Public Psychiatric Units Research Articles

Smoking in psychiatry: realities and implications for its management

This study looks at tobacco use among persons with psychiatric disorders and its management in public psychiatric units in France. A thematic analysis based on semi-directive interviews with 10 patients and 9 caregivers was carried out. Patients use tobacco to deal with their emotions and mood swings. However, mental health professionals, who only focus on mental disorders and addictions that have a direct impact on behaviors, disregard smoking addiction. Moreover, tobacco is sometimes integrated into the way services operate. However, it would be too simplistic to reduce the issue of smoking cessation to a matter of goodwill of caregivers. The structural dimension of smoking was evident, particularly in psychiatric hospitals, where it was an important bargaining chip and activity. Patients desire to receive individualized smoking-cessation interventions. This underlines the relevance of a public health intervention co-construction that goes beyond simply prescribing nicotine substitutes. This intervention should take into account characteristics of tobacco consumption among psychiatric patients, and the need to offer such interventions when patients are stabilized. In the meantime, psychiatric caregivers should be encouraged to engage in shared decision-making processes with patients for tobacco-use reduction and cessation.

Risk of Dental Caries and Erosive Tooth Wear in 117 Children and Adolescents' Anorexia Nervosa Population-A Case-Control Study.

IntroductionRestrictive type of anorexia nervosa (AN) is still one of the most severe eating disorders worldwide with an uncertain prognosis. Patients affected by AN should be encouraged to undertake psychiatric care and psychotherapy, but whether they should necessarily be included in careful dental care or not may still be questionable. Even though there is a constantly increasing number of AN studies, there are just a few data about the youngest group of AN children and adolescents aged < 18.MethodologyThis case-control study aimed to compare the dental health and gingival inflammation level in female adolescent inpatients affected by severe AN restrictive subtype vs. controls. Based on clinically confirmed 117 AN cases (hospitalized in years 2016–2020 in public Psychiatric Unit, BMI < 15 kg/m2, mean age 14.9 ± 1.8), the dental status has been examined regarding the occurrence of caries lesions using Decay Missing Filling Teeth (DMFT), erosive wear as Basic Erosive Wear Examination (BEWE), gingival condition as Bleeding on Probing (BOP) and plaque deposition as Plaque Control Record (PCR). The results were compared with age-matched 103 female dental patients (BMI 19.8 ± 2.3 kg/m2, age 15.0 ± 1.8, p = 0.746) treated in a public University dental clinic.ResultsAN patients were found to present a higher incidence of oral-related complications according to dental status (DMFT 3.8 ± 4.5 vs. 1.9 ± 2.1, p = 0.005), erosive tooth wear (BEWE 18.9 vs. 2.9%, p < 0.001), less efficient in controlling plaque (PCR 43.8 vs. 13.7%, p < 0.001) and gingival inflammation (BOP 20.0 vs. 3.9%, p < 0.001) compared with female adolescents. In the AN group, a significant correlation between BOP, BEWE, and duration of AN disease (p < 0.05), similarly to the number of decayed teeth D, filled teeth F and PCR were detected (p < 0.05).ConclusionsAlthough the obtained results did not reveal any severe oral status, our findings indicated impaired dental and gingival conditions in young anorexics. Considering AN's potential role in oral health, it is essential to monitor dental treatment needs and oral hygiene levels in their present status to prevent forward complications in the future.

Nurse managers in mental health units: from activities to time management

Objective: to understand the use of time by nurse managers in psychiatry and mental health units, as they carry out their daily tasks. Methods: cross-sectional study, carried out by 48 managers from public psychiatric units and from the social sector. Data collection was made through an online questionnaire that is part of the Scale of Perception of Nurse Manager Work, including 43 items separated in five functional domains of nurse managers. The responses were in a Likert scale: does not take time, takes little time, takes some time, takes much time. Results: the activities inherent to ethical and legal professional practices and to the management of care and of human resources required more time from the manager when compared to policy interventions, and consulting and professional development. Conclusion: the managers recognize that managing time implies organization, planning work, and establishing priorities in the tasks to be developed.

Substance‐Induced Psychosis: Clinical‐Racial Subjectivities and Capital in Diagnostic Apartheid

AbstractThis article examines the ways in which psychiatrists differentially deploy schizophrenia and addiction diagnoses among white, privately insured patients in comparison with black and Latino patients in a public psychiatric unit. Drawing on critical race theory and the anthropology of moral agency, the article tracks the ways in which the overlapping and competing diagnostic frames of schizophrenia and addiction are structured by, and structure, the personhood and political position of those who are subjected to them. It ends by identifying and tracking these logics of diagnosis and treatment, and their racially stratifying influence, in recent calls for integration of mental health with physical health care. Enhancing the agency of people who are subject to psychiatric diagnoses, and dampening the racializing and segregating impulse of diagnoses, ultimately requires clinical rejection of codified “evidence‐based medicine” in favor of spaces that serve, following Cheryl Mattingly, as moral laboratories for creating social selves.

