Swiss Psychiatric Hospital Research Articles

Voluntary sport programs for individuals with mental health disorders: The trainer’s and participant’s view

Introduction
 There is strong evidence that physical activities are important in increasing and maintaining mental health as well as in preventing relapse after mental health disorders (Schulz et al., 2011). Physical activity is an integral part of the treatment program in psychiatric hospitals in Switzerland (CH; Brand et al., 2016). However, after discharge from the hospital in CH, there are insufficient opportunities to engage in physical activity for individuals with mental health disorders (IMHD). To close this gap, voluntary sports groups (VSG) for IMHD have been growing in Switzerland since 2016, mainly organized by the PluSport Umbrella Organization of Swiss Disabled Sports (Kiselev & Loosli, 2019). Yet, little is known about these VSG and their training settings. The perspectives of IMHD and trainers of these groups as well as the perceived barriers and facilitators for participating for IMHD have neither been assessed nor included in the design of sports programs. Therefore, two studies aimed to explore the point of view of the IMHD (first study) and the trainers of these groups (second study) on challenges, barriers, and facilitators for IMHD regarding participation in VSG for IMHD. Additionally, given the crucial role of the trainers in the training process and the importance of their interpersonal characteristics, both studies aimed to identify reasons/motivations and proper personality characteristics of the VSG trainers from the interviewees’ perspective.
 Methods
 Both studies consisted of 15 semi-structured interviews each (with participants (1st study) and with trainers (2nd study) of VSG for IMHD). The results were analyzed using thematic analysis using Nvivo (Guest et al., 2012).
 Results
 Several training facilitators and trainers’ characteristics supporting the participation of the IMHD in VSG for IMHD were named by interviewees (e.g., offer-specific, emotional, rational motives, social skills of the trainers, and ability to set boundaries). At the same time, respondents reported several barriers as possible inhibitors for the participation of IMHD in VSG for IMHD (e.g., intrapersonal, structural, offer-specific, interpersonal and socio-cultural). Within the interviews, IMHD described predominantly positive perceived outcomes from participating in VSG for IMHD. On the other side, trainers of VSG for IMHD highlighted the satisfaction of doing sports with IMHD and of the contribution to improving the physical activity habits of IMHD as the main factors for their commitment as coaches (Baumberger et al., under review; Epiney et al., 2023).
 Discussion/Conclusion
 IMHD benefit socially, physically, and psychologically from participating in VSG for IMHD. However, participation is associated with barriers that need to be minimized in the future to make participation more accessible. Furthermore, the findings suggest improving the recruitment of future trainers of VSG for IMHD by focusing on assessing the appropriate personality characteristics of trainers and their motives. Additionally, findings should be integrated into the educational materials of Swiss disabled sports systems to ensure the proper upskilling of the new and present trainers of VSG for IMHD and ensure the quality and attractiveness of these groups for the target population . Finally, a large-scale survey is necessary to validate the results among the population.
 References
 Baumberger, C., Wieber, F., Pauli, C., Loosli, D., Kleim, B., & Kiselev, N. (under review). Active bodies - Active minds? A deep dive into the voluntary sports programs for individuals with psychiatric disorders in Switzerland: Participants view. BMC Public Health.
 Brand, S., Colledge, F., Beeler, N., Pühse, U., Kalak, N., Sadeghi Bahmani, D., Mikoteit, T., Holsboer-Trachsler, E., & Gerber, M. (2016). The current state of physical activity and exercise programs in German-speaking, Swiss psychiatric hospitals: Results from a brief online survey. Neuropsychiatric Disease and Treatment, 12, 1309-1317. https://doi.org/10.2147/NDT.S107313
 Epiney, F., Wieber, F., Loosli, D., Znoj, H., & Kiselev, N. (2023). Voluntary sports programs for individuals with mental health disorders: The trainer’s view. Plos one, 18(10), Article e0290404. https://doi.org/10.1371/journal.pone.0290404
 Guest, G., MacQueen, K., & Namey, E. (2012). Applied Thematic Analysis. SAGE. https://doi.org/10.4135/9781483384436
 Kiselev, N., & Loosli, D. (2019). Kann ich mitmachen? Behinderten- und Rollstuhlsportclubs in der Schweiz und der Zugang zum Behinderten- und Rollstuhlsport [Disabled and wheelchair sports clubs in Switzerland and access to disabled and wheelchair sports]. Schweizerische Zeitschrift für Heilpädagogik, 25(5-6), 13-20.
 Schulz, K. H., Meyer, A., & Langguth, N. (2011). Körperliche Aktivität und psychische Gesundheit [Physical activity and mental health]. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 55(1), 55-65. https://doi.org/10.1007/s00103-011-1387-x

Work-related participation impairments and support needs of patients in a Swiss psychiatric university hospital.

