State Psychiatric Hospital Research Articles

Olanzapine-Induced Hypothermia: A Case Report in an Elderly Black Male Patient Diagnosed with Bipolar 1 Type Disorder

There are few reports that describe incidence of hypothermia in patients treated with olanzapine. We report a case of an elderly 83-year-old black male, readmitted to the state psychiatric hospital December 2023 due to psychiatric exacerbation after 6 months of successful discharge to community, who experienced a fall and profound hypothermia with bradycardia that resulted in a 10-day acute hospitalization in January 2024. Medical workup was unrevealing except for multivessel disease found on CT stroke study of the brain. When patient returned to inpatient psychiatric hospital, his psychiatric medications, including both quetiapine and olanzapine, were restarted at half the dose. The next morning, the patient was again hypotensive, bradycardic and hypothermic. For this patient, only the olanzapine was new upon the most recent admission, and thus this case report supports the other few reports already published, implicating olanzapine in the pharmacologic adverse effect of drug induced hypothermia.

Social Vulnerability and Prevalence and Treatment for Mental Health and Substance Use Disorders

Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study. To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older. A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews. Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level. The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80). In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.

TAC report on state psychiatric hospital beds features consumers' voices

People seeking hospital‐level care for their mental health find it challenging to access a state hospital bed until they have been charged or convicted of a crime, suggests one of the key findings in a new report released by the Treatment Advocacy Center (TAC) and based on the personal stories of family members and an individual with lived experience in the state hospital system.

Assessing the impact of long-acting injectable compared to oral antipsychotic medications on readmission to a state psychiatric hospital.

People living with schizophrenia spectrum disorder (SSD) have a higher death rate which is caused, in part, by poorer adherence to treatment as compared to those with other mental illnesses. Using long-acting injectable antipsychotic (LAI) medications can improve medication adherence and reduce hospitalizations for people living with SSD but are often underutilized. As compared to oral antipsychotic medications provided to patients with SSD at discharge from a psychiatric hospitalization, being provided with an LAI antipsychotic medication may reduce subsequent rehospitalization. Specifically, patients discharged on an atypical or second-generation LAI medication are less likely to be readmitted to the hospital when compared to those discharged on a typical first-generation oral medication. Because LAI antipsychotic medications are often underutilized as treatment options, the study findings suggest that this modality may be considered for patients with SSD when being discharged from a psychiatric hospitalization. Ideally, psychiatric-mental health nurses can educate patients about indications, benefits, and risks of using atypical or second-generation LAI antipsychotic medications during hospitalization and at discharge prevent the risk for future rehospitalizations. INTRODUCTION: People living with schizophrenia spectrum disorder (SSD) have poorer medication adherence compared to those with other mental illnesses. Long-acting injectable antipsychotic (LAI) medication use is associated with greater adherence, reduced re-hospitalizations, and improved recovery outcomes when compared to oral formulations. To compare LAI antipsychotic medication use versus oral formulations on readmission to an inpatient hospital. Medical records (N = 707) from a state psychiatric hospital in the southern region of the United States were reviewed. Controlling for demographic variables, logistic regression analyses were used to examine LAI compared to oral formulations on readmission. Compared to patients discharged with oral antipsychotic medications, those with LAIs had a lower proportion of readmission rates in 6-month and 1-year periods, but not 30-day or 2-year periods. When controlling for demographic variables, those discharged with an atypical LAI had significantly lower odds of being readmitted within the 24-year period compared to those discharged on a typical oral antipsychotic. Compared to orals, LAIs do not increase and may mitigate readmissions to psychiatric hospitalization. Psychiatric-mental health nurses and other professionals may recommend LAIs when indicated for those with SSD.

