State Hospital Setting Research Articles

Comparison of Physical Activity, Functional Capacity and Quality of Life between Older Patients with Chronic Comorbidities and Healthy Peers: A Case of the State Hospital

Aim: This study aimed to compare physical activity (PA), functional capacity (FC), and quality of life (QoL) among older patients with chronic comorbidities and their healthy peers in a state hospital setting. Material and Methods: A total of 148 older adults, divided into groups of obesity, hypertension (HT), type 2 diabetes (T2D), and healthy, with 37 participants in each group, were included. PA, FC, and QoL were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the 6-minute walk test (6MWT), and the SF-36 Quality of Life Questionnaire, respectively. The Kolmogorov-Smirnov test assessed variable distribution. Continuous variables were compared with one-way ANOVA, discrete variables with the Kruskal-Wallis test, and categorical variables with the chi-square test. Bonferroni and Mann-Whitney U tests were used for post-hoc pairwise comparisons. Results: The obesity group exhibited significantly lower PA and FC compared to all other groups (p=0.044). The QoL of the obesity group was also significantly lower than that of the HT and healthy groups (p=0.017). The HT group had significantly higher PA compared to the T2D group (p=0.046), with no significant difference between the HT and healthy groups (p=0.077). The FC in the HT group was significantly higher than in the T2D group (p=0.043) but not different from the healthy group (p=0.074). The QoL was significantly higher in the HT group compared to the T2D group (p=0.017), with no significant difference between the HT and healthy groups (p=0.803). The T2D group had significantly lower PA, FC, and QoL compared to the healthy group (p=0.040). Conclusion: PA, FC, and QoL were lowest in the obese group. Older patients with T2D also showed lower levels in these parameters compared to HT and healthy groups, though no significant differences were found between the HT and healthy peers.

Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey.

Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient's endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs. Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February11, 2019 and July24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution's perspective. There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20months, the hospital's cardiovascular surgery department saved 6,596,934 TRY (€342,302). This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey.

From the medical model to the recovery model: Psychologists engaging in advocacy and social justice action agendas in public mental health.

There is increasing recognition of the need for civil rights advocacy for people with mental illness, as basic human rights continue to be violated in mental health systems. Relatedly, an elevated call for recovery-oriented care creates new opportunities for psychologists to act as social change agents and advocates for patients in state hospital and community settings. Despite lack of specific preparation and training to take on this role, psychologists' overall training places them in a unique position to advocate in many ways. This can be for individuals in the system (patients or staff), for the discipline of psychology, as well as acting as advocates for the continued growth of recovery-oriented approaches, more socially just practices in systems of care, and by engaging in public policy transformation. Psychologists, through creating cultural change, can work to advocate for a transformation from a medical model to a recovery-oriented care model, which focuses on building meaningful lives, autonomy, and rights of the individual. We discuss the many ways in which psychologists can act as advocates in state hospitals and community settings via diverse mechanisms, including at a policy level, the challenges that they encounter, and ways to overcome these. Future directions and ways to increase the effectiveness of advocacy efforts are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examination of a social-learning program implemented in a maximum-security state hospital setting.

The present study examines the extent to which clients with serious mental illnesses (SMI) enrolled in a social-learning program (SLP) within a maximum-security state hospital were able to achieve discharge to less restrictive settings without requiring a return to maximum security. Retrospective analyses were undertaken to examine several time periods of the SLP's operation within maximum security. From 1988 to 2019, 248 clients were discharged from the SLP. Only 20 were readmitted to maximum security, primarily for violence in less restrictive facilities. The proportion of clients who were discharged from one 19-bed ward offering the SLP differed significantly from the proportion of clients who were discharged from an identical 19-bed ward offering treatment as usual within maximum security from 1988 to 1995. The rate of readmission to maximum security was also significantly lower for clients treated on the SLP than for clients treated on other long-term treatment programs within maximum security from 2010 to 2019. Violence in a less restrictive facility was the most common reason for readmission, which typically occurred more than 1 year after discharge. The results of the present study demonstrate the SLP's success in discharging clients with SMI from a maximum-security state hospital. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Improving health promotion activities in Sri Lanka state hospital setting; Effectiveness of a clinic-based intervention

Improving health promotion activities in Sri Lanka state hospital setting; Effectiveness of a clinic-based intervention