To assess work-related participation impairments and support needs of adult patients in inpatient and day-care treatment at a Swiss psychiatric university hospital. Cross-sectional survey on a department-dependent cut-off date in May and June 2022 using a standardized structured interview. Data were available for 93 patients (response rate 59%), of which 51% (n = 47) stated that they had a job or training place. Patients in first hospitalization and with a job or training place were approached significantly more often. Regardless of age and first hospitalization, 76% of the patients expressed a need for support, of which 92% expressed interest in job coaching. A total of 54% of the patients stated that they had received support from the treatment team. From the patients' point of view, work and education were not addressed by the treatment team across the board and independently of patient characteristics. The need for support was insufficiently met. There is a considerable interest for support programs through job coaching, and this offers opportunities to promote the inclusion of patients in the regular labor market.

Persistent High Smoking Prevalence in a Swiss Psychiatric Hospital between 2001 and 2020 despite Smoking Bans and Perspectives for Further Necessary Interventions

Persistent High Smoking Prevalence in a Swiss Psychiatric Hospital between 2001 and 2020 despite Smoking Bans and Perspectives for Further Necessary Interventions

Work-schedule management in psychiatric hospitals and its associations with nurses' emotional exhaustion and intention to leave: A cross-sectional multicenter study

BackgroundManaging nurses' work schedules in hospitals is challenging because employer needs, like shift changes at short notice and overtime, may conflict with nurses' desires for a predictable and stable schedule. Nurses should have a certain degree of control over their work schedules, and their supervisors should support their needs in scheduling. How perceived control over work schedules, perceived support from supervisors in scheduling, shift changes at short notice, and overtime affect nurses' emotional exhaustion and intentions to leave has not been studied. ObjectivesThe aims are (1) to describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses in psychiatric hospitals; (2) to assess the variation of these four factors between units at psychiatric hospitals; and (3) to investigate the association between these factors with nurses' emotional exhaustion and intentions to leave. DesignCross-sectional survey study. Setting(s)Swiss psychiatric hospitals with 24-hour services. ParticipantsRegistered nurses (N = 994) from 114 adult-inpatient units. MethodsTo describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses, we calculated frequencies, percentages, means, and standard deviations of their responses to the survey. To assess the variation between units, we computed intraclass correlations for the four factors. We constructed random-effects models accounting for the clustering of nurses in units for emotional exhaustion and intentions to leave separately. ResultsPerception of work-schedule control was 3.32 (SD 1.39, range 0–5); perception of supervisor work-schedule support was 3.28 (SD 1.14, range 0–4). On average, 9 % of the nurses had to take over a shift at short notice at least three times per month, and 40 % worked at least 15 minute overtime on their most recent shift. Intraclass correlation for all four factors was higher than 0.05. Emotional exhaustion was significantly associated with supervisor support and overtime, and leaving intentions were significantly associated with perceived control, supervisor support and overtime. ConclusionPerceived control, perceived supervisor support, shift changes at short notice, and overtime are promising factors for interventions to prevent nurses' emotional exhaustion and allay their intentions to leave. Unit managers should provide nurses with increased predictability and influence on their work schedules. This could reduce early career endings and early retirement and counteract nurse shortages.

The deployment of temporary nurses and its association with permanently-employed nurses' outcomes in psychiatric hospitals: a secondary analysis.