EFFECTS OF COVID-19 ANXIETY AND COVID-19 QUALITY OF LIFE ON COVID-19 BURNOUT IN PSYCHIATRIC NURSES

Nurses are key professionals in fighting the COVID-19 pandemic and they provide services beyond expectations. Although psychiatric nurses are suffering from anxiety and burnout they need to enhance and protect their quality of life. The major aim of the study was to investigate the effects of COVID-19 anxiety on COVID-19 quality of life and COVID-19 burnout, and the impact of COVID-19 quality of life on COVID-19 burnout on psychiatric nurses. The descriptive-relational design was used. The sample consisted of 159 nurses working in a state psychiatric hospital in İstanbul, determined by convenience sampling method. The data of the study was collected by using the socio-demographic form, COVID-19 Anxiety Scale, COVID-19 Life Quality Scale, and COVID-19 Burnout Scale. Statistically significant relationships were found between COVID-19 anxiety, COVID-19 life quality, and COVID-19 burnout. The increase in the anxiety of psychiatric nurses due to COVID-19 also increases the negative effect on their quality of life. COVID-19 anxiety positively affects burnout related to COVID-19. The increase in the negative effects of COVID-19 on the life quality of nurses causes an increase in burnout levels. The effect of COVID-19 on their life quality and the burnout based on COVID-19 was investigated in the research. Nurses are surpassing traditional boundaries, providing their services without constraints to confront the challenges posed by the COVID-19 pandemic. Their dedication knows no bounds as they work tirelessly to navigate through these difficult times, transcending conventional limits to offer essential care and support. Policymakers can alleviate the increasing physical and psychosocial burden of psychiatric nurses by providing financial and moral support. Additionally, medical, psychosocial, and legal resources should be provided to psychiatric nurses.

Mental and Substance Use Disorders Prevalence Study: Background and Methods

AbstractObjectiveThe Mental and Substance Use Disorders Prevalence Study (MDPS) builds upon previous epidemiologic studies to provide estimates of prevalence and treatment rates of mental and substance use disorders among adults aged 18–65 in the U.S. The study background and methods are described.MethodThe MDPS employed novel techniques such as the inclusion of household, prison, homeless and state psychiatric hospital populations, a semi‐structured clinical interview administered by trained clinical interviewers to assess disorders, the assessment of both past year and lifetime schizophrenia spectrum disorder (SSD) using full Diagnostic and Statistical Manual 5 criteria, as well as other mental and substance use disorders, and video‐based interviewing. Population specific and combined sample weights were developed to estimate nationally representative prevalence and treatment rates.ResultsData collection was conducted between October 2020 and October 2022 resulting in 5679 clinical interviews. The statistical weighting and analytic plan are described. Weighted response rates and reasons for non‐response are provided for each study population.ConclusionsThe MDPS successfully developed and employed novel techniques to estimate the prevalence and treatment rates of mental and substance use disorders in both household and non‐household populations, including some of the most impairing disorders such as SSD.

U.S. Department of Justice Investigation of a State Psychiatric Hospital.

The Department of Justice investigation of state psychiatric hospitals is nothing like investigation by more familiar regulatory agencies such as The Joint Commission or Centers for Medicare and Medicaid Services (CMS). For one, it comes with the threat of serious legal consequences for both the state psychiatric hospital under investigation and the state in general. Although little has been written about this topic, much of what has been written describes a negative, painful, and expansive experience affecting every aspect of the hospital system. Using an example of a state psychiatric hospital that has been investigated by the DOJ, this article examines this portrayal and explores whether there are positive aspects of such investigations that have been overlooked.

Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program.

Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states.

Predicting Quality of life of Schizophrenia Patients

Background: Previous studies on sociodemographic characteristics connected to quality of life in schizophrenia discovered inconsistent results. This study aims to analyze predicting factors of quality of life (QoL) of schizophrenia patients. Methods: A quantitative study included 153 respondents who were selected using random sampling at the State Psychiatric Hospital Surakarta. The research instruments were a questionnaire containing questions about demographics consisting of age, age at first experiencing schizophrenia, gender, education level, work status, marital status, frequency of treatment, duration of suffering from schizophrenia, insight, physical health problems and quality of life by using WHOQOL-BREF. The analyses used were Spearmen's rank (rho) and the Pearson Chi-Square to analyze factors connected to QoL of schizophrenia patients and multiple logistic regression tests to analyze predictors of QoL of schizophrenia patients. This study was conducted in the State Psychiatric Hospital of Surakarta from September 2020 to March 2021. Results: There were 4 characteristics of sociodemographic that have a positive significant relationship with the overall quality of life of schizophrenia patient, namely work status (p = 0.000), marital status with p = 0.000, gender (p=0.032), and adherence to take medicine with p=0.015 (p <0.05). marital status and work status that influence the quality of life (p=0.000 and p=0.001). Marital status and work status influence the quality of life (p=0.000 and p=0.001), the largest OR value obtained is 25.499. It means that married patients have a 25.499 times chance of having a better quality of life controlled by work status. Conclusion: Marital status and work status are predictors of QoL of schizophrenia. In providing services to schizophrenic patients, health professional need to pay attention in assessing social demographics such as work status and marital status so that appropriate action can be taken with an approach to these aspects.

