psychotropic medication, particularly antipsychotics. The emotional development (ED) approach may help to better understand the nature of challenging behaviour (CB) and tailor treatment and support accordingly. The aim of this retrospective study was to investigate the impact of the ED approach on the prescription of psychotropic medication during inpatient psychiatric treatment. The clinical data of 1758 patients were analysed within a retrospective study design over a period of 12years. ED level was assessed (1) for the first time (INITIAL-SEO), (2) during a previous hospital stay (PAST-SEO) or (3) not at all (NO-SEO). The effects of the ED assessment and the respective intervention during the current admission on the number of psychotropics and the number and dosage of antipsychotics were analysed for the total sample, including those with CB, autism spectrum disorders and psychosis. Group differences were analysed by a chi-square test and a one-factorial analysis of variance. For analysing the impact of the application of the ED approach on psychotropic medication, a covariance model was applied. Changes between the subsamples were analysed by t-tests for dependent samples. The ED approach had a significant impact on reducing the overall amount of psychotropic medication and the dosage of antipsychotics in all patients with IDD. These effects were mainly attributable to those showing CB. In patients with autism spectrum disorders, the developmental approach reduced the number of antipsychotics. No effects could be observed in patients with psychosis; in this subsample, both the number and dosage of antipsychotics increased. The application of the ED approach in the current hospital stay reduced the number of psychotropic drugs and the number and dosage of antipsychotics, especially in those patients with IDD and CB, but also in those with autism spectrum disorders.

Adolescent Psychiatric Inpatient Episodes and Subsequent Labor Market Trajectories

PurposeAdolescents with psychiatric disorders are known to be more often not in education, employment, or training (NEET) in young adulthood than their peers. However, since most of the available evidence is based on cross-sectional measurement of NEET, there is less evidence on the processes underlying these differences in labor market disadvantage. We assessed these processes by examining transitions between NEET and non-NEET states across young adulthood and the differences in these transitions by adolescent psychiatric inpatient treatment. MethodsWe used longitudinal register data on all individuals born in Finland in 1980–1984 (N = 315,508) to identify psychiatric inpatient episodes between ages 10 and 19 and NEET between ages 20 and 34. We modeled the transitions between NEET and non-NEET states and the impact of psychiatric disorders on these transitions with multistate models. ResultsIndividuals who had psychiatric inpatient episodes in adolescence started their labor market careers as NEET twice as often as their peers. They were also more likely to transition into NEET states and less likely to transition out of NEET. In total, individuals with a history of psychiatric episodes spent from 1.8 to 6.9 more years as NEET between the ages 20 and 34 than their peers, depending on sex, baseline NEET, and diagnostic group. DiscussionAdolescents with severe psychiatric disorders are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures are required both at the start of employment trajectories and during later career stages.

Bright Light Therapy as Add-On to Inpatient Treatment in Youth With Moderate to Severe Depression

Major depressive disorder is one of the most common mental disorders among adolescents, entailing severe, long-term psychosocial impairment and a high risk of chronicity. In view of the large number of patients requiring treatment, along with insufficient treatment responses with small effect sizes, innovative adjunctive treatment strategies are urgently needed. To investigate whether the effect of adolescent psychiatric inpatient treatment as usual for major depressive disorder can be enhanced by simultaneous use of morning bright light therapy. This was a double-blind, placebo-controlled randomized parallel-group trial with enrollment between March 2018 and November 2020 and follow-up completed in May 2021. The study took place among inpatients at 4 university hospitals for child and adolescent psychiatry across Germany. Of 248 eligible youth aged 12 to 18 years fulfilling ICD-10 criteria for major depressive disorder, 227 were randomized to bright light therapy (n = 116) or placebo red light (n = 111); 151 participants completed the study. Up to 20 sessions of either morning bright light therapy with an intensity of 10 000 lux or placebo red light (100 lux) in addition to multimodal inpatient treatment as usual over 4 weeks. The primary outcome was the change in Beck Depression Inventory-II (BDI-II) score from baseline to posttreatment in the intention-to-treat sample. Among the 224 patients included in the intention-to-treat analyses (192 girls and 32 boys; mean [SD] age, 15.5 [1.4] years), the mean (SD) BDI-II score at baseline was 37.3 (8.7). BDI-II scores were significantly reduced after 4 weeks (postassessment) by a mean of -7.5 (95% CI, -9.0 to -6.0; Hedges g = 0.71). Bright light therapy had no impact on this change (no significant group × time effect). Loss to follow-up was 31% (n = 69) at 16 weeks and 49% (n = 110) at 28 weeks. There were 10 serious adverse events throughout the whole trial, which were not considered related to study treatment. The findings in this study did not indicate superiority of bright light therapy over placebo red light therapy in a large sample of adolescent inpatients with moderate or severe major depressive disorder. Both groups benefited equally from treatment as usual, showing relevant symptom reduction. German Clinical Trials Register: DRKS00013188.

