Treatment In Acute Setting Research Articles

From Dangerous to Discharged: An Application of Social-Learning-Based Procedures in an Acute Hospital Setting

Psychiatric inpatients who demonstrate persistent aggressive behavior present unique treatment planning and placement challenges. This article presents the case of a severely Veteran who demonstrated high levels of aggressive behavior as well as persistent adaptive behavior deficits. A comprehensive Treatment Recovery and Rehabilitation Plan (TRRP) based on Social-Learning Program procedures resulted in rapid improvements in recovery-related outcomes and discharge within 31 days of TRRP initiation. This intervention significantly reduced maladaptive behavior and increased treatment participation.These improvements were unrelated to pharmacotherapy changes during the hospitalization. Following discharge, a re-emergence of problematic behaviors in a community placement resulted in a more restrictive rehospitalization. The absence of TRRP implementation at this placement likely contributed to the re-emergence of problem behavior. This case illustrates the importance of implementing evidence-based psychosocial interventions in acute settings, engaging in recovery-oriented treatment planning, and maintaining continuity of care across settings.

Effectiveness and medication acceptance of olanzapine disintegrating tablets compared to standard olanzapine tablets in acutely treated psychiatric patients

This study compared effectiveness and acceptance of orally disintegrating olanzapine tablets (ODT) with standard-coated tablets (SOT) in acutely ill psychiatric patients admitted to psychiatric hospitals for emergency treatment. Large, prospective, observational study at hospital emergency units across Germany in patients with a diagnosis or tentative diagnosis of acute schizophrenia treated with ODT or SOT. Clinical (CGI-S and CGI-I) outcomes, attitudes towards medication (Nursing Assessment of Medication Acceptance, NAMA) scale, suicidal ideation, and adverse events were assessed at start of treatment and after 2 weeks. Both olanzapine formulations, ODT (N = 247) and SOT (N = 207), showed similar effectiveness after 2 weeks. CGI-I improved in 92.1% of patients (ODT: 91.8%, SOT: 92.3%). In patients receiving both formulations suicidal ideations were reduced (ODT from 53.9% to 20.6%, SOT from 51.2% to 22.7%). ODT was preferably given to severely ill (SOT: 49.8%, ODT: 64.4%) and aggressive patients. Adverse events were reported for 6.5% of ODT- and 2.9% of SOT-patients. This difference was possibly caused by the characteristics of patients receiving ODT. This non-randomized, observational study shows comparable outcomes and tolerability in patients treated with both olanzapine formulations. In an acute treatment setting, orally disintegrating tablets were preferably used for more severely ill and aggressive patients with low medication acceptance.

The impact of a history of childhood abuse on hospital outcome of affective episodes.

Despite increased awareness of the prevalence of a history of childhood abuse among adults with psychiatric disorders, the implications for treatment and outcome are generally unknown. This study examined the impact of childhood sexual abuse (in some cases combined with physical abuse) on the hospital treatment of severe mood disorders. A chart review was conducted of 110 cases of consecutively admitted adult inpatients with affective disorders. The abused and nonabused groups were compared in terms of demographic variables, severity of illness, treatment history, duration of hospitalization, and outcome of the hospital treatment episode. A history of childhood abuse was associated with younger age, comorbid personality disorders, and shorter duration of hospitalization. Other measures, such as level of functioning at discharge and recidivism, were not related to abuse status. The results suggest that childhood abuse may be associated with earlier onset of affective episodes and personality disorders but is not strongly associated with other clinical and outcome measures in the acute treatment setting.

Psychoeducation About Sexual Issues in an Acute Treatment Setting

Psychoeducation About Sexual Issues in an Acute Treatment Setting

Group Psychotherapy in Acute Treatment Settings; Theory and Technique

Group psychotherapy has long been a part of most inpatient and partial hospital programs, but conducting groups in these settings has become more difficult as the average patient stay has shortened. The authors integrate findings from previous research in which patients ranked the importance of several therapeutic processes in acute care groups, and they suggest a theory of group psychotherapy that incorporates realistic clinical objectives for these short-term settings. Seven therapeutic factors--self-responsibility, self-understanding, instillation of hope, group cohesiveness, catharsis, altruism, and universality--are identified as important in promoting patient change. Specific techniques to enhance these factors in short-term settings are recommended.