Psychiatric Inpatients Research Articles

Psychotropic drug-induced adverse drug reactions in 462,661 psychiatric inpatients in relation to age: results from a German drug surveillance program from 1993–2016

Abstract Background Clinical practice suggests that older adults (i.e., ≥ 65 years of age) experience adverse drug reactions (ADRs) more often than younger patients (i.e., < 65 years of age). ADRs such as falls, extrapyramidal symptoms (EPS), metabolic disorders, sedation, and delirium are particularly worrisome and often associated with psychotropic drugs. Methods This observational study investigated the risk for psychotropic drug-related ADRs in older (n = 99,099) and younger adults (n = 363,562) in psychiatric inpatients using data from the German pharmacovigilance program “Arzneimittelsicherheit in der Psychiatrie” (AMSP) from 1993–2016. The aim was to assess whether age influenced the risk of specific ADR types and if certain psychotropic drugs posed particular concerns. Results The risk for ADRs did not differ between older and younger patients (relative risk 0.98, 95% confidence interval 0.92–1.05). However, older patients had a higher risk for delirium (2.35, 1.85–2.99), hyponatremia (3.74, 2.85–4.90), and orthostatic syncope (2.37, 1.72–3.26), as well as certain types of EPS, e.g., parkinsonism (1.89, 1.45–2.48) and Pisa-/metronome syndrome (3.61, 2.51–5.18). The risk for other ADRs, such as acute dystonia (0.20, 0.10–0.37), akathisia (0.47, 0.29–0.76), liver dysfunction (0.63, 0.48–0.82), weight gain (0.07, 0.04–0.14), sexual dysfunction (0.03, CI 0.00–0.25), and hyperprolactinemia/galactorrhea (0.05, 0.02–0.17) was significantly lower for older patients. Older patients treated with any type of antidepressant drug (1.33, 1.26–1.40)—especially selective serotonin reuptake inhibitors (1.57, 1.26–1.40) and selective serotonin-norepinephrine reuptake inhibitors (2.03, 1.80–2.29)—and lithium (1.74, 1.52–2.00) had a higher ADR risk than younger patients. Second-generation antipsychotic drugs had a lower (0.74, 0.71–0.77) and low-potency first-generation antipsychotic drugs a higher (1.19, 1.07–1.33) ADR risk in older patients. The risk for ADRs involving multiple drugs was higher in older patients (1.28, 1.22–1.34). ADRs in older patients were 6.4 times more likely to result in death. Conclusions Clinicians and pharmacists should be aware of the types of ADRs and high-risk drugs across age groups and provide appropriate monitoring. Pharmacovigilance is crucial in psychiatric patients of all ages and should not be neglected, even for drugs generally considered “safe”.

Risk factors for deep vein thrombosis and pulmonary embolism: a comparative study between acute hospital care and mental health inpatient settings for older people

Purpose This study aims to establish if risk factors for venous thromboembolism (VTE) in older hospitalized psychiatric patients differ from geriatric inpatients and if the current risk assessment tools being used are suitable. Design/methodology/approach The authors undertook a single centre retrospective review of 75 records for presence of predetermined risk factors. In total, 55 discharged patients with thrombotic events within geriatric settings were compared with 20 from mental health settings. Differences in risk factors were determined using t-test and Fisher’s exact test. Findings VTE patients in geriatric units were older and had reduced mobility. Psychiatric patients were more likely to be dehydrated and treated with psychotropics. Whilst rates of VTE screening were comparable in both settings, geriatric inpatients were more frequently prescribed thromboprophylaxis. Research limitations/implications Older psychiatric inpatients differ from those in medical/surgical settings in their profiles and risk factors for VTE. Approaches for VTE risk management also differed. Practical implications The study suggests the need for VTE screening tools and treatment protocols specific to older psychiatric settings. Social implications Targeted approaches may improve outcomes specific to each group. Originality/value To the best of the authors’ knowledge, this is the first attempt in comparing VTE risk factors across acute physical health care and mental health settings.

Association between behavioral parameters of men in psychiatric emergency department video recording and subsequent violence in the psychiatric ward.

