Psychiatry Center Research Articles

Dr. Robert Brockelesby Davis

Dr. Robert B. Davis was one of the eminent figures shaping the field of Psychiatry in India. He was one of the founding member of the Indian Psychiatric Society and served as the president. He drafted the first proposal of the Mental Health Act of India along with other eminent psychiatrists in 1949. He served as the Superintendent and developed the European Mental Hospital (now known as the Central Institute of Psychiatry) in Ranchi into a leading centre for Psychiatry in India. He started the Kishore Nursing Home (now known as the Davis Institute of Neuropsychiatry) along with his wife. He was a passionate postgraduate teacher and a pioneer for introduction of several significant treatment procedures in India. He was awarded the Padma Shree in 1966 for his contributions to the field.

Repetitive transcranial magnetic stimulation in the treatment of major depressive disorder: Preliminary results from the United Arab Emirates

Background: Despite evidence for its efficacy, the use of repetitive transcranial magnetic stimulation (rTMS) to treat major depressive disorder (MDD) remains limited in the Middle East and North Africa. The following study evaluated the efficacy of this therapy on patients diagnosed with MDD attending the Outpatient Clinic at the American Center for Psychiatry and Neurology in Abu Dhabi, United Arab Emirates. Methods: Thirty-three patients with treatment-resistant MDD were treated with rTMS according to the Food and Drug Administration (FDA)-approved protocol. The patients received five treatment sessions per week over a period of 4–6 weeks, and they completed the Patient Health Questionnaire (PHQ-9) before and after the treatment course. Results: We observed a 58% response rate to treatment, with a 30% remission rate of depressive symptoms, consistent with previous studies. Limitations: Our results do not reflect long-term efficacy of rTMS, as post-therapy scores were obtained immediately after treatment. Although significant, the reduction in PHQ-9 scores cannot be generalised due to the relatively small sample size. Future studies could look into specific characteristics of patients for better profiling of rTMS candidates. Conclusion: An FDA-approved protocol involving five weekly sessions of rTMS over the dorsolateral prefrontal cortex was effective in treating MDD. Our secondary finding of lower acceptability rate among patients may indicate the need for shortened treatment duration and comprehensive insurance plans providing coverage for rTMS therapy.

The prevalence of catatonic syndrome in acute psychiatric wards.

The aim of this prospective study was to determine the prevalence of the catatonic syndrome in a cohort of patients admitted to acute psychiatric units in Hungary. Patients admitted to the acute inpatient unit of the Center of Psychiatry and Addiction Medicine, SzentIstván and SzentLászló Hospitals in a 4-month period were screened for catatonic signs and symptoms. Catatonic signs/symptoms were scored according to both the DSM-5 diagnostic criteria and the Bush-Francis Catatonia Rating Scale (BFCRS). Clinical diagnoses were established using the Structured Clinical Interview for DSM-IV Disorders (SCID), while cognitive performance was estimated with the Clock Drawing Test and the Mini-Mental State Examination (MMSE). During the study period, 342 patients were admitted to the above-mentioned acute inpatient units. The prevalence figures for the catatonic syndrome were 8.55% and 5.02% according to the BFCRS and the DSM-5, respectively. The prevalence of catatonic syndrome in an acute inpatient setting is within the broad range of figures reported in the literature. The difference between the standardized assessment (BFCRS) and routine clinical judgment (DSM-5) is noteworthy and suggests that a significant minority of catatonic patients might not be identified in clinical practice. As acute catatonia can be effectively treated, and early treatment could prevent potentially lifethreatening complications, recognition of catatonic symptoms is vitally important.

Efficacy of Mindfulness Based on Cognitive Therapy on Impulsivity and Self- Inhibition in Patients with Bipolar Disorder under Medical Treatment

Introduction: Bipolar disorder is combined with chronic symptoms that have effect on cognitive abilities and executive functions. The purpose of present study was to investigate efficacy of mindfulness based cognitive therapy (MBCT) on impulsivity and self-inhibition in the patients with bipolar disorder under medical treatment. Methods: This study was quasi-experimental, pretest-posttest design with the control group. 30 men and women with bipolar disorder referred to psychiatry center of Almahdi Welfare in Esfahan were selected through convenience sampling method and assigned in two groups: experimental (14) and control (16) randomly. Both groups performed behavioral impulsivity scale (BIS-11) and self-inhibition scale (SRS) in the pretest and posttest phases. Experimental group was treated with mindfulness based cognitive therapy (MBCT) for 8 sessions. The data were analyzed by MANCOVA. Results: Covariate analyze demonstrated that of mindfulness based cognitive therapy (MBCT) was effective on reducing the impulsivity and increasing the self-inhibition in the experimental group. Conclusion: Based on this finding, reduce cognitive impulsivity and motor impulsivity, and increase self-inhibition in anger control, impulse control and respect for others dimensions, is because of mindfulness based on cognitive therapy. Considering psychological intervention based on mindfulness, in addition to medical treatment is of particular importance.