Smoking Restrictions and Treatment for Smoking: Policies and Procedures in Psychiatric Inpatient Units in Australia

Tobacco smoking is the leading preventable cause of death and disease in Australia. Even though smoking prevalence in the general population has been reduced (20% smoke), prevalence rates remain high among psychiatric inpatients (70%-90%). This study aimed to identify smoking policies and procedures in public psychiatric inpatient units in New South Wales, Australia; the provision of "smoking care" in such units (for example, quit-smoking advice or nicotine replacement therapy); and policies and procedures associated with the assessment of smoking status and provision of smoking care. A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales for completion by nurse unit managers. Of the 131 units, 123 units completed and returned surveys (94%). Over one-third (36%) of respondents reported instances in which inpatients began smoking during their admission. A similar proportion (39%) reported that staff provided cigarettes to patients who smoked when patients' supply was expended. Fifty percent of respondents reported that all patients were assessed for smoking status; however, 70% reported that nicotine dependence was not assessed. Units on which staff adhered to smoking restrictions were three times as likely to assess patients' smoking status as units where staff never adhered to restrictions (odds ratio=3.05, p=.01). Inadequate establishment of nonsmoking environments and of smoking restriction enforcement as well as inconsistencies in the provision of smoking care were evident. The findings suggest that failure of psychiatric services to provide smoking care is systemic and not related to particular types of services (for example acute versus nonacute or regional versus metropolitan).

Dimensions that relate to cross‐cultural counselling

PurposeSets out to report on an exploratory study in which perspectives on cross‐cultural counselling in mental health care in Auckland, New Zealand, are to be examined.Design/methodology/approachThe study utilised a single questionnaire which sought mental health professionals' perceptions on issues and concepts of cross‐cultural counselling. The questionnaire was administered in the nine public psychiatric units in Auckland.FindingsApart from the health units providing bicultural (European and Maori) counselling services, there was little cross‐cultural counselling available to an increasingly multicultural community.Originality/valueWith regard to the need for cross‐cultural counselling, rather than address the issue of population change this study examines the effect that lack of diversity would have on the gains that would otherwise be made in the health‐care system of Auckland, New Zealand.

Safe times: 11.30am&amp;ndash;12.00&amp;nbsp;and 4.30pm&amp;ndash;5.00'

RECENTLY I WENT to visit a friend in a public psychiatric unit. I had quite a long wait as she was being brought out of the High Dependency Unit. As I was sitting there I was staring at the nurses? station when I spotted the sign attached to the wall. It simply said, ?SAFE TIMES: 11.30am?12.00 and 4.30pm ? 5.00?. I laughed. As a veteran of acute psychiatric wards it seemed absolutely appropriate that two half-hour slots were the only times that the unit staff felt confident to claim that safety for patients could be anticipated. Eventually I worked out what it really meant. Of course, silly me, these were the times the safe would be unlocked and you?d be able to get your money out!

Length of inpatient stay and recidivism among patients with schizophrenia.

The study examined whether length of hospital stay is related to recidivism among psychiatric patients. A quasi-experimental approach was used to address limitations of controlled and epidemiological research. Three matched groups, each consisting of 55 inpatients with schizophrenia, were selected from public psychiatric units with different mean lengths of stay. Regression models were used to compare the groups on three variables: time to first readmission (survival analysis), number of readmissions (ordinal logit regression), and total time in the community in the postdischarge year (multiple linear regression). An analysis based on the units with different lengths of stay, which was similar to that typically used in controlled studies, found no differences in the three outcome measures. However, a second analysis that examined data for all patients irrespective of their unit assignment found that inpatients treated for 30 days or less relapsed sooner than those with stays longer than 30 days. The disparity in results was largely due to overlapping quasi-experimental conditions: many patients on the short-stay units had a long lengths of stay, and vice versa. The first analysis supports an administrative policy of short stays. The second reinforces previous findings that a group of patients, primarily young males with onset of illness at an early age and multiple previous hospitalizations, is at greater risk of relapse with short-term treatment. The apparent contradiction between a unit- or patient-based analysis suggests that unit-based results should be interpreted with caution when used to make clinical or utilization review decisions.