In Case You Haven't Heard…

For those readers who are NSDUH (National Survey on Drug Use and Health) nerds, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a new, second survey. The Mental and Substance Use Disorders Prevalence Study (MDPS) includes gaps not covered by the NSDUH: Those who do not reside in households; including homeless, institutionalized or incarcerated populations. These populations, according to SAMHSA, have disproportionately high rates of mental health and substance use disorders. Between October 2020 and October 2022, this study, conducted in partnership with the research organization, RTI International, conducted 5,679 clinical interviews among 18–65‐year‐olds, including those living in households, prisons, state psychiatric hospitals and homeless shelters. For the MDPS, released last week, click HERE.

Architectural Design Qualities of an Adolescent Psychiatric Hospital to Benefit Patients and Staff.

This study is focused on how architectural design of adolescent psychiatric hospitals could positively affect not only patients but also staff members working at the hospitals. Adolescents between the ages of 12 and 18 are among the young population with the highest percentage of mental illness. However, there are limited number of intentionally designed psychiatric hospitals for adolescents. Staff who work in adolescent psychiatric hospitals may face workplace violence. Studies on environmental impacts suggest that the built environment affects patients' well-being and safety as well as staff's satisfaction, working condition, safety, and health. However, there are very few studies that focus on adolescent psychiatric hospitals and the impact of the built environment on both staff and patients. Data were collected through literature analysis and semi-structured interviews with staff of three psychiatric state hospitals with adolescent patient units. The triangulation of multiple data sources informed a set of environmental design conditions that captures the complexity and connectedness of architectural design and the occupants of an adolescent psychiatric hospital. The results present architectural composition, atmosphere, lighting, natural environment, safety, and security as indispensable design conditions to create an enclosed and city-like campus that provides a serene, secure, and structured environment that benefit staff and adolescent patients. The specific design strategies that need to be incorporated in the architectural design of a safe and secure adolescent psychiatric hospital include an open floor plan that respects patients' autonomy and offers privacy while always providing staff with full visibility of patients.

Prevalence and Predictors of Relapse among Patients with Schizophrenia at Psychiatric Healthcare Institutions in North-Western Nigeria

Background: Nigerians with Schizophrenic disorder are experiencing multiple relapses during the course of the illness. Relapse is disabling and distressing, associated with progressive functional deterioration as well as worsening treatment response and clinical prognosis.
 Aim: Thestudy aims to assess the prevalence and predictors of relapse among patients with Schizophrenia in North-western Nigeria.
 Methods: A cross-sectional descriptive design was employed to conduct the study in Federal Neuro-Psychiatric Hospital Kaduna, Kano State Psychiatric Hospital Dawanau, and Federal Neuro-Psychiatric Hospital Kware, Sokoto States. The Population of the study constitutes all patients with schizophrenia attending the outpatient units of the Hospitals with a sample size of 464 patients a crossed the facilities. A purposive sampling technique was used in the study to recruit respondents. Self -structure Questionnaire was the instrument for data collection. Data collected were analyzed using SPSS Version 23 and presented using mean, standard deviation, frequency, and percentages. Regression analysis was used at a 0.05 level of significance to determine predictors of relapse..
 Results: Findings revealed that from the year 2018 to 2020, the prevalence of relapse among patients with schizophrenia is very high in the year 2020 with 71% relapse in Kano state, 40% relapse in Sokoto state, and 14% relapse in Kaduna state. The study shows that co-morbid illness, stressful life events, and inadequate mental health services are predictors of relapse (p<0.05).
 Conclusion: The study concludes that personal, social, and health facility factors are predictors of relapse among patients with Schizophrenia in North-west Nigeria.
 Recommendations: Emotional and social support like halfway home, assertive community therapy, self -help groups should be provided to patients with schizophrenia, as these can play a vital role in their response to the ailment thereby reducing relapse and the prevalence of the disease.