A randomized study on the effect of tDCS on cognitive function in schizophrenia

Psychiatrist Dr Tomiki Sumiyoshi is the Director of Preventive Intervention for Psychiatric Disorders at National Centre of Neurology and Psychiatry, with extensive experience in clinical and basic research on schizophrenia and mood disorders. His deep interest in schizophrenia is driven by his background investigating neurobiological substrates responsible for cognitive impairment, but also in discovering effective therapeutics to facilitate social outcomes in patients with psychiatric conditions. Sumiyoshi explains that the connection between psychiatric disorders and cognitive impairment is well-established. Yet, limited efforts have been made towards implementing novel approaches that can truly help psychiatric patients to overcome this impairment, and hence live a normal life. He believes it is critical that current research needs to shift its focus on investigating innovative methods such as transcranial direct current stimulation (tDCS) that can facilitate cognitive enhancement in patients with schizophrenia.

The Relationship between Chronic Lower Urinary Tract Symptoms and Psychological Disorders in Women Referring to Baqyiatallah Hospital Clinic in Tehran City

Introduction: Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms with the prevalence of 62.5% in men and 66.6% in women. LUTS (Lower Urinary Tract Symptoms) was associated with increased risk of having clinically relevant depressive symptoms or depression and vice versa. We assumed that patients with chronic lower urinary tract symptoms who referred to urology clinic and have negative urologic evaluations, may suffer from psychological symptoms such as anxiety, depression or obsession. 
 Methods and Materials: This was a cross-sectional, single group survey of women living in Tehran province. Patients who were suffering from lower urinary tract symptoms for over than 6 months, were included in the study. We evaluate the presence of LUTS by asking the patients about their problems of urinary tract in two major categories: Filling or irritative symptoms - e.g. frequency, urgency, dysuria, nocturia, stress incontinence, urge incontinence. Chi square and independent T tests were used to evaluate the correlation between study variables. All statistical analysis was performed using SPSS software version 16.
 Results: There was a positive correlation between irritative symptoms and depression symptoms (p‹0.001) and a negative correlation between obstructive symptoms and depression (p‹0.001). There was no association between LUTS and symptoms of OCD (Obsessive- Compulsive disorder). The mean age of participants with positive BDI (Beck depression inventory) was higher than those with negative BDI. (p= 0.007).
 Discussion: The results of this study emphasized the important association of LUTS and depression. In conclusion, depressive disorder can increase the risk of developing LUTS or accelerate this process. So when a patient with either urinary or depression symptoms referred to a psychiatry center, he should be screened for the other disease. This requires an adequate interaction between urology and psychiatry departments to achieve.

Measurement of 2D:4D ratios in patients with major depressive disorders: A pilot study

Introduction: Digit ratio or 2D:4D ratio is a sexually dimorphic trait. It is a proxy marker of prenatal androgen exposure and is negatively correlated to prenatal androgens especially, testosterone. Literature search revealed significant correlations between digit ratios and various physiological, psychological or performance traits in adulthood. Objectives: The pilot study was conducted to measure 2D:4D ratios of patients with Major Depressive Disorder (MDD) and to compare it with normal (non-depressed) individuals and also to evaluate the correlation between digit ratios & depression scores. Materials and Methods: The present study was conducted in adults of age group belonging to 25-40 years with MDD (Group 1: n=30), from a tertiary care centre for Psychiatry. Using digital vernier calipers 2D:4D ratio was measured. Diagnosis of depression was done by the psychiatrist using DSM –IV criteria and depression scores were calculated by Hamilton depression rating scale (HDRS). Depression scores using Beck’s Depression Inventory and digit ratios were measured in age and sex matched healthy controls (Group 2: n=30). Results: The Mean ratios of Group 1 (0.9659 0.04161) was found to be lower than Group 2 (0.9788 0.0371). Using standard cutoffs, Group 1 was divided into Low and High digit ratios. The proportion of Group 1 patients with high ratios (84%) was significantly more than those with than low ratios (16%) (p Discussion: The outcomes of the present study were synchronous with reports of higher incidence of depression in females, nationally and globally. This was concurrent with the other reports of the previous studies. This would help us to conduct the future studies even on large study population. Keywords: Digit ratio, 2D:4D ratio, Prenatal testosterone, Depression, Vernier Caliper, Beck’s Inventory.