Suicide risk after discharge from in-patient psychiatric care: A 15-year retrospective cohort study of individual patient data

BackgroundSuicide rates are known to be increased in patients after discharge from in-patient psychiatric treatment. However, evidence on risk factors for suicide within this patient group are contradictory. Thus, this study aims to investigate suicide after discharge from a sizeable psychiatric care facility to determine associated risk factors. MethodsData on individual patient level from a 15-year single-centre cohort were linked to data from the national death registry and cumulative incidence rates were calculated applying competing risk models. Independent variables included the patients' sex, age at admission, diagnosis, and length of admission. For each of these factors, subdistribution hazards ratios were calculated using a Fine-Gray model. ResultsIn our sample of 18,425 discharges, when using patients with the diagnosis of substance-use-disorders as a comparator, a significant increase in hazard of post-discharge suicide for male sex (SHR = 1.67;p = 0.037) as well as the discharge diagnoses of affective disorders (SHR = 3.56;p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73;p = 0.024) were found. Interestingly, the hazard of suicide significantly decreased in more recent discharges (SHR = 0.93;p = 0.006). No statistically significant association of the length of admission with the suicide risk was found (SHR = 0.98;p = 0.834).Limitations.Suicides may have been mis-identified as natural death in the national death register. ConclusionMale sex and distinct diagnoses were associated with an increased risk for suicide after discharge from a psychiatric care institution. The markedly increased suicide risk within this patient collective highlights the need for the development of tools to assess suicidal behaviour in this group of patients reliably.

Mentalization-based supervision in environmental therapy: a guide to mentalizing chaos in residential care and inpatient treatment

This paper is the first to present a model for mentalization-based supervision of professionals working with environmental therapy. Mentalization-based supervision should be based on a mentalizing stance and theory aligned with the current mentalizing perspective, that is, the theory of attachment, mentalization and should aim at establishing ‘we-mode’ and epistemic trust. This paper offers a practical guide, models, and templates that are easy to apply and beneficial for the supervisor to underpin the mentalizing stance and focus on mentalizing processes during complex supervision sessions with groups of supervisees. The approach and method of supervision are demonstrated through a clinical case, and the supervision process is illustrated via templates to aid the reader who is a supervisor for groups in this field. The article is based on current theory and research on mentalization and on the clinical practice of supervision in psychiatric inpatient treatment and residential care.

Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis.

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.

Patient Satisfaction with Psychological Treatment on a Voluntary Inpatient Psychiatric Unit.

Despite the empirical literature suggesting the benefits of providing patient support and psychotherapy, research examining patient satisfaction with psychological services integrated within inpatient psychiatric treatment settings remains scarce. A sample of 122 adults within a voluntary inpatient psychiatric unit, who were receiving psychological services completed a satisfaction questionnaire. Overall, participants reported high levels of satisfaction with psychological services and perceived them as helpful to their overall care. These results remained consistent when exploratorily examining satisfaction and helpfulness prior to and during the COVID-19 pandemic. These findings suggest the importance of integrating psychologists within inpatient psychiatric treatment settings. Future research may investigate the influence of psychological services on patient outcomes and how psychologists are perceived by other treatment team members.

Feasibility of using virtual reality in geriatric psychiatry.