ANALYSIS OF THE PSYCHIATRIC HOSPITALIZATIONS THROUGH THE SUS IN PIAUÍ, BRAZIL, FROM 2008 TO 2020

Objective: to analyze the behavior of data referring to psychiatric hospitalizations in Piauí between 2008 and 2020. Method: an ecological study conducted with secondary data referring to psychiatric hospitalizations between 2008 and 2020 in Piauí, obtained from the Hospital Information System/DATASUS. Descriptive and linear regression analyses were performed. Results: a total of 40,608 psychiatric hospitalizations were found. The main causes were schizophrenia (17,877) and mood disorders (8,239). Mental retardation and schizophrenia presented higher costs and mean hospitalization times. A reduction in the number of hospitalization was recorded from 2009 to 2012 and there was increase between 2016 and 2019, regardless of age and gender. Hospitalizations were more frequent among adults (94.4%) and men (62.4%). Conclusion: the reduction in the number of psychiatric hospitalizations in Piauí from 2009 to 2012 coincides with the closing of the state's psychiatric hospital and with the strengthening of the Psychosocial Care Network. The data reflect previous mental health policies and allow planning health strategies.

Improving the Physical Health of Psychiatric Hospital Residents: An Evaluation of an Obesity Education Program for Mental Health Professionals.

Background: People living with mental health disorders are at increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the obesity rate is 36% in the general population and more than 50% for people living with mental health disorders. Although mental health clinicians concentrate on managing psychiatric disorders, they seldom recognize the gradual increase in body mass index of their patients. The result is a disconnection between the clinical management of psychiatric disorders and the medical management of obesity. Purpose: This study assessed the effectiveness of an evidence-based education program for improving the obesity management practices of mental health clinicians caring for residents at a state psychiatric hospital. Methods: This was a quasi-experimental study design with a pretest and posttest evaluation. Convenience sampling was used to recruit mental health professionals, or clinicians, at a large psychiatric hospital in the Southern region of the United States. Data was collected with the Advising and Treating Overweight and Obese Patient questionnaire (17 items). Data analysis included descriptive and inferential statistics. The findings were reported in accordance with the TREND and GREET guidelines. Results: The education program was completed by 50 MHCs. The pretest indicated that 76% of MHCs were not involved in helping obese residents manage their weight, but the posttest indicated 90% were involved. There was a significant increase in MHC knowledge about obesity management and reported actions 90-days after the program. MHCs were unable to arrange follow-up visits for residents, a task not directly within their control. Conclusions: Mental health clinicians reported increased knowledge and improved clinical practice after an education program. Because the outcomes were reported at 90-days after the program, further research needs to evaluate the longitudinal impact of this type of program, where the reported behaviors are correlated to process and clinical outcome measures for obesity.

Enhancing Provider Delivery of Tobacco Treatment Within the Inpatient Psychiatric Setting

ABSTRACT People with mental illnesses (MI) smoke at higher rates than the general population. However, few mental health providers (MHPs) deliver tobacco treatment to patients with MI especially within inpatient psychiatric settings. According to evidence, fewer than half of MHPs in the US mental and behavioral health settings provide the recommended evidence-based tobacco treatment interventions to their clients with MI. This paper uses the theory of planned behavior to examine factors associated with provider intentions to deliver and their experiences in providing evidence-based tobacco treatment to clients with MI. Data were obtained from a cross-sectional survey of 219 providers in a state psychiatric hospital in Kentucky. Attitudes, subjective norms, and perceived behavioral control were associated with providers’ intentions to deliver tobacco treatment when controlling for demographic and work-related variables. However, only profession, subjective norms, and attitudes were associated with reported provision of evidence-based tobacco treatment. Given the underuse of routine tobacco treatment for this vulnerable population, understanding factors influencing provider delivery of tobacco treatment is needed to guide strategies for reducing the disproportionate rates of tobacco use and related burden among people with MI.

Dialectical Behavior Therapy Skills Training With Music Therapy Interventions for Adults With Serious Mental Illness: A Quasi-Experimental Nonequivalent Control-Group Pilot Study.