P.344Assessment of longitudinal developmental milestones in Fukuyama congenital muscular dystrophy

Patients with Fukuyama congenital muscular dystrophy (FCMD) exhibit psychomotor impairment, and their motor function peaks between the age of 5 and 10 years, after which it starts deteriorating. It is known that an intellectual disability itself can cause a delay in motor developmental milestones. However, the relationship between intellectual and motor functions in FCMD remains unclear. We aimed to assess the potential relationship between intellectual and motor developments by assessing the data of patients with FCMD who were older than 10 years, i.e., those who had experienced motor ability regression. Medical records of patients with FCMD who visited the National Center of Neurology and Psychiatry, Japan, were retrospectively reviewed. Intellectual function was represented by language achievements. A total of 20 patients (mean age 17.5 SD 4.6 years) were identified, and FCMD had been confirmed in all of them through genetic analysis. On assessment of maximum motor ability achievement, it was observed that 13 patients were sitters and 4 were walkers. The median age of achieving sitting was 18 months (range: 9 to 48 months). Regarding language achievement, 18 of 20 patients had achieved verbal communication and 15 patients were capable of combining words and were able to speak phrases or sentences. Eight patients were able to speak their first word at the age of ≤18 months and 12 spoke their first word after the age of 18 months or remained nonverbal. The number of individuals who progressed to speak phrases or became ambulatory tended to be higher in the group that achieved its first word at the age of ≤18 months than in the group that did not; furthermore, more individuals had poorer motor development and were bed-ridden in the group with first word after the age of 18 months. Our data suggest that patients with FCMD with more severe intellectual disability may have poorer motor functions.

Factors Influencing Aphasia Outcome in Patients with Occlusive Stroke

AbstractBackground: Aphasia related to ischemic stroke is a major health problem affecting the quality of life profoundly.Aim of Study: Is to assess factors influencing aphasia outcome in patients with occlusive stroke and the role of functional magnetic resonance imaging in detection the patterns of post-stroke language recovery.Patients and Methods: This was a prospective cohort study done at Neuropsychiatry Department and Center of Psychiatry, Neurology and Neurosurgery, Diagnostic Radiol-ogy, Tanta University, from January 2017 to January 2018. Aphasia Rapid Test (ART) at day 1 and follow-up at day 8 which is a bed side clinical test to assess aphasia severity, Diffusion Tensor Imaging (DTI) and fMRI were done at day 8 to assess aphasia severity. A total of 34 cases were finally included in this study after fulfilling the inclusion and exclusion criteria, 12 patients who had receptive or global aphasia, were not suitable for fMRI, their native language Arabic, age Results: The total number of the studied patients was 34 of them 18 patients (52.9%) were males and 16 patients were females (47.1%). The age of the studied patients ranged from 28-79 years. The older group of patients had severe language disability also those with global aphasia and perisylvian lesion, risk factors as HTN, DM, Cardiac Disease, Dyslipidemia had worse prognosis, those with no reconstruction of the Arcuate Fasiculus in DTI and fMRI data analysis showed negative effect of the site contralateral to lesion.Conclusion: Age was a significant factor with the higher age group had the worst prognosis regarding aphasia. Large lesion sizes and those with damage to strategic language areas had a bad prognosis. fMRI and DTI were the cornerstone of our study and they were a highly reliable tools in the prognosis of language outcome, with those who had activity in the perilesional and bilateral activity (perilesional and contralateral homotopic) in fMRI to have better outcome than those with only contralateral activity, also DTI to delineate the AF and the degree of its integrity and reconstitution.

