Specialized Treatment Unit Research Articles

Utilization of a Specialized Outpatient Service for Parents with Mental Disorders

Patients with mental disorders have a high need for support during the peripartum period. Only few outpatient services have specialized on parents with mental disorders. This study assesses a newly established outpatient unit. We analyzed the population utilizing the outpatient service for parents with psychiatric disorders (N=279) at the psychiatric university hospital of Charité at St. Hedwig-hospital in Berlin, Germany, from June 2017 until December 2021. The service was mainly utilized by individuals with affective disorders, a higher education and good compliance. Patients with migration background started psychotherapy less often. The data indicate a good acceptance of a specialized outpatient unit for parents with psychiatric disorders; however, it was mainly utilized by individuals with a higher socioeconomic status and less commonly by individuals with severe mental illness. More specialized treatment units for parents would be desirable.

Developing "MinDag" - an app to capture symptom variation and illness mechanisms in bipolar disorder.

IntroductionThe illness course of bipolar disorder (BD) is highly heterogeneous with substantial variation between individuals with the same BD subtype and within individuals over time. This heterogeneity is not well-delineated and hampers the development of more targeted treatment. Furthermore, although lifestyle-related behaviors are believed to play a role in the illness course, such mechanisms are poorly understood. To address some of these knowledge gaps, we aimed to develop an app for collection of multi-dimensional longitudinal data on BD-relevant symptoms and lifestyle-related behaviors.MethodsAn app named MinDag was developed at the Norwegian Center for Mental Disorders Research in Oslo, Norway. The app was designed to tap into selected areas: mood, sleep, functioning/activities (social, occupational, physical exercise, leisure), substance use, emotional reactivity, and psychotic experiences. Ethical, security and usability issues were highly prioritized throughout the development and for the final app solution. We conducted beta- and pilot testing to eliminate technical problems and enhance usability and acceptability.ResultsThe final version of MinDag comprises six modules; three which are presented for the user once daily (the Sleep module in the morning and the Mood and Functoning/Activities modules in the evening) and three which are presented once weekly (Substance Use, Emotional Reactivity, and Psychotic Experiences modules). In general, MinDag was well received in both in the beta-testing and the pilot study, and the participants provided valuable feedback that was taken into account in the final development. MinDag is now in use as part of the research protocol at the NORMENT center and in a specialized treatment unit for BD at Oslo University Hospital in Norway.DiscussionWe believe that MinDag will generate unique longitudinal data well suited for capturing the heterogeneity of BD and clarifying important unresolved issues such as how life-style related behavior may influence BD symptoms. Also, the experiences and knowledge derived from the development of MinDag may contribute to improving the security, acceptability, and benefit of digital tools in mental health.

The experience of healthcare professionals treating adolescents with eating disorders in psychiatric and pediatric inpatient units for adolescents: A qualitative study

ObjectivesThe recommended treatment for Eating Disorders (EDs) is multidisciplinary and multimodal. Nonetheless, the complex linkage of the different disciplines involved is not necessarily simple. We analyzed the experience of healthcare professionals faced with psychiatric and psychological symptoms in adolescents with EDs in two “multidisciplinary” inpatient units embedded predominantly in different paradigms — one pediatric and one psychiatric. MethodsQualitative analysis of 20 healthcare staff members’ interviews from different professional backgrounds working in inpatient units for EDs in Montreal (Canada) and Paris (France). ResultsThe “Complex patients” theme discusses the need for a global approach to the multiplicity of symptoms presented by these patients. “Management and its limits” describes the daily management of psychiatric symptoms in both units. “Psychiatry and Adolescent medicine: from opposition to collaboration” describes the different levels at which these disciplines work together and how this cooperation may be evolving. ConclusionsThe complex entanglement intrinsic in EDs of the patients’ somatic, psychosocial, psychiatric, and adolescent problems requires collaboration between disciplines, but the modalities of this collaboration are multiple and evolve non-linearly in specialized treatment units. A multilevel approach must be offered, with the degree of collaboration (multidisciplinary, interdisciplinary and transdisciplinary) appropriate to the complexity of each adolescent's issues.