Violence risk is a major challenge among acute psychiatric inpatients. The study aimed to predict violent behavior risk in an acute psychiatric ward using video recordings from the emergency department. 69 videos of the emergency department recording the first ten minutes following patients' arrivals were included. Psychiatrists watched the videos, completed relevant Brief Psychiatric Rating Scale items and answered intuitive questions about each patient's risk of violence. Demographic and clinical data were also collected. Motoric mannerisms as rated in the BPRS significantly differed between violent and non-violent patients (p < 0.05). Additionally, we found a significant correlation between intuitive prediction of violence and actual violence (p = 0.008). Violent behavior was predicted in 42.1% of the cases by the intuitive evaluation compared to 11.5% mistakenly evaluated patients. Logistic regression revealed that the intuitive question and the BPRS items regarding tension and motoric mannerism created a successful model for predicting violence with 88.2% sensitivity and 72.5% specificity. We sought to define the factors that most accurately predict violence in the acute psychiatric ward, based solely on behavior in the emergency department. Intuitive impressions of clinicians and motoric mannerisms should be considered when evaluating patients for potential violent behavior.

Institutional Betrayal in Inpatient Psychiatry: Effects on Trust and Engagement With Care.

Patients' experiences of inpatient psychiatry have received limited empirical scrutiny. The authors examined patients' likelihood of experiencing institutional betrayal (harmful actions or inactions toward patients) at facilities with for-profit, nonprofit, or government ownership; patient-level characteristics associated with experiencing institutional betrayal; associations between betrayal and patients' trust in mental health providers; and associations between betrayal and patients' willingness to engage in care postdischarge. Former psychiatric inpatients (N=814 adults) responded to an online survey. Data were collected on patients' demographic characteristics; experiences of institutional betrayal; and the impact of psychiatric hospitalization on patients' trust in providers, willingness to engage in care, and attendance at 30-day follow-up visits. Participants' responses were linked to secondary data on facility ownership type. Experiencing institutional betrayal was associated with less trust in mental health providers (25-percentage-point increase in reporting less trust, 95% CI=17-32), reduced willingness (by 45 percentage points, 95% CI=39-52) voluntarily undergo hospitalization, reduced willingness (by 30 percentage points, 95% CI=23-37) to report distressing thoughts to mental health providers, and lower probability of reporting attendance at a 30-day follow-up visit (11-percentage-point decrease, 95% CI=5-18). Participants treated at a for-profit facility were significantly more likely (by 14 percentage points) to report experiencing institutional betrayal than were those treated at a nonprofit facility (p=0.01). Institutional betrayal is one mechanism through which inpatient psychiatric facilities may cause iatrogenic harm, and the potential for betrayal was larger at for-profit facilities. Further research is needed to identify the determinants of institutional betrayal and strategies to support improvement in care quality.

Characterization and Outcomes of Profoundly and Non-profoundly Autistic Individuals Admitted to a Specialized Psychiatric Inpatient Unit.

The prevalence of autism spectrum disorder (ASD) is currently estimated to be 1 in 36 children. While much is known about the impact of ASD on family and community functioning as well as treatment outcomes, less is known about a relatively new categorization of ASD, called "profound autism." The current study evaluated 14 consecutively admitted patients meeting criteria for profound autism to a specialized psychiatric inpatient and partial hospitalization program. We then selected 15 non-profoundly autistic youth admitted immediately before or after each profoundly autistic youth to serve as a comparison. Patient caregivers completed measures about parental stress and the severity and frequency of patient problem behavior, and patients participated in functional analyses of problem behavior and function-based treatment programs during their admission. Results showed profoundly autistic youth spent an average of 14 more days admitted to the psychiatric unit, and they engaged in higher parent-reported severity and frequency of self-injurious and stereotypic behavior. Functional analysis results for profoundly autistic youth showed a higher occurrence of automatically reinforced problem behavior but otherwise similar results. As well, profoundly autistic youth showed a lower percentage reduction in problem behavior at the end of the psychiatric hospitalization than their non-profoundly autistic peers. Profoundly autistic youth seem to require a high level of behavioral support, even after psychiatric hospitalization. Insurance companies and therapists need to recognize these challenges and invest sufficient resources to meet their treatment needs.