This study's objective was to investigate possible associations between the frequency of temporary nurse deployments and permanently-employed nurses' outcomes including staffing levels in Swiss psychiatric hospitals. Faced with widespread nursing shortages, some nursing managers frequently deploy temporary nurses to meet their staffing needs. While various studies have investigated the relationships between temporary nurses' deployment and permanently-employed nurse outcomes, few anywhere, and none in Switzerland, have explored such deployments' relationships with permanently-employed nurses' job satisfaction, burnout, or intent to leave their organization or profession. Furthermore, especially in psychiatric hospitals, research on temporary nurse deployments and their association with permanently-employed nurses' outcomes remains scarce. This secondary analysis is based on the MatchRN Psychiatry study, which included 79 psychiatric units and 651 nurses. Using descriptive analyses and linear mixed modeling, we assessed the frequency of temporary nurses' deployment and its association with four permanently-employed nurse outcomes: staffing levels, job satisfaction, burnout, and intention to leave their organization or profession. Roughly one-quarter of the studied units reported frequently deploying temporary nurses. Nonetheless, no differences in nurse staffing levels were found. Regarding permanently-employed nurses' outcomes, we identified slightly higher levels of intention to leave the profession (beta = 0.18; 95% CI [0.03-0.33]) and burnout (beta = 0.19; 95% CI [0.4-0.33]) on units where temporary nurses were frequently deployed. Deploying temporary nurses appears to help units maintain adequate staffing levels. However, additional research will be necessary to better understand whether working conditions are the common cause of temporary nurses' deployment and permanently-employed nurse outcomes. Until more information is available, unit managers should consider alternatives to deploying temporary nurses.

The Impact of Foehn Wind on Mental Distress among Patients in a Swiss Psychiatric Hospital.

Psychiatric patients are particularly vulnerable to strong weather stimuli, such as foehn, a hot wind that occurs in the alps. However, there is a dearth of research regarding its impact on mental health. This study investigated the impact of foehn wind among patients of a psychiatric hospital located in a foehn area in the Swiss Alps. Analysis was based on anonymized datasets obtained from routine records on admission and discharge, including the Brief Symptom Checklist (BSCL) questionnaire, as well as sociodemographic parameters (age, sex, and diagnosis). Between 2013 and 2020, a total of 10,456 admission days and 10,575 discharge days were recorded. All meteorological data were extracted from the database of the Federal Office of Meteorology and Climatology of Switzerland. We estimated the effect of foehn on the BSCL items using a distributed lag model. Significant differences were found between foehn and non-foehn admissions in obsession–compulsion, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, and general severity index (GSI) (p < 0.05). Our findings suggest that foehn wind events may negatively affect specific mental health parameters in patients. More research is needed to fully understand the impact of foehn’s events on mental health.

Referral to aftercare following inpatient withdrawal treatment and readmission: retrospective chart review of patients with substance use disorders.

Aftercare following inpatient withdrawal treatment improves the prognosis and prevents future readmissions in patients with substance use disorders. According to the stepped care approach, the setting and intensity of aftercare should be adjusted to the patients' specific needs and resources. This study evaluated the real-life referral to different types of aftercare in Switzerland and the rate of inpatient readmission within a 1-year follow-up. All substance use disorder patients admitted for inpatient withdrawal treatment in a Swiss psychiatric hospital between January and December 2016 (n = 497) were included in this retrospective study. Clinical and sociodemographic characteristics were extracted from the electronic medical records and their impact on the likelihood of being referred to a particular type of aftercare (general practitioner, psychiatric outpatient care, psychiatric day clinic, inpatient rehabilitation programme) was evaluated. For each type of referral, we determined the readmission rate within one year after discharge. In the sample of substance use disorder patients (mean age 41 years; 69% male), alcohol use disorder was by far the most frequent substance use disorder. Most patients were referred to psychiatric outpatient care (39.8%), followed by a general practitioner (31.0%), inpatient rehabilitation (19.3%) and psychiatric day clinic (9.9%). Patient characteristics that point to an unfavourable course of disease, including higher symptom severity, history of more than two previous admissions, compulsory admission and treatment discontinuation, were associated with a higher likelihood to be referred to lower-level aftercare (general practitioner, psychiatric outpatient care), whereas patients with lower symptom severity, fewer than two previous admissions, voluntary admission and regular discharge were more likely to be referred to high-intensity aftercare (psychiatric day clinic, inpatient rehabilitation). The readmission rate after one year did not differ between the different settings of aftercare (range 40.4-42.9%). The findings of this study suggest that patients suffering from severe substance use disorders and/or from an unfavourable course of disease who would benefit from a more intensive aftercare setting, such as psychiatric day clinics or inpatient rehabilitation programs, might be under-treated, whereas patients with a rather favourable prognosis might similarly benefit from a less intensive treatment setting, such as psychiatric outpatient care. Regarding the comparable readmission rates, we recommend considering more efficient resource management by promoting stepped care approaches for substance use disorders and establishing standardised placement criteria in Switzerland.