Experiences when implementing enhanced cognitive behavioral therapy as a standard treatment for anorexia nervosa in outpatients at a public specialized eating-disorder treatment unit

BackgroundEnhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area.MethodsThis study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment.ResultsA high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered.ConclusionsPatients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate.Trial registration ClinicalTrials.gov. Identifier: NCT02745067. Registered: April 20, 2016. https://clinicaltrials.gov/ct2/showNCT02745067

CME: Traumatized Refugees in Family Practice - A Quick Reference Guide

CME: Traumatized Refugees in Family Practice - A Quick Reference Guide Abstract. Traumatic experiences, flight and life in exile do not constitute an illness per se, but are associated with an increased risk of mental illness. In view of the lack of specialized treatment units, the general practitioner's office often remains the only place of treatment for traumatized refugees. Particularly challenging is the combination of complex complaints, multidimensional psychosocial stress factors and difficult treatment conditions which face managerial and organizational limitations in the dense daily practice routine. In this article, recommendations for working with this heterogeneous group of patients are discussed.

CME/Answers: Traumatized Refugees in Family Practice - A Quick Reference Guide

CME/Answers: Traumatized Refugees in Family Practice - A Quick Reference Guide Abstract. Traumatic experiences, flight and life in exile do not constitute an illness per se, but are associated with an increased risk of mental illness. In view of the lack of specialized treatment units, the general practitioner's office often remains the only place of treatment for traumatized refugees. Particularly challenging is the combination of complex complaints, multidimensional psychosocial stress factors and difficult treatment conditions which face managerial and organizational limitations in the dense daily practice routine. In this article, recommendations for working with this heterogeneous group of patients are discussed.

Factors associated with diagnostic delay in children with Wilms’ tumor

Background: In Wilms’ tumor, the time elapsed between clinical diagnosis and the start of treatment is clearly associated with morbidity and mortality. As treatment delay can influence patient survival, identification of possible causes can mitigate the consequences arising from prolonged diagnostic uncertainty. Objective: To ascertain whether an initial diagnosis of Wilms’ tumor in the emergency department influences patient prognosis depending on the type of referral for definitive treatment. Patients and methods: Retrospective chart review of 98 children receiving treatment for Wilms’ tumor at the Brazilian National Cancer Institute (INCA) between April 2003 and December 2016. Patients were categorized into two groups: those referred directly from an emergency public department to INCA and those first transferred to another hospital before being referred to INCA. Results: Of the 98 cases included in the study, 42.9% were direct referrals and 57.1% were indirect referrals. Presence of an abdominal mass was the most common presenting complaint, followed by abdominal pain. In cases with larger tumors, the mean tumor volume was greater than reported elsewhere in the literature, suggesting longer disease duration. Significantly higher tumor volumes were observed in patients with a palpable abdominal mass as compared to those with the second most frequent complaint (abdominal pain). Conclusion: The findings of this study support the hypothesis that patients diagnosed with kidney masses in the emergency department are at greater risk of delayed diagnosis when they are referred first to a non-specialized outside hospital than when referred directly to a specialized cancer treatment unit.

No Apparent Increase in Treatment Uptake for Gambling Disorder during Ten Months of the COVID-19 Pandemic-Analysis of a Regional Specialized Treatment Unit in Sweden.

The COVID-19 pandemic and its impact on society has been suspected to affect gambling behaviors. Potentially, the pandemic crisis may result in increased problem gambling, for example, due to COVID-19-related psychological distress, unemployment, and financial difficulties. In addition, the cancellation of sports in early parts of the crisis has been suspected to alter gambling behaviors. Policy makers have called for action and, in some cases, have changed regulations, and media have reported possible increases in treatment seeking. However, research data are hitherto lacking. The present study assessed the treatment uptake at a regional specialized gambling-disorder unit in the healthcare system of Region Skåne, Sweden. Number of patients, treatment contacts, and patterns of rescheduling or cancellations of appointments were quantified for each month, January–December 2020, and compared to corresponding months of 2018 and 2019. Possible trends were analyzed, using an interrupted time-series analysis. Results did not indicate an increase in treatment uptake for gambling disorder during the months of COVID-19 impact in Sweden. The proportion of digital treatment increased, but total treatment uptake was unaffected by the pandemic. In conclusion, during the first ten months of the pandemic in Sweden, no obvious increase in treatment uptake for gambling disorder could be seen. Moreover, longer follow-up may be necessary in order to see if effects of worsening socioeconomic conditions may be a possible long-term risk factor of increased gambling after COVID-19.