Clinical Characteristics of Inpatients with Schizophrenia Spectrum Disorder Treated with Electroconvulsive Therapy: A Population-Level Cross-Sectional Study: Titre: Caractéristiques cliniques des patients hospitalisés présentant un trouble du spectre de la schizophrénie et traités par électrochocs : Une étude de population transversale.

Electroconvulsive therapy (ECT) is an evidence-based treatment for schizophrenia when anti-psychotic medications do not sufficiently control symptoms of psychosis or rapid response is required. Little is known about how it is used in routine clinical practice. The aim of this study was to identify the association of demographic and clinical characteristics with administration of ECT for schizophrenia spectrum disorders (SSD). Among psychiatric inpatients with a diagnosis of SSD in Ontario, Canada (2006-2023), patient-level socio-demographic and clinical characteristics were described in those who did and did not receive ECT. We used multi-variable logistic regression to assess the association between patient-level characteristics and administration of ECT during index hospitalization. From 164,632 admissions, 2,168 (1.3%) involved exposure to ≥1 inpatient ECT procedure. Compared to those not receiving ECT, those receiving ECT were older, had higher rates of pre-admission medication use, medical and psychiatric comorbidities, outpatient mental health service use, but lower rates of substance use disorders. In the multi-variable logistic regression model, patient-level characteristics most strongly associated with receiving inpatient ECT were the presence of catatonia (odds ratio [OR]: 5.83; 95% confidence interval [95% CI]: 4.01-8.46), comorbid depression (OR: 2.49; 95% CI: 2.07-2.98), obsessive-compulsive disorder (OR: 2.16; 95% CI: 1.55-3.00), while characteristics most strongly associated with not receiving inpatient ECT were myocardial infarction (OR: 0.44; 95% CI: 0.20-0.95) and family conflict towards patient (OR: 0.47; 95% CI: 0.31-0.71). Neither severity of psychotic symptoms, non-command auditory hallucinations nor delusions were associated with administration of ECT. While characteristics associated with the use of ECT are generally consistent with the indications for ECT (e.g., catatonia, mood disorders), ECT is rarely used amongst individuals with SSD. Severity of psychotic symptoms was not associated with the use of inpatient ECT suggesting an opportunity to increase the use of ECT in this population.

Validation of the SCOFF as a Simple Screening Tool for Eating Disorders in an Inpatient Sample Before and During COVID-19.

Eating disorders (EDs) represent a significant public health concern, with a high prevalence among adolescent girls. The COVID-19 pandemic has led to a marked increase in EDs, underlining the need for a brief screening tool in clinical settings. The present study compared ICD-10-based ED-diagnoses with SCOFF-identified at-risk female patients in a clinical setting and assessed the tool's reliability. Routine data (n = 955 participants) from a child and adolescent psychiatric hospital were evaluated regarding the incidence of ED-diagnoses before (n = 312) and during the pandemic (n = 643) and compared with SCOFF results. The SCOFF's sensitivity and specificity were examined. ED-diagnoses significantly increased, almost doubling from before to during the pandemic. The number of at-risk patients identified by the SCOFF likewise differed between the two time points. The SCOFF showed high sensitivity at cut-offs of 2 (pre-pandemic) and 3 (peri-pandemic) but low specificity. Internal consistency was poor. The findings align with previous research indicating an elevated rate of admission to clinical care for ED-diagnoses during the pandemic, a trend also reflected in the SCOFF results. However, the SCOFF's low specificity and poor internal consistency raise concerns about its applicability among adolescent psychiatric inpatients.