Prevention and treatment of psychiatric disorders through physical activity, exercise, and sport

Prevention and treatment of psychiatric disorders through physical activity, exercise, and sport

Analysis of the socio-demographic risk factors associated with mild, moderate, and severe dementia in the Swiss psychiatric hospital landscape

Analysis of the socio-demographic risk factors associated with mild, moderate, and severe dementia in the Swiss psychiatric hospital landscape

Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study.

BackgroundPsychiatric hospitals are becoming increasingly digitized because of the disruptive rise in technical possibilities. This digitization leads to new tasks and demands for health professionals, which can have an impact on technostress. It is unclear whether digital competence reduces technostress and how technostress affects health professionals’ mental and physical health.ObjectiveThis study aims to assess the association between digital competence and technostress, considering individual characteristics and the association between technostress and long-term consequences for health professionals.MethodsCross-sectional data from 3 Swiss psychiatric hospitals were analyzed using multiple linear regression. The dependent variables for the models were digital competence, technostress, and long-term consequences (intention to leave the organization or the profession, burnout symptoms, job satisfaction, general health status, quality of sleep, headaches, and work ability). One model was calculated for each long-term consequence. The mean scores for technostress and digital competence could range between 0 (fully disagree) and 4 (fully agree), where a high value for technostress indicated high technostress and a high value for digital competence indicated high digital competence.ResultsThe sample comprised 493 health professionals in psychiatric hospitals. They rated their technostress as moderate (mean 1.30, SD 0.55) and their digital competence as high (mean 2.89, SD 0.73). Digital competence was found to be significantly associated with technostress (β=−.20; P<.001). Among the individual characteristics, age (β=.004; P=.03) and profession were significantly associated with both digital competence and technostress. Technostress is a relevant predictor of burnout symptoms (β=10.32; P<.001), job satisfaction (β=−6.08; P<.001), intention to leave the profession (β=4.53; P=.002), organization (β=7.68; P<.001), general health status (β=−4.47; P<.001), quality of sleep (β=−5.87; P<.001), headaches (β=6.58; P<.001), and work ability (β=−1.40; P<.001).ConclusionsPhysicians and nurses who have more interaction with digital technologies rate their technostress higher and their digital competence lower than those in other professions. Health professionals with low interaction with digital technologies appear to overestimate their digital competence. With increasing digitization in psychiatric hospitals, an increase in the relevance of this topic is expected. Educational organizations and psychiatric hospitals should proactively promote the digital competence of health professionals to manage expected disruptive changes.

Matching Registered Nurse Services With Changing Care Demands in Psychiatric Hospitals: Protocol for a Multicenter Observational Study (MatchRN Psychiatry Study).

BackgroundThe quality of care is often poorly assessed in mental health settings, and accurate evaluation requires the monitoring and comparison of not only the outcomes but also the structures and processes. The resulting data allow hospital administrators to compare their patient outcome data against those reported nationally. As Swiss psychiatric hospitals are planned and coordinated at the cantonal level, they vary considerably. In addition, nursing care structures and processes, such as nurse staffing, are only reported and aggregated at the national level, whereas nurse outcomes, such as job satisfaction or intention to leave, have yet to be assessed in Swiss psychiatric hospitals. Because they lack these key figures, psychiatric hospitals’ quality of care cannot be reasonably described.ObjectiveThis study’s purpose is to describe health care quality by exploring hospital structures such as nurse staffing and the work environment; processes such as the rationing of care; nurse outcomes, including job satisfaction and work-life balance; and patients’ symptom burden.MethodsMatchRN Psychiatry is a multicenter observational study of Swiss psychiatric hospitals. The sample for this study included approximately 1300 nurses from 113 units of 13 psychiatric hospitals in Switzerland’s German-speaking region. In addition, routine patient assessment data from each participating hospital were included. The nurse survey consisted of 164 items covering three dimensions—work environment, patient safety climate, and the rationing of care. The unit-level questionnaire included 57 items, including the number of beds, number of nurses, and nurses’ education levels. Routine patient data included items such as main diagnosis, the number and duration of freedom-restrictive measures, and symptom burden at admission and discharge. Data were collected between September 2019 and June 2021. The data will be analyzed descriptively by using multilevel regression linear mixed models and generalized linear mixed models to explore associations between variables of interest.ResultsThe response rate from the nurse survey was 71.49% (1209/1691). All data are currently being checked for consistency and plausibility. The MatchRN Psychiatry study is funded by the participating psychiatric hospitals and the Swiss Psychiatric Nursing Leaders Association (Vereinigung Pflegekader Psychiatrie Schweiz).ConclusionsFor the first time, the MatchRN Psychiatry study will systematically evaluate the quality of care in psychiatric hospitals in Switzerland in terms of organizational structures, processes, and patient and nurse outcomes. The participating psychiatric hospitals will benefit from findings that are relevant to the future planning of nurse staffing. The findings of this study will contribute to improvement strategies for nurses’ work environments and patient experiences in Swiss psychiatric hospitals.International Registered Report Identifier (IRRID)DERR1-10.2196/26700