Improvement culture in the public mental healthcare sector: evaluation of implementation efforts

The Danish public healthcare system has been forced to improve performance in terms of better service and lower costs. One regional Danish public healthcare organization has systematically implemented an improvement culture in its psychiatry sector. This research paper contains an evaluation of the organization’s transformation journey towards continuous improvement in psychiatry. The study was based on twenty-five personal interviews, two group interviews and four focus group interviews with centre managers, doctors, psychologists, psychiatrists, nurses and medical personnel in two of the ten psychiatry centres in the region. The objectives of implementing an improvement culture were to create better service for patients and to improve efficiency. Findings indicate that a number of critical success factors and barriers exist in mental healthcare and that even though a number of resources was invested up front, adjustments of the implementation process were needed from centre to centre. Furthermore, the implementation of a lean culture had some positive effects on treatments. In particular, internally, efficiency improved in some areas, creating a common view of what creates value and how to make improvements. Involving different groups of specialists in the implementation of an improvement culture is important. However, the achievement of continuous improvement efforts could be challenging, as results can be difficult to quantify. The novelty of the paper lies in the fact that data is collected from different groups of employees (from both managers’ and employees’ perspectives) on the effects of a full-scale implementation of an improvement culture in public mental healthcare.

The Feasibility and Efficacy of Social Cognition and Interaction Training for Outpatients With Schizophrenia in Japan: A Multicenter Randomized Clinical Trial.

Background: Schizophrenia is a disabling illness. Social cognition and interaction training (SCIT) seeks to improve patients’ social functioning by alleviating deficits in social cognition. SCIT has shown promise in improving social cognition in patients with schizophrenia, but has not yet been studied in Japan. Design: An assessor-masked, randomized, parallel-group clinical trial was conducted to compare the feasibility and efficacy of SCIT with treatment as usual (TAU). Setting: Participants were recruited from outpatient clinics at the National Center of Neurology and Psychiatry and four other hospitals in Japan. Participants: Seventy-two patients diagnosed with schizophrenia or schizoaffective disorder consented to participate in the trial. Procedure: Participants were randomly allocated to either a SCIT subgroup or a TAU subgroup. SCIT is a manual-based group intervention that is delivered in 20–24-h-long weekly sessions. Groups include two to three clinicians and four to eight patients. Hypotheses: We hypothesized that SCIT would be found to be feasible and that patients who were randomized to receive SCIT would exhibit improvements in social cognition. Results: Data from 32 participants in each subgroup were entered into analyses. The persistence rate in the SCIT subgroup was 88.9%, and the average attendance rate was 87.0%. Intrinsic motivation was significantly higher in the SCIT subgroup than the TAU group during the first half of the program. Mixed effects modeling of various outcome measures revealed no significant interaction between measurement timepoint and group in any measures, including social cognition, neurocognition, symptom severity, and social functioning. In the case of the social cognition measure, significant change was observed only in the SCIT subgroup; however, the interaction between timepoint and group failed to reach significance. In an exploratory subgroup analysis, a shorter duration of illness was found to be associated with significantly better improvement on the social cognition measure in the SCIT subgroup compared with the TAU subgroup. Conclusions: In terms of the primary objective, the relatively low dropout rate observed in the present study suggests that SCIT is feasible and well tolerated by patients with schizophrenia in Japan. This view is also supported by participants’ relatively high attendance and intrinsic motivation.

A Web-based Survey for the Association Between Food Allergy and Depression/psychological Distress in 11,876 Japanese (P18-019-19)

ObjectivesThe aim of this study is to examine whether food allergy (FA) is associated with depression/psychological distress in a large Japanese sample. MethodsThis web-based survey was conducted on a platform of “Yahoo! JAPAN -HealthData Lab” and the Genequest Inc. (Tokyo, Japan). Participants were 1000 individuals with self-reported history of depression (mean age: 41.4 years, 501 men and 499 women) and the remaining 10,876 controls (mean age: 45.1 years, 5691 men and 5185 women). Six-item Kessler scale (K6) test cut-off score ≥13 was used to estimate severe psychological distress. We gained self-reported information on FA and 27 specific food allergens. ResultsThe proportion of individuals with FA, 2 or more, 3 or more, and 4 or more allergens was higher in the depression group compared to the control group (odds ratio [OR] = 1.64, 1.75, 2.02, and 2.27, respectively; P < 0.001). Allergen analyses revealed that allergies for shrimp, egg, mackerel, crab, kiwi fruit, milk, banana, and squid were more common in the depression group compared to the control group (P < 0.05). Individuals who had severe psychological distress was more common in the FA group than in the non-FA group, in the total participants (OR = 1.32, 1.62, 2.04 and 2.51; 1, 2, 3, and 4 or more allergens, respectively; P < 0.001). ConclusionsWe suggest that FA is likely to be a risk factor for depression and severe psychological distress, which is dependent on the number of food allergens. Funding SourcesThis work was supported by an Intramural Research Grant for Neurological and Psychiatric Disorders of National Center of Neurology and Psychiatry.