A descriptive retrospective hospital based review of chest x ray findings of Sri Lankan Covid 19 patients in a single centre (National Institute of Infectious Disease) in Sri Lanka

COVID-19 ravaging through the world and third world countries with limited resources envisages a cost effective and feasible imaging and prognostication score. We aim to develop a prognostication score based on the first chest X-ray to assess deterioration and need to transfer to specialized treatment units should the wave of COVID – 19 surge to higher levels. A retrospective study reviewing chest X rays and case notes were analyzed by two radiologists and in case of disagreement a third radiologist was consulted. The lung changes were classified using Fleischner Society Glossary of Terms for Thoracic Imaging. Each lung was divided into 4 zones and a score of 1 given to each affected zone. The total score was used to prognosticate. Of the 146 patients there was a male preponderance. In 26.7%, the initial chest X-rays were abnormal. The peripheral, lower zone and bilateral involvement was more common. The scores of the initial chest X-ray correlated with the severity of the disease. With a sensitivity of 31.6%, chest X-ray is a poor screening investigation but with a specificity of 96.2% it can be used to prognosticate the outcome and monitor the progression of the disease.

Preparedness Tested: Severe Cerebral Malaria Presenting as a High-Risk Person Under Investigation for Ebola Virus Disease at a US Hospital.

In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a "wet" person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.

Clinical Outcomes of Specialized Treatment Units for Patients With Serious Mental Illness in the New York City Jail System.

New York City's (NYC) Correctional Health Services has introduced specialized treatment units for patients with serious mental illness in the NYC jail system. With multidisciplinary mental health staffing and a coordinated approach with NYC's Department of Correction, these units expand therapeutic options for patients vulnerable to clinical instability and physical harm, including those at high risk of psychiatric medication nonadherence and those returning to jail from psychiatric hospitalization. This study evaluated the extent to which these units improve clinical outcomes for this population. This retrospective, observational cohort study included adult males with serious mental illness with a length of jail stay of ≥14 days between January 1, 2016, and March 31, 2018. Patients on treatment units were matched with patients of similar characteristics (control group) by using propensity score matching (N=302 pairs). Rates of self-injury, injury due to violence, and psychiatric medication adherence were analyzed. Most patients on treatment units had diagnoses of schizophrenia spectrum and other psychotic disorders (81%), and most had a violent felony as their most severe charge (68%). Compared with patients in a control group, those on the treatment units had lower rates per 100 person-days of injury due to violence at 30 and 60 days (0.04, 95% confidence interval [CI]=0.02-0.07, and 0.03, 95% CI=0.02-0.06, respectively) and higher mean medication adherence (77% versus 55%, p<0.001). They also experienced lower rates of self-injury, although the difference was not statistically significant. Initial outcomes indicate substantial benefits to patients, demonstrating the value of a rehabilitative approach to psychiatric care in jail.

The influence of ligth on habitat design and feelings of the population deprived of liberty: the case of Cómbita, Boyacá

El presente artículo muestra el resultado de la investigación de un estudio de caso en la Unidad de Tratamiento Especial (UTE) de la cárcel de Cómbita, Boyacá, sector de máxima y mediana seguridad. El objetivo de la investigación fue identificar los factores lumínicos que inciden en las emociones, con el ánimo de proponer modificaciones al diseño del hábitat carcelario, como estrategia en los procesos de resocialización y resignificación de la población condenada. La etapa inicial correspondió a la formulación metodológica. Se definió la problemática, en la cual se identificó la población y el lugar. Se establecieron tres conceptos: luz, emociones y hábitat. A partir de esta información, se formularon y aplicaron técnicas e instrumentos para la recolección de datos. La información obtenida se analizó con el software NVivo 12. Durante el proceso de investigación, se utilizó el modelo desing thinking, y se hizo uso de las herramientas mapa de empatía y customer journey maps.

Effectively Assessing Treatment Needs in Incarcerated Seriously Mentally Ill Individuals: The Utility of the Personality Assessment Inventory-Level of Care Index.

Early identification of treatment needs in incarcerated individuals with serious mental illness has significant implications. Validated assessment instruments to guide treatment are lacking in correctional settings. Hierarchical linear modeling was used to examine the predictive validity of the Level of Care Index (LOCI) in 35 inmates admitted to a specialized treatment unit. The LOCI score was predictive of levels of depressogenic psychopathology and psychological well-being as well as changes in these constructs over time. These results validate the use of the LOCI in a correctional setting and demonstrate the utility of the LOCI to identify treatment trajectories.

