Special Psychiatric Hospitals Research Articles

ПОЛІТИЗАЦІЯ ДІЯЛЬНОСТІ ТВОРЧОЇ ІНТЕЛІГЕНЦІЇ УКРАЇНИ (1960-ті рр.)

The article examines the politicization of the cultural and educational activities of the creative intelligentsia of Ukraine in the 60s of the last century. It is noted that the general atmosphere of the considered era was the awakening of national consciousness in the field of creative intelligence. In a state where terror became a means of state policy, the very fact of the emergence of political dissidence was a phenomenal phenomenon. The regime introduced a whole system of the most ingenious means of neutralizing the opposition: surveillance, various provocations, as well as special psychiatric hospitals, traditional prisons and camps. However, all these means did not justify themselves. State terror only intensified political resistance, as the trials united and crystallized its core, strengthened the beliefs and tasks of Ukrainian dissidents. The dissidents agitated society, caused a conflict of worldviews, which was an outstanding achievement under the conditions of general unanimity. Their views can be accepted or denied, but do not ignore the reaction to the fact of their conscious self-sacrifice. With their position, the dissidents challenged the general mass, which had come to terms with its position, the system, which imposed its rules on every cell of the social organism. Against the background of the All-Union dissident movement, the defining feature of Ukrainian became the emphasis on the position that human rights cannot be fulfilled without ensuring the rights of the nation. Among the representatives of the creative intelligentsia of Ukraine, who have put forward a number of political conditions since the early 1960s, a special place belongs to the representatives of the Donetsk region.

Coercion rates in different mental health care models: flexible assertive community treatment vs care as usual

IntroductionIn 2018, within the Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro. During the years 2019 and 2020 Community mental health team (CMHT) within the Special Psychiatric Hospital Kotor was established. This team became responsible for management of treatment of a group of users with severe mental health illnesses, based on the principles of „Flexible Assertive Community Treatment (FACT – A Dutch model).ObjectivesThe main objective of this research was to establish whether there were substantial differences regarding the use of seclusions, restraints and forced medication during the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro.MethodsA sample of 202 users of mental health services from Kotor and surrounding municipalities were recruited. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued (outpatient treatment without field work and hospital readmissions during the psychotic relapses).To estimate and follow-up the frequency of application of coercive measures in this research, hospital documentation was used.ResultsPatients in the intervention group had statistically significant less coercive intervention (such are mechanical restraining, seclusions, isolations and forced medication) during the study. There were no significant differences in the number of hospital days and readmission rates.ConclusionsThis study showed that CMHT care could reduce some of the coercive measures during the treatment of severe mental illnesses.Disclosure of InterestNone Declared

Coercion rates in different mental health care models: flexible assertive community treatment vs care as usual

Abstract: IntroductionIn 2018, within the Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro. During the years 2019 and 2020 Community mental health team (CMHT) within the Special Psychiatric Hospital Kotor was established. This team became responsible for management of treatment of a group of users with severe mental health illnesses, based on the principles of „Flexible Assertive Community Treatment (FACT – A Dutch model). Objectives: The main objective of this research was to establish whether there were substantial differences regarding the use of seclusions, restraints and forced medication during the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro.MethodsA sample of 202 users of mental health services from Kotor and surrounding municipalities were recruited. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued (outpatient treatment without field work and hospital readmissions during the psychotic relapses).To estimate and follow-up the frequency of application of coercive measures in this research, hospital documentation was used.ResultsPatients in the intervention group had statistically significant less coercive intervention (such are mechanical restraining, seclusions, isolations and forced medication) during the study. There were no significant differences in the number of hospital days and readmission rates.ConclusionsThis study showed that CMHT care could reduce some of the coercive measures during the treatment of severe mental illnesses.Disclosure of InterestNone Declared

Socio-Demographic Correlates and Patterns of Use Among Patients Visiting Addiction Services of Almadinah Specialized Psychiatric Hospital in Saudi Arabia