Virtual Reality-based interventions have become an important element of digital mental health, offering accessible and scalable treatment options. However, studies on VR-based approaches in elderly patients are scarce. This explorative study examined the feasibility of using Virtual Reality (VR) for elderly patients with psychiatric illness, focusing on the sense of presence as the primary outcome. The study included N=30 patients between the ages of 59-92years who were currently in geriatric psychiatric inpatient and day clinic treatment. Participants were assessed before, during and after a relaxing ten-minute VR experience. Attitude towards digital media and VR, subjective digital competence, and previous experience were examined using questionnaires. Motion sickness was measured repeatedly during the VR experience using the Fast Motion Sickness Scale (FMS). Patients rated their motion sickness and their general well-being in the virtual environment. Sense of presence in the virtual environment was quantified with the Igroup Presence Questionnaire (IPQ). Participants reported a notable sense of presence (M=0.41±1.4) in the virtual environment, particularly in terms of spatial presence. Motion sickness was reported by a minority of patients. Three patients terminated the VR application before it was finished. The average well-being during the VR experience was reported as high (70/100). Sense of presence and motion sickness showed a significant negative correlation. Presence, motion sickness and well-being were not significantly correlated with age, nor did they differ significantly between groups. This study underscores the potential of VR-based experiences in the treatment of elderly psychiatric patients and highlights their willingness and ability to engage with VR technology. While the results are promising, future research should explore more interactive VR scenarios and assess their safety and feasibility in elderly populations.

Patient perspectives on psychological interventions provided in adult psychiatric inpatient wards: A thematic synthesis

AbstractObjectivesPsychological intervention is an important part of psychiatric inpatient treatment for people experiencing severe problems affecting their mental health. Unfortunately, many service users accessing acute inpatient services are not being offered psychological interventions. Recent research has focussed on effectiveness, facilitators and barriers to providing psychological interventions in this setting. This review aimed to provide a qualitative synthesis of service user perspectives regarding psychological interventions provided on inpatient wards, to understand what is helpful and unhelpful about current provision.MethodA systematic literature search of four databases was conducted to identify published qualitative literature regarding service user perspectives of NICE‐recommended psychological interventions provided on adult acute mental health inpatient wards. Study quality was assessed using the Critical Appraisal Skills Programme tool. Data was analysed and synthesised using thematic analysis.ResultsThe search was completed in May 2023. Seventeen studies were included in the review and encapsulated feedback from at least 192 service users. All studies were rated as high or moderate on the quality appraisal tool. Three superordinate themes were identified: ‘Connecting with Others’, ‘Psychological Processes’ and ‘Engaging with the Intervention’. Participants valued supportive relationships with peers and therapists and felt empowered to achieve change through expression, focussing on difficulties and gaining new perspectives. Participants wanted more support to maintain benefits and sometimes struggled to engage with group therapy due to difficult peer dynamics.ConclusionsThe results give a detailed synthesis of some of the important factors, from service users' perspectives, for accessing psychological interventions. Recommendations for clinical practice and future research are provided.

Exploring primary mental healthcare nurses’ perceptions of the post-treatment needs of women admitted for psychiatric treatment

Primary mental healthcare nurses are an essential workforce that provide necessary inpatient psychiatric treatment. Continuity of care has become a significant aspect of the provision of mental health services. However, caring for South African healthcare users comes with challenges, including difficulties accompanying the provision of care for acutely ill patients with complex mental health problems. Therefore, this study explored the perceptions and experiences of primary mental healthcare nurses concerning the continuity of care required in post-inpatient psychiatric treatment for mental health users from low-income communities in the Western Cape. Through undertaking a study using a qualitative exploratory design and purposive sampling technique, and in which nine primary mental healthcare nurses from two psychiatric hospitals in the Western Cape were interviewed, the researchers were able to obtain a deeper understanding of the participants’ experiences. Four themes were identified during the reflexive thematic analysis namely: the roles and responsibilities of primary mental healthcare nurses, the lack of support within the current continuity-of-care system, barriers to continuity of care for women patients, and suggested improvements for quality of mental healthcare. It was evident that both women patients and primary mental healthcare nurses experienced various forms of marginalisation, discrimination, and gendered oppression. This intersectionality accentuates systemic issues within the current public healthcare system and highlights the stigmatisation of mental illness, especially among women. Overall, primary mental healthcare nurses have a plethora of roles and responsibilities within the primary healthcare sector, which hinder their ability to provide mental health services to women patients. Their reports highlight the needs of a specific patient population that first need to translate into changes that will assist in improving their roles as primary mental healthcare nurses. Their shared experiences of a lack of support from South Africa’s healthcare system were the focal points of this study.