Managing competitive municipal solid waste treatment systems: An agent-based approach

Private sector participation in municipal solid waste (MSW) management is increasingly being applied in many countries recently. However, it remains a largely unexplored issue whether different self-interested treatment operators can co-exist in an economically feasible and sustainable manner. To help the policy-maker s understand and manage competitive MSW treatment systems, this paper proposes an agent-based waste treatment model (AWTM) that consists of four types of agents, namely the refuse collector, specialized treatment unit (STU), the general treatment unit (GTU), and the regulator. An estimation-and-optimization approach is developed for profit-maximizing agents to set optimal gate fee and vie for specific waste in low-information competition. Based on the Singapore case, the experimental results imply that if the regulator deliberately promotes the STUs by intervening in waste allocation, the GTU could give up competing for the waste and greatly increase its gate fees as retaliation. Besides, driven by the increasing gate fee of the GTU, the STUs conservatively raise their gate fee; while the GTU will be the major beneficiary in the AWTM. Finally, to identify the optimal mixed policy under predefined constraints, the AWTM is integrated into a simulation-based optimization problem, which is solved by a genetic algorithm.

Comprehensive diagnosis and treatment of alveolar echinococcosis: A single-center, long-term observational study of 312 patients in Germany.

Alveolar echinococcosis (AE) is the most Iethal human helminthic infection. The malignancy-like disease is rare, but morbidity and treatment costs are high. Objective of the study was to identify factors at baseline and during specific AE therapy influencing the long-term outcome of the disease.All patients with AE seen at the specialized treatment unit in Ulm between January 1992 and December 2011 were included in the analysis.The data of 312 patients were analyzed; 108 were diagnosed before 2000 (series A), 204 since 2000 (series B); 290 received specific AE treatment. Patients of series B were more often symptom-free at diagnosis (44.1% vs. 21.3%), had lower disease stages (50.0% vs. 34.2%) and more complete resections (57.7% vs. 20.0%), but higher rates of side effects and drug toxicity (54.1% vs. 40.8%). In series B, more patients remained relapse- or progression-free after 5 years (90.5% vs. 82.8%); after 10 years, the ratio of relapses converged (70.3% vs. 66.9%, p=0.0507). Relapses or progression occurred more often after incomplete surgery or long treatment pauses. The 5-year and 10-year survival rates were 96.9% and 90.6%, respectively, and 17% of the patients were cured.We observed a shift towards early diagnosis, earlier initiation of specific therapy and more complete resections after 2000. Although diagnosis and treatment of AE pose a challenge, with an individual interdisciplinary management 88.8% of the patients have a favorable outcome.

A Qualitative Study of Incest Offender Implicit Theories with the Use of a Modified Assessment Tool

This article aims to provide an insight into the Implicit Theories (ITs) [1] harboured by Incest Offenders. This study was conducted on a sample of 27 inmates, all convicted for incest offending, from TePiriti, a Special Treatment Unit within the Auckland Prison located near Auckland, New Zealand. The sample comprised of five sub-classifications of Incest Offenders – Fathers, Brothers, Grand Fathers, Step-fathers and Uncles. The study took place in two stages. Stage one involved a questionnaire administration. The questionnaire was inspired from Multiphasic Sex Inventory-II (MSI-II). The researchers have selected 100 questions, suggestive of the Five Implicit Theories - Children as Sexual Objects, Nature of Harm, Dangerous World, Uncontrollability and Entitlement - from the MSI-II and formulated a questionnaire for the study. After the questionnaire was administered, five incest offenders, who endorsed each of the five ITs, were select on the basis of their scores, for the second stage of the study which involved an interview. These five subjects were interviewed with an aim to get a deeper understanding of their endorsements of their ITs. The questionnaire was analyzed using quantitative analysis while the interviews were analyzed using the qualitative analysis method. The results indicated that the subjects strongly endorsed implicit theories to justify their offending behaviours.