Prevalence and severity of verbal, physical, and sexual inpatient violence against nurses in Swiss psychiatric hospitals and associated nurse-related characteristics: Cross-sectional multicentre study.

This analysis (1) describes the prevalence and severity of psychiatric inpatient violence against nurses in Switzerland’s German‐speaking region and (2) investigates the associations between nurse‐related characteristics (socio‐demographics; previous exposure to severe forms of psychiatric inpatient violence; attitude towards psychiatric inpatient violence) and nurses’ exposure to various types of psychiatric inpatient violence. We used cross‐sectional survey data from the MatchRN Psychiatry study sample of 1128 nurses working on 115 units across 13 psychiatric hospitals. In addition to lifetime severe assaults, nurses’ exposure to violence against property, verbal violence, verbal sexual violence, physical violence, and physical sexual violence was assessed for the 30 days prior to the survey. Descriptive statistics (frequency and percentage) were calculated for each class of violence as also for items under study. With generalized linear mixed models, odds ratios and 95% confidence intervals were calculated. Of nurse respondents, 73% reported facing verbal violence, 63% violence against property, 40% verbal sexual violence, 28% physical violence, and 14% physical sexual violence. Almost 30% had been subjected to a serious assault in their professional lifetimes. All nurse characteristics were associated with psychiatric inpatient violence against nurses, especially a history of sexual assault (OR 4.53, 95%‐CI 2.19–9.34; P = 0.00) and ≤3 years’ professional experience (OR 3.70, 95%‐CI 1.95–7.02; P = 0.00). Prevalence data suggest that widely used strategies such as aggression management courses or alarm devices cannot fully reduce patient violence against nurses in psychiatry. This situation demands proactive strategies in safety and violence prevention.

The new remuneration system TARPSY in Swiss psychiatric hospitals: effects on length of stay and readmissions?

In 2018, Switzerland introduced a nationwide case-based prospective remuneration system (TARPSY), with decreasing daily rates for reimbursement of inpatient care in mental health facilities. Initially, there were concerns that declining daily rates could result in early discharges and increased readmission rates. We compared length of stay (LOS) and readmission rates for patients in adult and geriatric psychiatry treatment at four psychiatric hospitals between 2017 (the last year with the traditional remuneration system) and 2018 (the first year with TARPSY). A total of 26,324 treatment episodes of 15,464 patients were analysed. The reduction of average LOS was not statistically significant in the first year after the implementation of TARPSY, neither in adult (mean &ndash;0.6 days, 95% confidence interval [CI] &ndash;1.6 to 0.4; p = 0.226) nor in geriatric psychiatry (mean &minus;1.6 days, 95% CI &minus;3.8 to 0.7; p = 0.178). When compared with the traditional remuneration system with fixed daily rates, the readmission risk was statistically significantly reduced by &minus;9.1% (95% CI &minus;4.9 to &minus;13.1%; p &lt;0.001) in adult psychiatry but not in geriatric psychiatry (&minus;6.8%, 95% CI &minus;19.2 to 7.4%; p = 0.329). If being evident at all, the effects of the new remuneration system TARPSY on LOS and readmission rates seem to be small. Concerns that declining daily rates in TARPSY would result in early discharges and increased readmission rates did not prove true in adult and geriatric psychiatry. &nbsp.