The Architecture of the mind: A Psychodynamic Case Study of Dissociated Selves.

The author seeks to explore the development and treatment of dissociative symptoms emerging in a 17-year-old nonbinary individual throughout two inpatient psychiatric hospitalizations. The patient endorsed the presence of multiple selves that remained connected with reality and internally with each other, emphasizing their existence in spatial allocations within the patient's mind both while dreaming and in waking life. The author highlights the therapeutic space as an opportunity to allow the interaction between dissociated selves surging from violent childhood experiences in hopes of allowing the integration of the fragmented parts of the main self. The roles of dreamwork, creative expressions, and language will be highlighted as essential components that allowed symbolization for a bicultural, bilingual individual who recently immigrated to the United States. Treatment was conducted within the limitations and particularities of inpatient psychiatric treatment, restricting treatment to a preliminary phase of exploration and containment.

Impact of the COVID-19 pandemic on acute mental health admissions in Croatia.

The pandemic of COVID-19 had a profound impact on our community and healthcare system. This study aims to assess the impact of COVID-19 on psychiatric care in Croatia by comparing the number of acute psychiatric cases before coronavirus disease (2017-2019) and during the pandemic (2020-2022). The paper is a retrospective, comparative analyzes of the hospital admission rate in Diagnosis Related Group (DRG) classes related to mental diseases, and organic mental disorders caused by alcohol and drug use. This study used DRG data from all acute hospitals in Croatia accredited to provide mental health care services and relevant publicly available data from the Croatian Institute of Public Health (CIPH) and the Croatian Health Insurance Fund (CHIF). All hospital admissions for acute psychiatric patients in Croatia were tracked during both periods under study. During the pandemic, the average number of all such cases decreased by 28% in secondary and tertiary hospitals, and by 11% in specialist psychiatric hospitals. It was also found that during COVID-19, there was a decrease in case numbers in DRG classes related to major affective disorders and anxiety, alcohol, and drug intoxication (31, 48, 34 and 45%, respectively). However, the same period saw an increase in hospital activity for eating disorders and for involuntary admissions related to schizophrenia and paranoia (30, 34 and 39% respectively). There were no changes in the admission rate for cases related to opioid use. The COVID-19 pandemic resulted in both a steep decrease in the overall number of psychiatric cases inpatient treatment at mental health facilities and their DRG casemix. Increasing our understanding of how pandemics and isolation affect demand for psychiatric care will help us better plan for future crises and provide more targeted care to this vulnerable group.

Adolescent psychiatric inpatient treatment and subsequent labor market trajectories

Abstract Background Adolescent psychiatric disorders are associated with subsequent labor market disadvantage, including unemployment, disability pensions, and not being in education, employment or training (NEET). However, most current research has focused on cross-sectional outcomes measured at single time points, which clouds the dynamics involved in the realization of early labor market careers. Methods The study is based on longitudinal register data on all individuals born in Finland in 1980-1984 and residing in the country between ages 10-20 (N = 316,526). We followed the study subjects from age 20 to 34 and used multistate models to model transitions between advantaged and disadvantaged labor market states. Labor market disadvantage was defined as being either unemployed, NEET or on disability pension. We examined differences in labor market trajectories by adolescent psychiatric inpatient episodes, measured using hospital discharge data from ages 10-19. Separate analyses by diagnostic groups were conducted. Results Individuals who had psychiatric inpatient episodes in adolescence (3%) started their labor market careers in disadvantaged labor market states twice as often as their peers. They were also more likely to transition from advantaged states to disadvantaged states (HR among men: 2.93; 95% CI: 2.85, 3.02) and less likely to experience the opposite transition (HR among men: 0.47; 95% CI: 0.46, 0.48). In total, individuals with a history of psychiatric episodes spent 1.7 to 6.7 more years in disadvantaged states than their peers, depending on sex, baseline state and diagnostic group. The associations were slightly stronger among men than among women. Conclusions The results suggest that adolescents with severe mental health problems are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures at the start of employment trajectories as well as during later labor market stages are required. Key messages • Psychiatric inpatient episodes in adolescence are associated with labor market disadvantage at the start of work careers and with disadvantageous transitions throughout subsequent trajectories. • To ensure that adolescents facing severe mental health problems are able to realize their full potential, supportive measures at different stages of work careers are required.