Altered Ethanolamine Plasmalogen and Phosphatidylethano-lamine Concentrations in Serum of Patients with Bipolar Disorder (P08-117-19)

ObjectivesGrowing evidence has suggested that metabolic alterations of plasmalogen ethanolamine (PlsEtn) are implicated in neuropsychiatric diseases. However, few studies examined the association of peripheral blood PlsEtn levels with bipolar disorder (BP). In this study, we measured serum PlsEtn and phosphatidylethanolamine (PtdEtn) levels in patients with BP and healthy controls. We investigated the relationships between serum PlsEtn and PtdEtn levels, diagnosis, symptom severity and medication status. MethodsSubjects were 40 patients with BP (DSM-IV) and 40 healthy controls matched for age, sex, and ethnicity (Japanese). Informed consent was obtained from each subject. Serum levels of PlsEtn and PtdEtn were determined by liquid chromatography/tandem mass spectrometry. ResultsSerum PlsEtn were significantly lower in patients with BP compared with controls (P = 0.017). Serum PtdEtn levels were significantly lower in patients with a BP type I (n = 12) versus patients with BP type II (n = 24) diagnosis (P = 0.011). In the BP patients, symptom severity did not correlate with serum PlsEtn or PtdEtn levels. ConclusionsLow serum PlsEtn might be involved in the pathophysiology of BP. PtdEtn might be related differently with BP I and BP II. Funding SourcesThis study was supported by an Intramural Research Grant for Neurological and Psychiatric Disorders by the National Center of Neurology and Psychiatry (H.K.).

Facilitators of healthy life style behaviors in persons with schizophrenia-A qualitative feasibility pilot study.

Persons with schizophrenia experience high rates of cardio metabolic disorders and have a 20-25% shorter life expectancy than the general population. Health professionals led life style modification behavior programs have shown improvements, in managing aspects of metabolic problems. This study sought to identify the life style modification by exploring (1) facilitators that help persons with schizophrenia to adopt the lifestyle modification behaviors and (2) factors that help to adhere to life style modification behaviors. A qualitative study utilizing face to face interviews was conducted for five persons (n = 5) diagnosed as schizophrenia (ICD 10) and their caregivers (n = 13) receiving inpatient mental health services in a tertiary level psychiatry centre, in South India. Qualitative data was collected, organized and analyzed with thematic analysis using ATLAS.ti software. The study results identified four major themes as facilitators. (1) Factors of increased self- confidence, and personal development. (2) The need for social support and conducive environment; (3) level of self motivation (4) encouragement from health professional and availability of health services. Participants believed that engaging with programs of physical activity, dietary modification, and illness support from family would motivate them to live more healthily. Individuals with serious mental illnesses such as schizophrenia encounter physical health related problems, facilitators of lifestyle change behavior help them to adhere to change in their routine life. Lifestyle change interventions also motivate individuals to eat healthy diet and exercise regularly to prevent premature mortality.

Comparison between substance-induced psychosis and primary psychosis

Background Distinguishing between substance-induced psychosis (SIP) and primary psychosis is crucial for understanding illness and providing optimal treatment. Substance use is widespread and causes concern for many reasons, particularly the psychotogenic properties of many substances. Aim The purpose of this study was to differentiate SIP from primary psychosis. Patients and methods A cross-sectional comparative study on 100 patients of both genders who were divided into two groups: group I included those with SIP and group II included those with primary psychosis; 18–65 years old was collected from the Neuropsychiatry Department, Tanta University and from the Centre of Psychiatry, Neurology and Neurosurgery. The study was conducted from July 2016 to July 2017. Psychosis was assessed by positive and negative syndrome scale. Arabic version of the addiction severity index was used to assess the severity of addiction and drug screen of urine once the patient was admitted. Results There was a significantly older age among group II (primary psychosis) with a mean age of 34.540±10.017. There were more men in group I, all patients were men in group I. Group II shows significantly more unemployed patients (45 patients, 90%). Unmarried patients were significantly more among group II. There were more patients with a family history of addiction among group I (35 patients, 70%) and more patients with a family history of psychiatric disorders among group II (30 patients, 60%). The number of patients presented with visual hallucination was higher among group I (33 patients, 66%). The number of patients presented by negative symptoms in group II was higher (42 patients, 84%). The total score of positive and negative syndrome scale was higher among group II. Conclusion There is a great difference between SIP and primary psychosis.