Dialectical behavior therapy (DBT) improves emotion regulation by building skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The purpose of this pilot study was to compare a DBT skills group with a combined DBT skills and music therapy (MT) group on participant outcomes of attendance, participation, skill practice, and skill knowledge, as well as determine feasibility of study procedures. We used a quasi-experimental nonequivalent control-group design with all groups co-led by a psychologist and a music therapist. Clinicians facilitated twice weekly 45-min groups in 12-week cycles for a total of eight groups over 2 years. The groups alternated DBT-only and DBT+MT; participant data were analyzed for their first cycle attended. The DBT-only group followed a standard DBT skills training format, whereas the DBT+MT group included music therapy interventions as group exercises. Participants (N = 26) were adults with serious mental illness referred to the inpatient psychosocial rehabilitation group (PSR) at a state psychiatric hospital. Participants completed a demographic form, diary cards, and exit interview; clinicians recorded attendance and session participation. Participants in the DBT+MT condition had significantly higher participation levels, slightly higher average attendance, submitted more diary cards, and included more feeling statements than the DBT-only condition. Although interpretations should be approached with caution, the pilot study intervention shows promise. Overall, this study could be implemented as intended under close monitoring, with minor modifications to assist with recruitment and data collection. Modifications, clinical implications, and recommendations for future research are discussed.

Jail-Based Competency Restoration: What's Out There and What's Missing.

Forensic systems have seen an increase in the number of defendants in need of competency restoration services. Traditionally, competency restoration services have occurred at state psychiatric hospitals. Unfortunately, the waitlists for hospital competency restoration are extensive and result in many defendants waiting in jail for more than 4 months for an inpatient bed. These waitlists have led to lawsuits forcing states to provide adequate treatment and evaluation services to mentally ill adults languishing in jails. To reduce waitlists for competency restoration and to combat the extensive delays in restoration, some states have implemented jail-based restoration to reduce hospital waitlists, restoration time, and costs to complete restoration. This review article discusses pros and cons of jail-based services and provides a framework for future services and research.

Foreign medical graduates and American psychiatry.

Graduates from foreign medical schools (FMGs) began to staff US state psychiatric hospitals after World War II, and became increasingly associated with the poor quality of those institutions. Public and professional commentary on FMGs criticized their skills and suitability for the US healthcare system in the 1970s, at the same time that state hospitals were under increasing attack. By the 1980s and 1990s, the association between international medical graduates (as they became known) and underserved populations became an argument in favour of easing restrictions on these graduates. The role of foreign-trained psychiatrists in the US public sector became a way for American psychiatry leaders to manage the problems of the seriously mentally ill, first with blame and then with neglect.

Olmstead's implementation: Differences in enforcement approaches.

Olmstead v. L.C. ex rel Zimring (1999) was a landmark U.S. Supreme Court decision holding that unjustified segregation of people with disabilities is impermissible discrimination; specifically, if the clinician and client believe community integration to be appropriate, the state must have reasonable accommodations in place for the client to be in the community. Enforcement of the Olmstead decision for people with serious mental illness (SMI) has taken many shapes, from the U.S. Department of Justice's (DOJ) settlement agreements requiring substantive development of community mental health services and aggressive community integration protocols, to the Third Circuit approach which requires only lower census numbers in the state psychiatric hospital (SPH). The question of whether Olmstead is being differentially enforced is addressed in an empirical, qualitative analysis of legal documents, including court opinions and settlement agreements. Through legal research spanning all U.S. jurisdictions, five distinct Olmstead enforcement approaches in ten different states were identified. The enforcement approaches are described, and limitations and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Legally involved individuals in state hospitals and community mental health settings: Introduction to the special section.

Over the past several years, individuals with serious mental illness (SMI) have become involved with the legal system at an increasing rate. State psychiatric hospitals and community mental health programs have seen a high number of referrals and admissions at a time when resources and staffing have been challenges. Individuals with SMI continue to be highly represented among those incarcerated in jails and prisons, often for minor charges. This article serves as an introduction to a special section of Psychological Services on innovations in assessment and treatment of legally involved patients in state hospitals and community mental health settings. Data are presented on the prevalence of legal involvement among individuals with serious mental illness, including the exponential growth in individuals evaluated and found incompetent to stand trial. A brief summary of the articles in the special section is presented, broken down by themes of assessment, treatment, and policy. We hope that the studies described in this issue will lead to further exploration of problems, barriers, and potential solutions for individuals with SMI who become involved with the legal system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).