Background: Substance use disorders are on the increase worldwide with negative consequences on individuals, their family and the community. Our objective is to study the socio-demographic and patterns of use in those requesting addiction treatment in Addiction treatment services of Almadinah Specialist Psychiatrist Hospital (ASPH). Methods: A descriptive chart review study of 622 patients requesting treatment between the first January 2019 and 31 December 2012. Information was taken from patients’ records and if necessary, completed by a direct interview with the patient. Data collected were analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: The majority were male (96.6%) with a mean age of 32.1 ± 9.2 years. More than half had less than a bachelor’s degree, while 23.5% were highly educated. The majority of patients were single (70.7%), 53.1% reported difficulty keeping a job, 17.8% a high income, 90% a negative family history of substance abuse and 94.7% a negative family history of psychiatric illness. The most frequent substances used, in descendant order, were captagon (69.8%), cannabis (63%) and alcohol (30.7%). The mean age of initiation was around 21 years for the three main substances. The prevalence of co-occurring disorders was at 14%. Two thirds of patients were from the outpatient department (67.7%) and 32.2% from the emergency department (ED). Around a third of our sample visited the emergency room at least once during the month prior to their evaluation and overall, 32.3% needed hospital admission. Conclusions: The fact that 90% of our sample reported a negative history of substance abuse with about 4 out of 5 having an early age of initiation to substance use emphasizes the urgent need for psychoeducational preventive efforts on substance abuse and dependence targeting our youths and their families, in multiple areas particularly in school and neighbourhoods.

Features of the manifestation of the COVID-19 epidemic process among employees of a large closed specialized hospital

The article presents the features of the epidemiological process of COVID-19 among medical workers of a closed specialized psychiatric hospital. The analysis of the incidence of COVID-19 employees for 2020–2021 was carried out, a laboratory study of blood sera of 310 individuals for class G antibodies to NC (nucleocapsid protein) SARS-CoV-2, twice vaccinated against COVID-19 with the Sputnik V vaccine. The data obtained showed that the true incidence of COVID-19 exceeds the official one. The seasonality of the disease is noted. There were no significant differences in morbidity between men and women. In the age structure of those who were ill and identified with positive IgG antibodies to nucleocapsid (NC)protein, persons aged 40 to 60 and older prevailed — 77.7 %. On a professional basis, the largest proportion of those who were ill and identified with positive results was noted among the middle and junior medical personnel — 50.7 % and 31.6 %, respectively. A laboratory study of the employees’ blood serums showed that IgG to RBD Spike SARS-CoV-2 over 300 IU/ml was detected only in 11.6. At the same time, 88.9 % of them have hybrid immunity formed after vaccination and illness.

Hospital readmissions in the group of users on the Flexible Assertive Community Treatment – experiences from RECOVER E Montenegro samples

IntroductionAs a part of Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro in 2018. The initial step involved a thorough situation analysis of the setting and circumstances of treatment of users with severe mental health illnesses, followed by the establishment of the community mental health team (CMHT) within the Special Psychiatric Hospital Kotor. The CMHT became responsible for the treatment of a group of clients with severe mental health illnesses, based on the principles of „Flexible Assertive Community Treatment (FACT – A Dutch model).ObjectivesThe main objective of this research was to establish whether there were substantial differences regarding the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro.MethodsWithin the RECOVER-E project, a sample of 202 patients, users of mental health services, were recruited in Montenegro. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued. To estimate and follow-up the frequency of hospital readmissions, medical documentation was used.ResultsPatients in the intervention group had less hospital days during the 18 months follow-up period. However, the differences between two groups regarding number of readmissions, and total length of hospital days were not statistically significant measured by independent T test.ConclusionsThis study showed that CMHT care could reduce the total length of hospital days during the treatment of psychotic disorders even dough during the COVID 19 pandemic and lock down measuresDisclosureNo significant relationships.

Coercion rates in different mental health care models: Experiences from RECOVER-E project samples in Montenegro

In 2018, RECOVER-E project activities were initiated in Montenegro, within the Horizon 2020 program. After conducting a thorough situation analysis of the setting and circumstances of treatment of patients with severe mental illnesses, the community mental health team (CMHT) within the Special Psychiatric Hospital Kotor was established. This team became responsible for the management of treatment of a group of users with severe mental health illnesses, based on the principles of "Flexible Assertive Community Treatment (FACT - A Dutch model). The main objective of this research was to establish whether there were substantial differences regarding the use of coercive measures during the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro. Materials and methods: A sample of 202 users of mental health services from Kotor and surrounding municipalities were recruited. Patients were randomized into two similar-sized groups - the intervention group, whose treatment was managed by the multidisciplinary CMHT, and the control group where treatment, as usual, was continued. To estimate and follow up the frequency of application of coercive measures, hospital documentation was used. Mac Arthur Admission Experience Survey has been used after completion of the study to explore the individual levels of perceived coercion during hospital readmissions. Results: Patients in the intervention group had statistically significant less coercive intervention (such are mechanical restraining and forced medication) during the study. There were no other significant differences between the two groups regarding the total number of readmissions, and the length of hospital treatment. Conclusion: This study showed that CMHT care could reduce some of the coercive measures during the treatment of severe mental illnesses, which can lead to the increased perceived quality of care and better treatment adherence.