Coercion in substance use disorders: clinical course of compulsory admissions in a Swiss psychiatric hospital

According to the Swiss legal system, involuntary admission is one of the farthest-reaching incursions into personal autonomy. The effect of compulsory admission in treatment of substance use disorders (SUDs) on variables such as length of stay or leaving treatment before recommended discharge remains elusive. In order to elucidate these effects, we retrospectively analysed the clinical course of treatment of 608 patients who were admitted between November 2016 and October 2017 to the Department of Addictive Disorders of the canton of Aargau. Involuntarily admitted patients showed lower health and social functioning, as measured by the Health of the Nation Outcome Scales (HoNOS), compared with those with voluntary status. In involuntary admissions for SUD treatment, length of stay was significantly shorter and the proportion of patients who left treatment against recommendation was twice as high as in voluntarily admitted patients. Furthermore, if treatment was initiated on a compulsory basis, a subsequent switch to voluntary treatment status appeared to be very uncommon. We conclude that, at least in involuntary admission according to the Swiss legal system, these admissions do not lead to sustained inpatient treatment.

Outcomes and feasibility of the short transitional intervention in psychiatry in improving the transition from inpatient treatment to the community: A pilot study.

Discharge from psychiatric inpatient care is frequently described as chaotic, stressful, and emotionally charged. Following discharge, service users are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments, which could result in serious problems and lead to readmission. The short transitional intervention in psychiatry (STeP) is a bridging intervention that includes pre- and post-discharge sections. It aims to prepare patients for specific situations in the period immediately following discharge from a psychiatric hospital. We conducted a quasi-experimental pilot study to determine the feasibility of the intervention, and gain insight into the effects of the STeP. Two inpatient wards at a Swiss psychiatric hospital participated in the study, and represented the intervention and control arms. Patient recruitment and baseline assessment were performed 2weeks prior to discharge. Follow-up data were collected 1week subsequent to discharge. Questionnaires measured coping, admission and health-care usage, self-efficacy, working alliance, experience of transition, and the number of difficulties experienced following discharge. Fourteen and 15 patients completed the follow-up assessment in the control and intervention groups, respectively. The STeP did not affect primary or secondary outcomes; however, it was shown to be feasible, and patients' feedback highlighted the importance of post-discharge contact sessions. Further research is required to improve understanding of the discharge experience, identify relevant patient outcomes, and assess the effectiveness of the intervention in an adequately-powered randomized, controlled trial.

Exercise is medicine for patients with major depressive disorders: but only if the "pill" is taken!

Major depressive disorders (MDDs) are a widespread and burdensome mental illness associated with a high comorbidity with other conditions and a significantly reduced life expectancy compared to the general population. Therefore, targeted actions are needed to improve physical health in people with MDDs, in addition to ongoing efforts to enhance psychological well-being. Meanwhile, the positive effects of exercise training on the treatment of MDDs are well documented, while compelling evidence exists that exercise interventions can improve cardiorespiratory fitness in clinically meaningful ways. On the flipside, the long-term effects of exercise therapy are still not well documented, and recent studies suggest that initial improvements in MDDs dissipate if regular exercise participation is discontinued after the end of interventions. A recent survey among Swiss psychiatric hospitals further shows that all institutions provide some form of physical activity and exercise program. However, only a limited number of patients participate in these programs, mainly because participation is voluntary and no particular efforts are undertaken to engage patients with the lowest physical activity levels. We argue that more systematic efforts are needed to fully exploit the potential of physical activity and exercise programs in psychiatric care. We also emphasize that initiating and maintaining regular physical activity among psychiatric patients is a major challenge because specific dysfunctional cognitive–emotional processes might interfere with their capacity to self-regulate health-related behaviors. Specifically, we claim that behavioral skill training should be used to support patients with MDDs in overcoming barriers to initiating and maintaining physical activity. Moreover, we suggest that the assessment of physical activity and cardiorespiratory fitness should become routine in psychiatric practice.

The current state of physical activity and exercise programs in German-speaking, Swiss psychiatric hospitals: results from a brief online survey.

BackgroundPhysical activity and exercise programs (PAEPs) are an important factor in increasing and maintaining physical and mental health. This holds particularly true for patients with psychiatric disorders undergoing treatment in a psychiatric hospital. To understand whether the benefits reported in the literature are mirrored in current treatment modalities, the aim of the present study was to assess the current state of PAEPs in psychiatric hospitals in the German-speaking part of Switzerland.MethodsAll psychiatric hospitals (N=55) in the German-speaking part of Switzerland were contacted in spring 2014. Staff responsible for PAEPs were asked to complete an online questionnaire covering questions related to PAEPs such as type, frequency, staff training, treatment rationale, importance of PAEPs within the treatment strategy, and possible avenues to increase PAEPs.ResultsStaff members of 48 different psychiatric hospitals completed the survey. Hospitals provided the following therapeutic treatments: relaxation techniques (100%), sports therapy (97%), activity-related psychotherapeutic interventions (95%), physiotherapy (85%), body therapies (59%), far-east techniques (57%), and hippotherapy (22%). Frequencies ranged from once/week to five times/week. Approximately 25% of patients participated in the PAEPs. Interventions were offered irrespective of psychiatric disorders. PAEP providers wanted and needed more vocational training.ConclusionAll participating psychiatric hospitals offer a broad variety of PAEPs in their treatment curricula. However, the majority of inpatients do not participate in PAEPs. Furthermore, those who do participate cannot continue to do so following discharge. PAEP providers need specific extended vocational trainings and believe that the potential of PA should be improved.