An Appreciation of Tony Kris

An Appreciation of Tony Kris James P. Frosch (bio) It didn't have to turn out this way. A young man born to the psychoanalytic manor, so to speak, could have developed into a not so young man who elevated himself above others and dedicated himself to the preservation of orthodoxy and the enhancement of his power. Instead, somehow, we have quite the opposite: a man who has lived a life of generosity, a life of personal and professional growth based on a fearless soul-searching of himself, a life of love and generativity. Love of the intellectual, love of the sensual, love of loving. The somehow of how people develop into who they are is always something of a mystery, and so it is with Tony. Somehow, he evolved into someone who embodies the Aristotelian virtue of balance. Balance between respect for tradition and appreciating the necessity for radical innovation. Balance between a healthy regard for self, and a capacity to admire and sacrifice for others. Balance between providing a place for the passions, but also for temperance and reason. In response to a question about who were Tony's major influences, he wrote the following in an email: "There were so many influences. Anna Freud and my father were my best teachers, but my mother's way with patients was probably even more influential. Semrad added a depth that I have aimed to achieve. Jocke Murray helped me understand my own narcissism, though my formulations were different from his. The work with psychotic adolescents drew my attention to ambivalence." A glance at Tony's CV reveals a broad range of experiences. Notable were training at Mass Mental Health Center in its heyday, directing a unit at the old Boston State Hospital dedicated to the treatment of psychotic adolescents, and a two-year stint doing empirical research in the department of neuroendocrinology at the Walter Reed Institute of Research while in the Army Reserves (yes, you can accurately call him Captain Kris). In addition to the influential psychoanalytic papers which we all [End Page 703] know, there were early papers that make for fascinating reading, such as one on the function of a library on an inpatient adolescent unit, and a prescient paper on combining behavior therapy with psychodynamic therapy in a State Hospital setting. Experiences are never lost, they either remain dissociated and sequestered or, as in Tony's case, become integrated into a whole that grasps complexity. It may be that Tony's experience doing laboratory research strengthened his belief that theory must never take precedence over observation. I first met Tony during my candidacy, which began in 1978. He was already a legendary and hard-to-get supervisor, and I joined the waitlist. Finally, he had time to supervise my third case (by this time we are in the early 1980s). Tony was in his early forties then and had already had a heart attack. His father had died of an MI in his fifties. Tony was about to have a coronary artery bypass surgery; I can't remember whether triple or quadruple. I think Tony never expected to live as long as he has. Though not uncaring of other people, I was an ambitious young man in a hurry. I had a bunch of potential analytic cases in my practice, and I wanted to be approved to see my third case and do unsupervised work at the same time. I needed a letter from Tony. So I had a lot of different thoughts. I was already developing a love for Tony and was worried about him. I also worried he would die on the operating table before writing the letter I needed. All of a sudden, Tony looked at me with affection and no judgment and started laughing. He said, "I'll write the letter before the operation." I don't know how he read my mind, probably through his extraordinary ability to put himself in the mind and situation of the other. But what really struck me was the non-judgmental acceptance of my self-interested thought and his genuine amusement about it, not to mention his existential courage in facing the possibility of...

Antibacterial Medicine Consumption in Private and State Sector Outpatient Settings in Colombo District, Sri Lanka

Introduction: Objective of this study was to determine the quantities and patterns of antibacterial medicine (ABM) consumption in the public and private hospital outpatient settings in Colombo District. Methods: A descriptive cross-sectional study was conducted in outpatient settings of selected State and private hospital settings between 2012 and 2013. 2009-WHO methodology was adapted to suit the Sri Lankan healthcare system. Oral systemic aggregated ABM (J01) consumption data was collected and categorized using Anatomical Therapeutic Chemical classification system. It was quantified using Defined Daily Doses (DDDs), and DDDs per 1000 outpatients per day (DID). Results were interpreted using descriptive statistics. Results: ABM consumption was 4.21DID and 3.46DID from private and State hospitals respectively. Most common ABM subgroup was penicillin in both private (1.34 DIDs) and State hospitals (2.67 DIDs) followed by macrolides (private hospital = 0.79 DIDs, State hospital = 0.36 DIDs). Five ABMs contributed to 90% drug utilization in State hospitals compared to 12 in private hospitals. Ratio of the consumption of broad spectrum penicillins: narrow spectrum penicillins, cephalosporins and macrolides were 30:1 and 04:1 in private and State hospitals respectively. Amoxicillin (60.3 %) was the predominantly consumed ABM in State hospitals compared to co-amoxiclav (22.9%) in private hospitals. Conclusion: Consumption of conventional ABM predominates in State outpatient settings whereas newer broader spectrum ABM in private hospital outpatient settings. The findings highlight the need for antimicrobial stewardship, especially in private hospital outpatient settings. Furthermore, the Ministry of Health, Nutrition and Indigenous Medicine of Sri Lanka should intervene to maintain complete ABM dispensed data of institutionalized ABM consumption surveillance in Sri Lanka.