Changing patterns and influencing factors of involuntary admissions following the implementation of China\u2019s mental health law: A 4-year longitudinal investigation

Involuntary admission (IA) is limited to particular situations in mental health laws to protect patients from unnecessary coercion. China’s first national mental health law has been in effect since 2013; however, the status of IA has not been sufficiently explored. To explore the changing patterns of IA since the clinical application of the IA criteria specified in the new law, an investigation of IA status was undertaken in 14 periods (each period lasting for one month from 05/2013 to 05/2017) in the tertiary specialized psychiatric hospital in Shanghai. The socio-demographic and clinical characteristics of 3733 patients were collected. The differences among IA rates in different periods were compared, and the characteristics of patients who were and were not involuntarily admitted were analysed. Multiple logistic regression analysis was used to clarify the independent variables of IA. The IA rate dramatically decreased after the implementation of the new law, while the overall trend gradually increased. The implementation of the IA risk criteria is effective, but IA is still common in China. The medical factors influencing IA following the implementation of the new law are similar to those in previous studies at home and abroad. Non-medical factors might be the main causes of the high IA rates in Chinese psychiatric institutions.

Risk factors that influence suicidal behavior in affective disorders

It is known in the literature that the incidence and prevalence of suicide and attempted suicide in psychiatric patients is significantly higher than in the general population. The paper examined risk factors for suicidal behavior in the category of admitted patients hospitalized with the diagnosis of sleep disorders and affective (Unipolar resp. Bipolar depression). Study activated by 80 patients, 40 in both diagnostic groups received treatment at the Special Psychiatric Hospital in Gornja Toponica near Nis. The work methodology used are: psychiatric interview, Hamilton Depression Rating Scale (HAMD), and the C-SSRS (Columbia-Suicide Severity Rating Scale)- assessment tool that assesses suicidal ideation and behavior. The study results show that there is a relationship between suicidal behavior (suicide attempts and suicidal ideation) and the diagnosis of bipolar affective disorder, positive history of previous suicide attempts, so that these factors are stronger, to the degree of suicidality higher. On this sample, clearly suicidal behavior, with the same purpose, intensity of suicidal thoughts and medical impairment after suicide attempts were significantly more frequent in patients with Bipolar Affective Disorder in the depressive phase of the illness. Patients with a previous suicide attempt, and poor personal and social circumstances had a higher rate of attempted suicide.

Brief Report: Understanding Crisis Behaviors in Hospitalized Psychiatric Patients with Autism Spectrum Disorder—Iceberg Assessment Interview

Children and adolescents with autism spectrum disorder (ASD) are at risk for emotional dysregulation and behavior problems that can escalate to levels requiring psychiatric hospitalization. Evaluating the etiology of such behaviors can be challenging for health care providers, as individuals with ASD can have difficulty self-reporting concerns. This brief report introduces the Iceberg Assessment Interview (IAI), a tool to organize and elucidate the assessment of issues potentially underlying problem behaviors. A summary of IAIs from a chart review of patients ages 5-18 with ASD (n = 23) admitted to a specialized psychiatric hospital unit illustrates the clinical utility of this tool. Summarized IAI data includes presenting crisis behaviors, caregiver-perceived environmental conditions, and underlying psychosocial and medical problems.

Historical facts about the Special psychiatric hospital 'Gornja Toponica' Nis, Serbia

The sale and the purchase of a large estate in the area of the village of GornjaToponica near Nis, was officially closed on the 9th of September 1911, providing the area on which today's Psychiatric Hospital was built. The land on which the hospital was constructed is known according to historical records and it was known as the 'King Milan's Estate'. It was the property of his ex-wife Natalija, who was divorced and banished from Serbia, the same lady who donated her spacious estate in Serbia to the University of Belgrade. The hospital started working in 1927. On that day 160 patients were transported from the Hospital for Mental Diseases in Belgrade to the railway station near Toponica. According to available data, in 1929, 320 patients were hospitalised in the hospital whose total number of beds was 160. Four doctors and 40 workers looked after and provided treatment to these number of patients. The number of applications for treatment kept increasing, so that in 1935 there were 492 patients, and in 1940 as many as 604 patients. The state hospital continued working also during World War II under very difficult, demanding and highly risky conditions for the patients, and in particular for the staff and management. The number of patients was increasing after building new pavilons in 1960. In 1970 the number of hospitalised patients was between 1200-1500. The current capacity of the hospital is 800 beds, the hospital has recruited 48 doctors (18 neuropsyhiatrists, 22 psychiatrics), 155 nurses, 41 senior nurses, 5 social workers and 9 psychologists. It should be noticed that the hospital are now actively involved in the implementation deinstituionalization and reorganization of psychiatry. As the first institution in the region, it has started and successfully implemented a pilot project of establishing the first Center for Mental Health in the community. There has also been significant progress in reducing the number of hospitalized patients with the trend of shortening the length of hospitalization and directing special attention to out-hospital treatment. It is planned to follow up the de-institutionalization and de-stigmatization psychiatric patients. The new management of hospital is moving into the new millennium according to the tradition based as far back in 1927. As the Hippocrates said 'Recovery takes time, but the right conditions.'.