Gratitude despite unease among Swedish male forensic psychiatric patients with substance use disorders: an interview study

ABSTRACT Purpose Forensic psychiatric inpatient care in Sweden is characterized by strict regulations and adherence to court-mandated rules, with a median care time of 7 years. Comorbity has significant clinical implications, impacting health and well-being, violent behaviour and criminal recidivism, and prolonging inpatient stays. This study investigated the individual experiences and perspectives of Swedish patients in forensic psychiatric care with substance use (SU) disorders, focusing on past, present and future orientations. Methods Ten male forensic psychiatric inpatients were individually interviewed following a semi-structured interview guide. A qualitative content analysis was conducted to inductively analyse the participants’ experiences. The study adhered to the Standards for Reporting Qualitative Research. Results Under the main theme of “embracing harmony in opposition”, three categories emerged: (1) unveiling the beginning of SU and its impact on navigating challenges in care, (2) exploring current confined care and gratitude despite unease and (3) yearning for a somewhat normal life. Conclusions Participants’ subjective perspectives underscored the importance of factors such as forensic nurses/healthcare providers in forensic psychiatry considering the patients’ life narratives, their aspirations for the future, their need for a secure environment and patient—staff relationships. These findings highlight the need for structural interventions that emphasize the importance of tailored and comprehensive health plans within rehabilitation.

Identifying momentary suicidal ideation using machine learning in patients at high-risk for suicide.

Strategies to detect the presence of suicidal ideation (SI) or characteristics of ideation that indicate marked suicide risk are critically needed to guide interventions and improve care during care transition periods. Some studies indicate that machine learning can be applied to momentary data to improve classification of SI. This study examined whether the classification accuracy of these models varies as a function of type of training data or characteristics of ideation. A total of 257 psychiatric inpatients completed a 3-week battery of ecological momentary assessment and measures of suicide risk factors. The accuracy of machine learning models in classifying the presence, duration, or intensity of ideation was compared across models trained on baseline and/or momentary suicide risk data. Relative feature importance metrics were examined to identify the risk factors that were most important for outcome classification. Models including both baseline and momentary features outperformed models with only one feature type, providing important information in both correctly classifying and differentiating individual characteristics of SI. Models classifying SI presence, duration, and intensity performed similarly. Results of this study may not generalize beyond a high-risk, psychiatric inpatient sample, and additional work is needed to examine temporal ordering of the relationships identified. Our results support using machine learning approaches for accurate identification of SI characteristics and underscore the importance of understanding the factors that differentiate and drive different characteristics of SI. Expansion of this work can support use of these models to guide intervention strategies.

Acoso escolar y suicidio

Bullying is an adverse event that can have serious consequences for victims, which can even lead to suicidal behavior. In this article, a study is carried out on adolescents who are psychiatric inpatients in the Hospital 12 de Octubre in Madrid. The bullying is examined in the inpatient adolescents and the reasons for admission to a psychiatric hospital. The results obtained are discussed and the importance of establishing preventive measures and protection against bullying is emphasized.

Riesgo autolítico en población adolescente.

Suicidal behavior in adolescents has increased in recent years and consequently the psychiatric hospitalization due to the suicidal risk.In this article, a study is carried out on adolescents who are psychiatric inpatients in the Hospital 12 de Octubre in Madrid. The reasons for admission to a psychiatric hospital are analyzed and they show that the most common reason is risk of self-injury, whether suicidal ideation or frustrated suicide attempt. The methods used in suicide attempts are also studied. The results obtained are discussed and the importance of establishing adequate measures for the prevention and intervention of suicidal behavior is emphasized.

Assessing the Risk of QT Prolongation in a Psychiatric Inpatient Cohort: A Retrospective Cross-Sectional Study.

QT prolongation is a potential serious adverse drug reaction, and assessing the risk of QT-prolonging drugs is routinely included in psychotropic medication reviews. However, the actual clinical benefits of such assessments are unknown. We investigate whether QT prolongation (QTc value > 480 ms) manifests in psychiatric inpatients at risk of QT prolongation as identified by assessing drug regimens. Secondly, we test the predictive value of well-known risk factors for QT prolongation. The median patient age was 49 years (IQR 34-64) for patients treated with a median of nine drugs (IQR 6-12) and a median QT-prolonging drug sum of three daily defined dosages (IQR 1.88-4.76). We extracted 290 ECGs for patients where pharmacist-led-medication reviews (PMRs) identified an increased risk of QT prolongation and 190 ECGs for patients with no such risk, identifying 33 cases of verified QT prolongation equally distributed between groups. Unadjusted regression analysis revealed that advanced age (OR 3.27 CI 95% 1.60-6.84) and cardiovascular comorbidity (OR 3.53 CI 95% 1.71-7.29) were associated with manifest QT prolongation, while the QT-prolonging drug load was not. We reviewed electronic health records (EHRs) of 799 psychiatric inpatients exposed to PMRs made from 1 September 2016 to 31 December 2018 in Region Zealand Denmark. Patients at risk of QT prolongation as identified by drug reviews rarely manifests with actual QT prolongation. Non-pharmacological risk factors seem to be better predictors for identifying patients with QT prolongation.