Art and Mental Health Care as Cultural Heritage and Current Practice

There is a tradition of integrating art into psychiatry. When Aby Warburg suffered a painful mental breakdown, he was treated at the Bellevue psychiatric hospital, Switzerland from 1921 to 1924. Bellevue was a center for existential psychiatry, and artistic expressions were encouraged. During previous decades, bio-medical treatments have become domineering. Simultaneously, there is an increasing interest in the health promoting aspects of art. The artistic heritage of psychiatry has been rediscovered. It is also acknowledged that users of psychiatry might express pain as well as joy through arts activities and art thus promotes wellbeing. Art is, however, not easily integrated into current psychiatry. In this paper I present interviews with four managers in psychiatry who have integrated artistic activities into a psychiatric in-patient clinic in Gothenburg, Sweden.

Are ‘neurotypical controls’ really neurotypical? Individual differences in mental health traits in ‘control’ populations

Are ‘neurotypical controls’ really neurotypical? Individual differences in mental health traits in ‘control’ populations

High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.

High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder.

New initiatives: A psychiatric inpatient facility for older adolescents in India.

Context:Almost 1/5th of the adolescent population suffers from mental morbidity. In older adolescents, clinical challenges are accompanied by unique psychosocial and developmental needs. Recent legislations in India – the Mental Health Care Act, 2017 and the Juvenile Justice Act, 2015 – mandate specific arrangements and provisions for evaluation and treatment of children and adolescents. A separate inpatient Adolescent Psychiatry Center (APC) was started at National Institute of Mental Health and Neurosciences, Bangalore, in 2016.Aims:(a) The aim of this study is to present the need for, development, infrastructure and workforce at APC; (b) to describe clinical profile of adolescents admitted to APC and (c) to identify clinical and psychosocial challenges in the management of older adolescents.Setting and Design:The paper covers consecutive inpatient admissions over the first 7 months of APC.Materials and Methods:Data were gathered from a review of hospital records, staff meetings, and case files.Statistical Analysis:Qualitative data, such as clinical management challenges, are summarized under major emergent themes. Quantitative data are summarized as means with standard deviations and frequencies with percentages.Results:Males, from urban, nuclear family background constituted the majority admissions. Family stressors and risk behaviors were prevalent. Unique clinical challenges included – risk behaviors, issues related to autonomy, conflict with family and conflict with the legal system.Conclusions:Older adolescents need to be treated in an environment appropriate to their age and developmental stage. Restructuring of spaces, routines, and creative inputs to interventions strategies must be made for healing environments for youngsters. APC could be a model for the development of other similar centers.

Lino Castle - An interior design concept to improve inpatient treatment in child and adolescent psychiatry

Lino Castle - An interior design concept to improve inpatient treatment in child and adolescent psychiatry Abstract. Only very few data exist concerning hospital architecture in psychiatry/child and adolescent psychiatry. Previous data suggest that architectural improvements do reduce the application of coercive measures as well as reducing aggressive behavior, endangerment of self and others, and provoking changes in the kind and frequency of medication. In order to improve the overall hospital environment of inpatient treatment, the Center for Child and Adolescent Psychiatry and Psychotherapy of Clienia Littenheid AG developed a spatial and communication concept named "Lino Castle." In cooperation with patients, their parents as well as members of the multidisciplinary team, we implemented a concept that serves to ameliorate the recovery process of the children and adolescents. "Lino Castle" is deeply rooted in the history of the local village and aims to allow patients to feel at ease for the duration of their stay. It hosts seven characters that serve as guardians and protectors of the individual wards and represent various types of disorders and emotional states. The respective architectural concept grew out of the storyline of "Lino Castle" and combines colors, forms, materials, graphics, and furniture to ensure an environment conducive to healing and reduced anxiety. With the implementation of "Lino Castle," we observed that the number of admissions and hospital occupancy increased significantly, whereas the length of stay and the ratio of involuntary admissions in closed wards decreased. We presume that this turn of events is due to higher commitment, acceptance, and less aggressive behavior in the patients, and to higher motivation and work satisfaction in the staff.