History of special hospital for psychiatric disorders 'Kovin' Kovin

Psychiatric hospital 'Kovin' Kovin was founded in 1924 and present one of the oldest established institution among hospitals and asylums, as they were called and considered in the past. Actually, in Republic Serbia, we have five special psychiatric hospitals, and after Clinic for Psychiatric 'Dr Laza Lazarevic' and Special Hospital 'Gornja Toponica' near Nis, Special Hospital for Psychiatric Disorder 'Kovin' started to work, as third founded. It is obvious that there was a need of inpatient facilities for accommodation, treatment and custody of mentally ill in the Kingdom of Yugoslavia. Actuality of necessary changes in the management and treatment of psychiatric patients and their overall trend of destigmatization is reflected in the reduction capacity of psychiatric institutions through the process of deinstitutionalization. The ultimate aim of this trend is final abolition of large capacity of psychiatric hospitals. Under this circumstances, the 90 years existence of Kovin hospital contributes to better understanding of one important historical process of theory and practice in the psychiatry environment. Special Hospital for Psychiatric Disorder 'Kovin' in Kovin, last 90 years of its existence presents part of Country healthcare system and substantially participates in the management of the most difficult psychiatric patients in Serbia. Decrepitude institutions partially reduces the human effort to approach and use of the most modern approaches to the treatment of persons with mental disabilities successfully heal and return to the community. Through continuing education institution and professional staff continues to follow the latest trends and developments in psychiatry. First of all it is full implementation The Law on the Protection of Persons with Mental Illness, inclusion and cooperation with all relevant participants in the process of deinstitutionalization.

Exploring the impact of common assessment instrumentation on communication and collaboration in inpatient and community-based mental health settings: a focus group study.

BackgroundRecognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade. However, actually bringing fully integrated services to life has eluded most health care organizations. Mental health has followed the rule, rather than the exception, when it comes integrating services. The lack of effective mechanisms to evaluate the needs of persons across mental health care services has been an important barrier to communication between professionals involved in care. This study sought to understand communication among inpatient and community-based mental health staff during transfers of care, before and after implementation of compatible assessment instrumentation.MethodsTwo focus groups were held with staff from inpatient (n = 10) and community (n = 10) settings in an urban, specialized psychiatric hospital in Ontario (Canada) – prior to and one year after implementation of compatible instrumentation in the community program. Transcripts were coded and aggregated into themes.ResultsVery different views of current communication patterns during transfers of care emerged. Inpatient mental health staff described a predictable, well-known process, whereas community-based staff emphasized unpredictability. Staff also discussed issues related to trust and the circle of care. All agreed that compatible assessments in inpatient and community mental health settings would facilitate communication through use of a common assessment language. However, no change in communication patterns was reported one year post implementation of compatible instrumentation.ConclusionsThough all participants agreed on the potential for compatible instrumentation to improve communication during transfers of care, this cannot happen overnight. A number of issues related to trust, evidence-based practice, and organizational factors act as barriers to communication. In particular, staff noted the need for the results of comprehensive mental health assessments to be transformed into meaningful, user-friendly clinical summaries to facilitate uptake of assessment information, and consequently use of a common assessment language across mental health settings.

Comment on Lara Rzesnitzek (2013) “Early Psychosis” as a mirror of biologist controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry

Comment on Lara Rzesnitzek (2013) “Early Psychosis” as a mirror of biologist controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry

P02-39 - Admissions of Roma people in psychiatric hospital in Gornja Toponica

The Roma people are an ethnic group with origins in South Asia (India). When the Roma people arrived in Europe, curiosity was soon followed by hostility and xenophobia. They were subject to ethnic cleansing, forced labor, assimilation schemes and restrictions of cultural freedom. Many Roma faced discrimination and prejudice from both private groups and national Governments. In this poster socio epidemiological characteristics of patients admitted in Special Psychiatric Hospital in Gornja Toponica in the period between 1995. and 2008. have been observed. Patients with serious psychiatric conditions from southern and eastern Serbia (approximately 2,5 million people) are admitted in this hospital. Percentage of Roma people in this area is about 1,96% (by the census from 2002.). Majority of the population are Serbs, but there are other national minorities (Albanians, Bulgarians, Romanians, Bosnians.). Between 1995. and 2008. 19961 patients have been admitted to the hospital. From these 19961, 578 were Roma, which make 2,89% of admissions. Most of the Roma are admitted with diagnose of Schizophrenia and other similar disorders (F20- F29)- 42,01%, while in the second place come disorders caused by the usage of psychoactive substances (F10- F19)- 33,7%. Like with other nationalities admissions of men (68,51%) are more common then admissions of women (31,49%). Percentage of unemployed Roma people, and Roma without any income is much higher (74,55%) than of other nationalities (25,29%). There are also differences in marriage status. Most of the treated Roma were married (47,41%) while most of the other patients were not married (44,41%).

P02-236 - The determined reasons for involuntary hospital treatment

The involuntary hospital treatment is presented as one of the most current problem in psychiatry at all, but not enough explored problem in Serbia. In spite of the fact that it has come to important contemporary of psychiatric service, however the number of involuntary hospitalized patients is still on high level - in some countries above 80% in relations to totally number of hospitalized patients. A primary aim of this study was to adjust comparative analysis of determined reasons for voluntary or involuntary hospital treatment of mental ill persons. This study involved 1274 patients which were hospitalized in Special Psychiatric Hospital nearby Nish, during the period of one calendar year. There were 435 voluntary hospitalized patients (34,1 %) and 839 involuntary hospitalized patients (65,9 %). The most often determined reasons for involuntary hospitalizations were: delusions, hallucinations and aggressive behavior.

Characteristics of morbidity and criminality of patients treated at Center of Forensic Psychiatry, Special Psychiatric Hospital Gornja Toponica 2003-2005

Characteristics of morbidity and criminality of patients treated at Center of Forensic Psychiatry, Special Psychiatric Hospital Gornja Toponica 2003-2005

MALINGERING AND ILLNESS DECEPTION

MALINGERING AND ILLNESS DECEPTION Edited by Peter Halligan, Christopher Bass and David Oakley 2003. Oxford: Oxford University Press Price £35.00 (paperback). ISBN 0–19–851554–5 In a recent television drama, a defendant charged with killing a mother and her two children while driving was compelled to appear in court against the wishes of his counsel. He was mute and unresponsive throughout the preliminary proceedings to determine his fitness to plead, but was finally provoked into ‘normal’ response mode following a recommendation that he should be detained in a special psychiatric hospital ‘at Her Majesty’s pleasure’. The presiding judge had an instinct from the outset that this was malingering (even without seeing the individual concerned)—and was correct. Luckily, few in the medical profession have to make this sort of decision—witnesses to the fact and expert witnesses, yes, but the buck stops with the legal process. Indeed, we are repeatedly reminded in this book that malingering is not a disease or a valid diagnosis (in contrast to deliberate self‐harm) and that its unmasking is a task for the legal process rather than the medical one. Why, therefore, should neurologists, psychiatrists and clinical psychologists be interested in this topic? Well, they are often (with others) the last port of call for patients with medically unexplained symptoms, with subconsciously driven symptoms and signs (hysteria) or with ‘the intentional production of false or exaggerated symptoms motivated by external incentives’ (to use one of the many related definitions of malingering in the book). In the role of investigating and caring for an individual with symptoms and signs, the clinician …

Roll up! Roll up!

Vladimir Bukovsky was first arrested in 1963 for the possession of anti-Soviet literature and interned in a special psychiatric hospital for 14 months. In 1965, he was rearrested for co-organising a Moscow human rights demonstration in defence of writers Andrei Sinyavsky and Yulii Daniel, and sent to a series of mental hospitals. Released in 1966, he was detained again in 1967 for organising a demonstration and sentenced to three years in a labour camp. His fourth arrest in 1971 led to a further seven years in prison and five years' exile. In December 1976, Bukovsky was released in exchange for the Chilean prisoner Louis Karvallan. He was interviewed by Irena Maryniak

Comparison of hcr-20 scores in violent mentally disordered men and women: Gender differences and similarities

Retrospective risk assessments based on the HCR-20 violence risk assessment scheme were performed on 63 female patients and 85 male patients at two special forensic psychiatric hospitals. The aim was to compare risk factors for violence in mentally disordered women with their male counterparts, and to study to what extent the HCR-20, which is mainly based on research on men, can be used in a female forensic psychiatric population. The results show that the HCR-20 displays very similar risk factors for violence in women as in men, but the nature of violence is somewhat different between the sexes. Implications of the findings are discussed.