Does clinical change always means the same? Comparison of different perspectives

IntroductionIn psychiatric practice, the assessment of change from pre- to post-treatment is a key approach for monitoring treatment effects and for the prediction of treatment outcomes. The Health of the Nation Outcome Scales (HoNOS) as a clinician-rated measure and the Brief Symptom Inventory (BSI) as a self-report measure are tools (that are) often incorporated in outcome monitoring. Their usefulness, however, has been questioned by two important issues: their psychometric properties and their lack of concordance.Aims and objectivesThe aim of the study is to evaluate the responsiveness of HoNOS and BSI as well as their interactions to predict clinical meaningful change according to the Global Clinical Impression (CGI) as quasi-gold standard for treatment outcome.MethodsA consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders was assessed with Brief Symptom Inventory (BSI) at admission and discharge. The HoNOS and the CGI were rated by the responsible clinicians at admission and discharge. Ordinal logistic regressions will be conducted using the CGI categories as ordered categorical outcome. HoNOS and BSI scores as well as their interaction terms will be used as independent variables.Results and conclusionComplete data of admission and discharge is available from approximately 600 cases. Graphical presentations will illustrate the resulting associations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Agreement between clinical judgments and subjective perceptions of clinical change

IntroductionResearch into the relationship between the subjective perception of clinical change and the objective evidence of the same is very limited. Less is known about the relationship between clinical judgments by mental health experts and the patient's perception of symptom change, in particular across different diagnostic groups.Aims and objectivesThis study aims to determine the level of concordance between the HONOS as a tool for clinical outcome monitoring and the self-reported change in psychopathology in a total sample of psychiatric patients as well as stratified by their primary diagnosis at admission.MethodsA consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders, was assessed using the Brief Symptom Inventory (BSI) at admission and at discharge. The HoNOS were rated by the responsible clinicians. Complete data of admission and discharge were available from approximately 600 cases. Reliable change index (RCI) will be calculated to determine a clinically meaningful change based on the HoNOS scores. Concordance of RCI and change in BSI scores will be explored and compared between different diagnostic groups.Results and conclusionsAccording to our preliminary results from this ongoing evaluation program, we hope to provide a step towards a deeper understanding of the interrelationship between clinical judgments and the course of subjectively experienced mental health problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Exploration of the link between clinical judgments and subjective perceptions of clinical change in patients treated for schizophrenia

IntroductionSubjective perceptions of clinical change in patients with schizophrenia are often not congruent to the objective evidence of the same, especially since a lack of insight is part of the symptomatology. However, the exploration of the relationship between clinical judgments from mental health experts and the patients’ perception of symptom change is fairly understudied.Aims and objectivesThis study aimed to investigate the performance of the Positive and Negative Syndrome Scale (PANSS) as a tool for clinical outcome monitoring in schizophrenia in concordance with the change of self-reported psychopathology assessed with the Frankfurt Complaint Questionnaire (FCQ) in patients with a schizophrenia.MethodsA consecutive sample of patients admitted to a Swiss psychiatric hospital for schizophrenia was assessed with the FCQ at admission and discharge. The PANSS was rated by the responsible clinicians at admission and discharge. Complete data of admission and discharge were available from approximately 60 cases. Reliable change index (RCI) was calculated to determine a clinically meaningful change based on the PANSS scores. Logistic regression models were conducted to explore the link between RCI levels and the change of self-reported perceptions of psychopathology.Results and xonclusionsOur study found no relationship between the change of PANSS and FCQ from admission to discharge in a sample of patients treated for schizophrenia. Therefore, our findings provide evidence for a large discrepancy between the observed clinical severity and the subjective perception of symptoms in individuals with schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.