Inception of a Peer-Run Wellness Center at a State Psychiatric Hospital.

Peer-run wellness centers provide safe places in the community for individuals with psychiatric disorders to develop personal and community supports, feel needed, and be accepted and grow. Until now, these centers have existed only in the community, not in the state hospital setting. The current article chronicles the development of what the authors believe is the first peer-run wellness center on the grounds of a state psychiatric hospital. After 8 years of operation, the center has served hundreds of visitors. In that time, centers have opened in the state's other state hospitals and contributed to peer presence in the hospitals' units and treatment malls. The benefits of peer-run wellness centers are important in the hospital setting as well as the community. Despite institutional barriers, the center was able to address the needs of hospitalized individuals while informing a more recovery-oriented inpatient culture. [Journal of Psychosocial Nursing and Mental Health Services, 56(12), 31-35.].

11.1 UNDERSTANDING MENTALIZATION-BASED TREATMENT FOR ADOLESCENTS

Mentalization-based treatment for adolescents (MBT-A), as studied in randomized controlled trials of self-harming adolescents, includes the established MBT approach developed initially for adults with BD and for families as well (mentalization-based treatment for families). This approach has been used in both inpatient and outpatient settings. This presentation will provide an understanding of the MBT-A model and its application as implemented in a children’s state hospital setting.

The new mission of forensic mental health systems: managing violence as a medical syndrome in an environment that balances treatment and safety.

The association between violence and mental illness is well-studied, yet remains highly controversial. Currently, there appears to be a trend of increasing violence in state hospital settings, including both civilly and forensically committed populations. In fact, physical aggression is the primary reason for admission to many state hospitals. Given that violence is now often both a reason for admission and a barrier to discharge, there is a case to be made for psychiatric violence to be re-conceptualized dimensionally, as a primary syndrome, not as the byproduct of one. Furthermore, treatment settings need to be enhanced to address the new types of violence exhibited in inpatient environments, and this modification needs to be geared toward balancing safety with treatment.

Characteristics of Patients With Borderline Personality Disorder in a State Psychiatric Hospital

Borderline personality disorder is common across mental health settings and associated with substantial suffering, disability, and mortality risk. However, it is often underdiagnosed and no prevalence data are available for state hospital settings. This study aims to provide a preliminary assessment of the prevalence and characteristics of borderline personality disorder (BPD) within an inpatient unit of a state psychiatric hospital. In order to improve the quality of care at a state psychiatric hospital, all patients admitted to a 40-bed unit from April 2008 to June 2009 were routinely administered a structured diagnostic interview for BPD. A total of 65 patients were screened and their charts were reviewed. Twenty patients (31%) met criteria for BPD, but only eight of them (40%) had a chart diagnosis of BPD. Compared to patients without BPD, patients with BPD were significantly more likely to be female (75%), to carry a diagnosis of major depressive disorder, and to have been admitted within the past year. Twenty-four percent of patients with a primary psychotic disorder also met criteria for BPD. BPD patients tended to have shorter lengths of stay, but they had significantly more management problems, including incidents of self-harm, episodes of restraint, and stat administrations of medications. The authors conclude that BPD can be a common but underappreciated co-occurring condition in a state psychiatric hospital. In this setting, BPD is associated with more frequent admissions and numerous management challenges, suggesting the need for comprehensive screening, coordination of care, and specialized treatment programming.