CBT group treatment for depression

AbstractThe effect of cognitive behavioural therapy (CBT) is well-documented for individual interventions for depression. Studies of group interventions for depression using CBT principles are more sparse. Hence the reason for this naturalistic study that reviews the results of a short term 12-session manualized CBT group intervention offered in an inpatient setting at the Specialized Treatment Unit for Depression and Anxiety at the Psychiatric Centre Copenhagen, Bispebjerg Hospital, over a 5-year period. The aim of the study was the treatment and relapse prevention of depressive symptoms by teaching patients cognitive behavioural therapeutic methods. The manual deviated only slightly from Melanie Fennell's treatment model. Sixty-two patients were referred and 48 participated, 45 of these had been inpatients with moderate to severe major depression admitted to the ward with a depressive episode or recurrent depressive episodes of at least 2 weeks and up to 2 years’ duration. So far the results are promising, measured by the decrease in the Beck Depression Inventory (BDI-II) score at session 12 [mean BDI-II score at baseline: 30.7 (s.d.= 9.9); post-treatment: 20.4 (s.d.= 12.6),p&lt;0.0001], relapse was measured by the rate of readmissions compared to data published in a previous register-based study on Danish patients with unipolar depression, which showed significantly lower rates of readmission in our sample (p= 0.003) and patients’ self-reported improvement, indicating that treatment in groups can be recommended, although a 12-session programme may have to be extended for people with more complex and longstanding personality impairments and recurring depression. Secondary gains not originally intended, but pointed out in patient feedback, were the strengthening of social skills and self-esteem.

Investigation of a new treatment outcome index for tuberculosis

To investigate a new treatment outcome index that may be useful in the Japanese tuberculosis surveillance system. For sputum smear-positive primary tuberculosis patients, we estimated (a) treatment completion rates at the end of the next year of registration, and (b) treatment completion rates within 1 year from starting treatment in cases in which ≥ 1 year of treatment are indicated. For (a), we estimated treatment completion rates for newly registered cases during 2009 in the Japanese tuberculosis surveillance system, specifically at Fukujuji Hospital, which has a highly specialized tuberculosis treatment unit. For (b), we estimated the above-mentioned cases as well as those of "A" Public Health Center. (a): The treatment completion rate at the end of the next year of registration was estimated to be 88.7% for newly registered cases during 2009 in the Japanese tuberculosis surveillance system. Among 66 jurisdictions, the highest and lowest completion rates were 100% and 58.3%, respectively, with a standard deviation of 6.7%. For Fukujuji Hospital cases, the completion rate was 93.1%. (b): The treatment completion rate within 1 year from the start of treatment was estimated to be 76.4% for newly registered cases during 2009 in the Japanese tuberculosis surveillance system. Among 66 jurisdictions, the highest and lowest completion rates were 90.9% and 44.1%, respectively, with a standard deviation of 8.8%. For Fukujuji Hospital and "A" Public Health Center cases, the completion rates were 91.1% and 80.0%, respectively. As a new treatment outcome index, treatment completion rates within 1 year might be more accurate than the treatment completion rate at the end of the next year of registration.

Improving Outcomes for Teenagers and Young Adults (TYA) with Cancer

The management of TYA with cancer is characterized by biological features in comparison to children. Therefore specialized treatment units have been established within professional structures of care for this group, and a European multidisciplinary framework for the treatment of TYA with cancer was founded.Objectives are to promote interdisciplinary collaboration and provide strategic concepts to improve patient care centered to the special needs of this age group. Access to clinical trials for all TYA in the EU will be improved and research initiated, examining biology, epidemiology and health services.Special goals of the interprofessional cooperation are:Different measurements are discussed improving outcomes for TYA is proceeding at different speeds in different parts of the world. In some there are established teams, bringing together paediatric and adult specialists from many healthcare professions, reviewing and contributing to the optimal care of all TYA with cancer as part of national health policy.

New Zealand's special treatment units: the development and implementation of intensive treatment for high-risk male prisoners

In the late 1980s, New Zealand developed two highly innovative residential treatment programmes for serious offenders that blended together the strengths of structured cognitive behavioural group programmes and therapeutic community approaches. Since the mid-1990s this hybrid model – recently advocated as a fruitful direction for future offender programme development – was adopted and further refined for use in New Zealand's four high-risk special treatment units (HRSTUs). We outline the HRSTU model, noting the challenges and potential benefits of providing an intervention that integrates therapy, resocialisation and reintegration experiences for high-risk, high need, low responsivity clients: many with significant psychopathic features. On average, the majority of those referred to HRSTUs complete the programme and make small but significant amounts of change on important treatment goals. But most changes remain tentative, suggesting the importance of more supportive aftercare. Although an earlier evaluation of the first unit to open found the programme to be modestly effective in reducing recidivism, an outcome evaluation currently underway will help establish whether improvements since that time are associated with reductions in disciplinary infractions and recidivism.