Can sheep help to improve positive emotions, mindfulness, and self-efficacy expectancy? A pilot study of animal-assisted intervention as an enhanced CBT-based therapy for substance use disorders.

Substance use disorders (SUDs) are common, and there is evidence of clinically significant benefit of cognitive behavioral therapy (CBT). The efficacy of CBT in SUDs has been confirmed, although relapse rates of 40%-60% have been reported. An enhancement of CBT-based therapy through an animal-assisted intervention (AAI) with sheep to normalize the occurrence of negative emotions and improve positive emotions as well as mindfulness and self-efficacy expectancy was investigated. A single-session AAI with sheep in a group setting was investigated against treatment as usual over time. N = 36 psychiatric inpatients with SUDs were examined by questionnaires before and 1 week after the intervention and additionally immediately after the intervention. Positive emotions improved significantly in the AAI group 1 week after the intervention with a medium effect size, but not in the control group. Similarly, mindfulness and self-efficacy expectancy improved over time in the AAI group. When exploratory results were evaluated immediately after the intervention while still on the farm, the effects in favor of AAI were even larger. AAI can thus be considered effective in improving positive emotions, mindfulness, and self-efficacy expectancy. The impressive effect sizes immediately after the intervention encourage us to consider what can be done to maintain these even greater effect sizes over time. https://drks.de/search/de/trial/DRKS00027539, identifier DRKS 00027539.

Staff’s understanding of the role of least restrictive practice in the development of obesity in secure psychiatric inpatients

PurposeThis study aims to explore the ethical challenges of managing the weight of psychiatric patients in the least restrictive manner in secure mental health settings and whether these could be considered as a source of moral distress for health practitioners, which may be linked to staff burnout and ultimately lead to suboptimal patient care.Design/methodology/approachA qualitative semi-structured interview study design was used to explore the understanding, views and experiences of six staff members working on two medium-secure wards in a UK mental health hospital using an opportunity sampling technique and Interpretative Phenomenological Analysis.FindingsAnalysis of semi-structured interviews revealed a multitude of moral events that evoked feelings of frustration, powerlessness and anxiety related to the management of obesity in the least restrictive way, which is indicative of moral distress.Research limitations/implicationsDue to the small sample size and the qualitative nature of the research, the findings of this study are of explorative in nature. Further quantitative research would be required to establish a causative link between the ethical challenges associated with obesity management and staff’s moral distress.Practical implicationsAddressing the health-care professionals’ knowledge deficit on how to achieve the right balance in their duty of care through inclusion of bioethics into professional discussions and training could improve staff’s well-being and the organisation’s ethical climate.Originality/valueTo the best of the authors’ knowledge, this is the first qualitative work exploring the role of least restrictive practice in the challenges associated with health promotion within secure psychiatric settings, and the effect these challenges have on mental health staff.