Physicians' Knowledge and Perception of Antimicrobial Resistance: A Survey in Khartoum State Hospital Settings

Physicians' Knowledge and Perception of Antimicrobial Resistance: A Survey in Khartoum State Hospital Settings

Physicians' Knowledge and Perception of Antimicrobial Resistance: A Survey in Khartoum State Hospital Settings

Aims: To assess physicians' knowledge and perception regarding antimicrobial resistance and current antibiotic practices at the three main hospitals at Khartoum State-Sudan. Study Design: A cross- sectional survey. Place and Duration of Study: Physicians from the three main Khartoum state teaching hospitals (Khartoum, Omdurman and Khartoum North) had been surveyed between October 2011 and March 2012. Methodology: A total of 350 Physicians identified from different departmental specialties were interviewed using a 40 item, self-administered questionnaire. Results: Of physicians surveyed 38.0% considered antibiotic resistance were very important in their hospitals, 41.7% nationally and 44.3% globally. The majority of respondents (47.5%) perceived the problem of antibiotic resistance as sever problem in their hospitals. Factors identified as important in producing resistance include, widespread antibiotic use (54.3%), poor access to local antibiograms (47.4%), inappropriate course duration (46.3%), and inappropriate empiric choice (44.9%).The respondents were less likely to perceive patient's demand and role of pharmaceutical companies' promotion of antibiotics as very important factors (19.1% and 18.3% respectively).The intervention considered very useful by the largest percentage of physicians was "educational programs" (45.7%) followed by "updating about local antibiotic resistance pattern" (37.4%) and "access to current antibiogram" (35.2%). Antibiotic restriction programs were regarded as less helpful. Knowledge of resistance organisms and resistance-prone antibiotics was poor. Conclusion: Although physicians were aware of the antibiotic resistance, their perceptions about its importance, its causes and potential solutions are often contradictory and variable. These contradictory perspectives present challenges that must be overcome if we are to successfully address the mounting problem of antibiotic resistance.

Comparison of Seclusion and Restraint Prevalence between Hearing Patients and Deaf or Hard of Hearing Patients in a State Hospital Setting

The present study is an effort to obtain preliminary data to assess the validity of the long-standing claim that the rate of seclusion and restraint is higher among deaf and hard of hearing individuals than among hearing individuals. This difference has been claimed repeatedly despite there being no research to support it. The sample was comprised of 22 deaf or hard of hearing individuals who had been committed to a large state hospital, all but three of whom had been discharged prior to data collection. The deaf and hard of hearing subjects were matched to subjects with no hearing loss on factors believed to be associated with behaviors that can result in seclusion or restraint. Archived clinical records of both groups of subjects were reviewed to determine the rates of seclusion and restraint for the two groups, as well as to assess the length of time each group was in seclusion or restraint. The results indicate a significantly higher frequency of seclusion and restraint for the deaf and hard of hearing group than for the hearing group. Of note is that the hearing individuals spent longer in seclusion and restraint than did the deaf and hard of hearing. The hypothesis of a higher rate of restrictive events among deaf and hard of hearing individuals is supported. The results of this study suggest that further research be undertaken to determine the generalizability of these results as well as possible sources of the differences between these two groups.

Cardiac effects of “mad honey”: a case series

Background. Grayanotoxins (GTX), also known as andromedotoxins, are produced by plants of the Ericacae family. This toxin is responsible for “mad honey” intoxication, which can present with fatal cardiac bradyarrhythmias and circulatory collapse. GTXs lead to cardiac toxicity because they increase sodium channel permeability and activate the vagus nerve. Objective. We evaluated 42 patients (33 males) prospectively who had been hospitalized with diagnosis of “mad honey” intoxication in a state hospital setting. Methods and results. The median age of patients was 48.5 years and all patients were admitted with complaints of nausea, vomiting, dizziness, fainting, and sweating. Five of the patients had syncope before admission. On admission, the mean systolic blood pressure was 73.1 ± 12.7 mmHg, the mean diastolic blood pressure was 52.1 ± 11.3mmHg, mean heart rate was 38 ± 7 bpm. On initial electrocardiograms, 18 patients had sinus bradycardia, 15 patients had complete atrioventricular block, and 9 patients had nodal rhythm. All patients were monitored in a coronary care unit and treated sympomatically with atropine, intravenous fluids, and dopamine. None of the patients needed temporary pacing and all were discharged without complications. Conclusion. “Mad honey,” which is produced widely in northern parts of Turkey can be toxic. This intoxication should be considered in patients admitted to emergency department with bradycardia and hypotension especially in regions where this honey is produced.