Patients’ knowledge of the indications for their medications – a scoping review

BackgroundInadequate medication knowledge may contribute to inappropriate medication use and treatment harms. We aimed to map and synthesise the existing evidence on patients’ knowledge of the indications for their medications.MethodWe searched MEDLINE, Embase, CINAHL, PsychInfo and the Cochrane Library for studies that assessed patients’ knowledge of the indications for their medications from inception to June 16, 2022. A pair of reviewers independently screened and extracted data on study characteristics, aims, and methods used to assess and report patients’ knowledge of the indications for their medications.ResultsWe included 99 studies conducted in 33 countries, published between 1979 and 2021, with 42,377 participants in total (median 126 participants [Interquartile range: 63–338]). Studies were observational (n = 77), experimental (n = 18), or qualitative interviews (n = 4). The exact question used to assess knowledge of the indications was reported in 27 studies and was phrased in 25 different ways. Knowledge of the indications was reported as a proportion of either 1) all participants (n = 65) or 2) the total number of medications used by all patients (n = 13). Sixteen studies used both reporting methods, while five only reported a proportion without specifying the denominator. Fourteen studies in various populations reported the number of participants with correct knowledge of all their medications, ranging from 19% (long-term psychiatric in-patients) to 87% (general practice patients).ConclusionWe did not identify any established scientific standard for assessing patients’ knowledge of the indications for their medications. The wide range of study methodologies and reporting styles observed call for a methodological consensus in this research field. Estimates of correct knowledge varied widely between studies, but whether this was due to differences in study populations or study methodology could not be determined. Furthermore, we did not identify any study investigating whether participants’ knowledge of the indications for their medications was associated with the quality, e.g. appropriateness, of their treatment.

Pre-disaster family visits and post-evacuation return to Fukushima among psychiatric inpatients evacuated to out-of-area hospitals after the nuclear accident.

This study aimed to elucidate the effects of pre-evacuation family hospital visits on post-evacuation returns to Fukushima Prefecture (hometown) among psychiatric inpatients who mandatorily evacuated to hospitals outside the prefecture because of the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Of the inpatients in Fukushima, 44 were admitted to a hospital in the nearby Soso district on March 11, 2011, and were therefore included in the current analysis. We collected information on their discharge after the evacuation and family visits before the evacuation by reviewing the medical records of both the evacuation destination and former hospitals. The average durations from the accident to post-evacuation return among patients with and those without former family visits were 681.8 days (standard error [SE] = 163.3) and 1,027.8 days (SE = 152.0), respectively. The log-rank test showed a tendency of earlier return to Fukushima among inpatients who had received family visits to the hospital before evacuation (p = .073). The results highlight the critical need for close collaboration between psychiatric medical practitioners and families, to not only support patients' community reintegration into daily life but also facilitate a timely return to their hometowns following long-distance evacuation caused by an unforeseen large-scale disaster.

Suicidality Trajectory, Hopelessness, Resilience, and Self-Efficacy Among Patients With Treatment-Resistant Depression in Vietnam.

Patients with treatment-resistant depression (TRD) have higher rates of suicidal ideation and a higher suicide attempt prevalence than patients with other types of depression. This study was designed to study the suicidality trajectory and relationships between hopelessness, resilient coping, and self-efficacy, respectively, and suicidal ideation and suicide attempts in patients with TRD during hospitalization and at 3 months after discharge. A longitudinal survey of 53 psychiatric inpatients with TRD was conducted. Suicidality, hopelessness, resilient coping, self-reported medication adherence, and self-efficacy were assessed at Weeks 1 and 2 (T0 and T1) after hospitalization and Week 1 and Months 1 and 3 after discharge. Data were analyzed using a Cox regression model. Suicidality varied across the five time points, with a downward trend observed between T0 and T1 (reflecting the initial effects of inpatient treatment) and an upward trend observed across the 3-month follow-up. Antidepressant overdose was the most common method used for suicide. The risk of high suicidal ideation during follow-up was 1.63, 2.63, and 1.14 times higher, respectively, in participants with a high level of hopelessness, low level of resilient coping, and low self-efficacy. Also, having a higher level of hopelessness and being younger in age increased the risk of attempting suicide by 3.07 times and over 6 times, respectively, compared to older participants. Suicidality was shown to fluctuate between the in-hospital treatment phase and the first 3 months following discharge in this sample of patients with TRD. Younger age, feelings of hopelessness, low resilience, and low self-efficacy were the top four factors contributing to postdischarge suicide risk. These findings highlight the need for regular patient monitoring and assessment to identify those with TRD who are at high risk of suicide as well as the importance of focusing on hopelessness, resilience, and self-efficacy as predictors of suicide ideation and attempts. Nurses should help patients with TRD, especially those who are younger, and improve and maintain their hope, resilience, and self-efficacy both during hospitalization and shortly after discharge.