A Motivational Interviewing Group to Manage Cardiometabolic Risk on an Inpatient Psychiatry Unit

To the Editor: Patients with severe and persistent mental illness (SMI) have increased risk of death due to cardiovascular disease compared with the general population.1 A sedentary lifestyle is a risk factor for cardiovascular disease2 and is more prevalent in the SMI population.3 Increasing moderate aerobic activity can decrease the risk of cardiovascular events in patients known to be at high risk.4,5 Motivational interviewing has been used in combination with other modalities to increase healthy lifestyle choices among patients without mental illness,6–10 but is understudied in patients with SMI. We report the case of a patient with a favorable response to group motivational interviewing for healthy lifestyle changes in a state hospital setting. Case report. Mr A, a 31-year-old divorced man, was admitted in 2008 for his fourth psychiatric hospitalization following threats of harm to himself and also fears he would harm others. His depressive symptoms of poor sleep, self-disparagement, dysphoric mood, apathy, diminished interest in most activities, poor concentration, indecisiveness, and recurrent suicidal thoughts were present throughout this admission. Mr A's psychiatric history was significant for a hanging attempt and psychotic symptoms over the past 5 years resistant to multiple medication trials and electroconvulsive therapy. His medications at admission included metformin 1,000 mg bid, glyburide 2.5 qam and 5 mg qhs, diltiazem 180 qam, hydrochlorothiazide 25 qam, lisinopril 40 qam, fluoxetine 80 qam, quetiapine 50 tid and 200 qhs, and trazodone 50 qhs. His medical history was significant for type 2 diabetes and sleep apnea requiring continuous positive airway pressure. His weight on admission was 289 lb and his abdominal girth was 49 in. Mr A attended 12 weekly motivational interviewing–oriented group sessions for patients who had been evaluated as being at high cardiometabolic risk with a focus on behavioral changes that promote and maintain physical health. The group is led by a psychologist and a licensed recreational therapist. Each session begins with a brief goal-setting discussion, followed by a review of prior participants’ progress on their goals. New members are encouraged to reflect on changes in behavior that would have an impact on their health. Ten-point self-rating scales help members clarify the importance of the changes and their confidence in being able to make the changes. At times, cognitive-behavioral interventions are also woven into the discussions, particularly when discussing ambivalence to change and to the obstacles that can interfere with making behavioral changes. The group ends with a review of topics discussed. Mr A's participation included setting exercise and weight loss goals at each group session over 12 weeks. He has consistently accomplished his exercise goal of 20–30 minutes of moderate aerobic activity per week for the latter 9 weeks, averaging 60.3 minutes per week and ranging from 85 to 145 minutes. He has lost approximately 22.2 lb, not only as a result of exercise but also through portion control and following a diet of reduced caloric intake. Mr A has been supportive to other group members and also states he continues to find the group helpful to him in his efforts to pursue a healthier life, emotionally and physically. He has not been noted to display marked improvement or worsening of his psychiatric symptoms in this time frame. To the best of our knowledge, this is the first case report describing the successful use of motivational interviewing to increase physical activity in an inpatient with severe mental illness. Both dietary and physical activity changes resulted in the patient's losing 8% of his baseline body weight. To be feasible for inpatients, motivational interviewing must be delivered in a group setting, as it was in this case. The SMI population's high cardiometabolic risk makes group inpatient motivational interviewing an attractive modality to improve lifestyle choices in a cost-effective manner and one that bears further investigation.

A Supported Education Program in a State Psychiatric Hospital

A Supported Education Program in a State Psychiatric Hospital

Academic-State Hospital Collaboration for a Rehabilitative Model of Care

Academic-State Hospital Collaboration for a Rehabilitative Model of Care

Assessing Intimidation Using a Brief Intrusiveness Measure

Aims: Patient intrusiveness has been associated with violence in psychiatric services and perceived intrusiveness may undermine therapeutic environments even without threatened violence. We assessed whether this construct was considered useful and quantifiable in a State Hospital setting. Methods: Staff members were asked to rate their perceptions of the intrusiveness of each patient using a single Likert-type item. Results: Staff from multiple disciplines found the indicator to have face validity and to be readily scorable. Ratings among staff varied moderately as did repeated ratings. The measure showed significant, albeit modest, associations with aggressive incidents (r=0.50; p<0.01). It appeared to track positive environmental change on the unit over time. Clinical Implications: Intrusiveness warrants investigation as an independent construct. The readily administered indicator shows promise for assessing patient and staff needs.

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