Sleep quality in secure psychiatric healthcare: Inpatient & staff perspectives

The lived experiences of psychiatric inpatients are not well represented in the literature, especially when these experiences pertain to health. Reports regarding sleep health are particularly sparse, despite the increasing prevalence of sleep disorders in this population. The current study aimed to explore inpatient and staff perspectives of inpatient sleep quality to aid the future development of a sleep quality intervention. Fourteen inpatients (average age 43 years, 36 % female) were recruited for individual interviews and eleven staff members were recruited for three focus groups, from a secure psychiatric hospital (England). A semi-structured interview guide facilitated discussions regarding the prevalence and type of inpatient sleep problems, existing support for inpatient sleep problems including medication, and the bidirectional relationships between nighttime sleep and daytime behaviours, such as napping and physical activity. Using reflexive thematic analysis, four themes were developed: Irregular Sleep Schedules, Nighttime Disruptions, The Patient's Bedroom, and Keeping a Routine & Staying Physically Active. Study results can be utilised when developing inpatient sleep interventions, which were identified within the study as being sorely needed. Such interventions could focus on managing daytime sleeping, sedentary behaviour, and physical activity, in order to support good sleep hygiene, foster regular sleep/wake cycles, and improve overall health.

Development and Effects of a Laughter Therapy Program for Middle-aged Women Hospitalized in Psychiatric Wards

Purpose: This study aimed to develop and implement a laughter therapy program for middle-aged women hospitalized in psychiatric wards and evaluate its effects on their hope, self-efficacy, and medication adherence.Methods: This study employed a non-equivalent control pre–post quasi-experimental design. Sixty middle-aged female psychiatric inpatients were enrolled in total, with 30 in the experimental group and 30 in the control group. The experimental group participated in laughter therapy sessions twice a week for a total of eight 60-minute sessions. Data were analyzed using descriptive statistics, independent t-tests, &lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; test, and repeated measures analysis of variance using SPSS/Win 20.0.Results: Following the implementation of the laughter therapy program, significant differences were observed between the experimental and control groups in hope (t=-0.21, &lt;i&gt;p&lt;/i&gt;&lt;.001) and self-efficacy (t=2.65, &lt;i&gt;p&lt;/i&gt;=.010). However, there was no significant difference found in medication adherence (t=-0.11, &lt;i&gt;p&lt;/i&gt;=.077).Conclusion: These findings indicate that the laughter therapy program effectively enhanced hope and self-efficacy among middle-aged female psychiatric inpatients. Future interventions should consider incorporating strategies to enhance medication adherence as well, as this would ultimately contribute to the development of comprehensive mental health nursing interventions for middle-aged women.

The effect of Qigong exercise on state anxiety levels of inpatients in psychiatric wards: A randomized controlled study

BackgroundQigong is a mind-body exercise that originated in China and is often described as a form of meditation or movement therapy. While the existing literature has investigated the impact of Qigong exercises on trait anxiety in outpatients, there is limited research on their influence on state anxiety in inpatients. This study examined the effect of Qigong exercise on state anxiety levels of inpatients in psychiatric wards. MethodsThis study was a single-blind, randomized controlled trial. Patients were randomly assigned to either the intervention or control group. Seventy inpatients participated in the study, with 35 in each group. In the intervention group, the STAI-I form was used to assess state anxiety levels before (Test 1) and after (Test 2) a single 40-minute session of Qigong. ResultsThe mean post-test scores of the intervention group (27.20±5.57) were significantly lower than those of the control group (39.72±10.84). Additionally, a statistically significant difference was observed between the mean test-1 (38.42±9.7) and test-2 scores (27.2 ± 5.57) within the intervention group. ConclusionA single 40-minute Qigong exercise session reduced state anxiety levels in psychiatric inpatients and reduced the risk of potential adverse outcomes associated with state anxiety. Practitioners may consider the use of Qigong exercise in the management of state anxiety in clinical practice, when making clinical decisions.