Treatment Of Psychiatric Patients Research Articles

Relationship Between the Atmosphere of Psychiatric Wards and the Motivation, Attitude, and Perception of Patients Hospitalized in Shiraz and Bushehr University Hospitals-2019

Background: Treatment of psychiatric patients is a challenging issue that requires special attention due to their unique nature and conditions. Identifying the factors that influence treatment acceptance among these patients can aid in disease management and health promotion. The environment in which individuals reside can significantly impact their behaviors. Objectives: The present study aimed to determine the correlation between ward atmosphere and the motivation, perception, and attitude of patients towards continuing the treatment process in psychiatric wards of certain university hospitals in Shiraz and Bushehr in 2019. Methods: The present cross-sectional study included 299 patients admitted to the psychiatric wards of hospitals in Bushehr and Shiraz, Iran. A convenience sampling method was employed. Data collection tools included a demographic characteristics form, a short-form psychiatric ward questionnaire, and patient attitude, motivation, and treatment perception questionnaires. Data were analyzed using SPSS 19 with Pearson or Spearman correlation tests, independent t-test, one-way analysis of variance, and linear regression. The significance level was set at less than 0.05 in all cases. Results: The mean score of ward atmosphere was lower than average (18.37 ± 2.99) from the patients' point of view. Among the subscales of ward atmosphere, the "support" subscale correlated with patients' attitudes towards continuing the treatment process (P = 0.042). Patients exhibited a more positive attitude towards treatment at higher levels of support. Two subscales, "support" (P = 0.048) and "programme clarity" (P < 0.001), correlated with patients' perceptions of the treatment continuation. In other words, patients' perception of the treatment process was higher at elevated levels of these two subscales. None of the ward atmosphere subscales correlated with the patient's motivation to continue the treatment process from the patient's point of view. Conclusions: Given the correlation between certain subscales of ward atmosphere and patients' attitudes and perceptions about continuing the treatment process, it is recommended to design programs to optimize the ward atmosphere. This could improve patients' attitudes and perceptions regarding continuing their treatment. Additionally, it is suggested to study other factors affecting treatment in psychiatric patients.

Analysis of drug-drug interactions in spontaneous adverse drug reaction reports from EudraVigilance focusing on psychiatric drugs and somatic medication

IntroductionPatients with severe mental illnesses (SMI) are often exposed to polymedication. Additionally, the risk of somatic diseases is twice as high in patients with SMI as in individuals without a psychiatric disorder. Furthermore, drug–drug interactions (DDI) between psychiatric drugs and somatic medications are a well-known cause of adverse drug reactions (ADR).ObjectivesThe aim of this study was to analyse whether already known DDI related to psychiatric drugs and somatic medication still occur in everyday clinical practice.MethodsTherefore we identified all spontaneous ADR reports contained in the European ADR database EudraVigilance from Germany received between 01/2017 and 12/2021 reported for patients older than 17 years in which antidepressants, antipsychotics and mood stabilizers were reported as suspected/interacting (n= 9,665). ADR reports referring to intentional overdoses and suicide attempts were excluded (n= 9,276 left). We used the ABDATA drug information system in order to identify all potential DDI (pDDI). The identified reports with pDDI were then assessed individually to determine whether the respective DDI occurred.Results 1,271 reports with 728 potentially interacting drugs pairs related to psychiatric drugs and somatic medications with 2,655 pDDI were found. Restricted to potentially interacting drug pairs with more than 10 reports, (i) hyponatremias related to antidepressants and diuretics (n= 362, 32.6%), (ii) bleeding events related to selective serotonin reuptake inhibitors (SSRI) and platelet aggregation inhibitors, anticoagulants or non-steroidal antiinflammatory drugs (NSAID) (n= 295, 17.5%), and (iii) increased beta-blocker effects related to SSRIs and beta-blockers (n= 126, 11.3%) were the most frequently identified pDDI. After individual case assessment, in 33.3% (14/42), 23.7% (45/190) and 17.4% (8/46) of the reports bleeding events related to SSRIs and anticoagulants, SSRIs and platelet aggregation inhibitors and SSRIs and NSAIDs were reported. Hyponatremia was reported in 7.6% (22/289) of the reports related to antidepressants and diuretics and increased beta-blocker effects in 6.9% (8/116) of the reports related to SSRIs and beta-blockers.ConclusionsAccording to our analysis, well-known DDI still occur in the treatment of psychiatric patients with psychiatric drugs and somatic medication. Whenever possible, alternative drug combinations with a lower potential of DDIs may be considered or appropriate monitoring measures should be conducted.Disclosure of InterestNone Declared

Virtual Reality and Transcranial Direct Current Stimulation for Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that is particularly difficult to treat in military veterans. Noninvasive brain stimulation has significant potential as a novel treatment to reduce PTSD symptoms. To test whether active transcranial direct current stimulation (tDCS) plus virtual reality (VR) is superior to sham tDCS plus VR for warzone-related PTSD. This double-blind randomized clinical trial was conducted among US military veterans enrolled from April 2018 to May 2023 at a secondary care Department of Veterans Affairs hospital and included 1- and 3-month follow-up visits. Participants included US military veterans with chronic PTSD and warzone-related exposure, recruited via referral and advertisement. Patients in psychiatric treatment had to be on a stable regimen for at least 6 weeks to be eligible for enrollment. Data were analyzed from May to September 2023. Participants were randomly assigned to receive 2-mA anodal tDCS or sham tDCS targeted to the ventromedial prefrontal cortex, during six 25-minute sessions of standardized warzone VR exposure, delivered over 2 to 3 weeks. The co-primary outcomes were self-reported PTSD symptoms, measured via the PTSD checklist for DSM-5 (PCL-5), alongside quality of life. Other outcomes included psychophysiological arousal, clinician-assessed PTSD, depression, and social/occupational function. A total of 54 participants (mean [SD] age, 45.7 [10.5] years; 51 [94%] males) were assessed, including 26 in the active tDCS group and 28 in the sham tDCS group. Participants in the active tDCS group reported a superior reduction in self-reported PTSD symptom severity at 1 month (t = -2.27, P = .02; Cohen d = -0.82). There were no significant differences in quality of life between active and sham tDCS groups. Active tDCS significantly accelerated psychophysiological habituation to VR events between sessions compared with sham tDCS (F5,7689.8 = 4.65; P < .001). Adverse effects were consistent with the known safety profile of the corresponding interventions. These findings suggest that combined tDCS plus VR may be a promising strategy for PTSD reduction and underscore the innovative potential of these combined technologies. ClinicalTrials.gov Identifier: NCT03372460.

Relationship Between Insomnia and Continued Outpatient Treatment in Psychiatric Patients.

Sleep plays an essential role in maintaining both physical and mental well-being. Many patients in psychiatric outpatient settings complain of insomnia. However, the causal relationship between insomnia and depressive symptoms in all mental illnesses remains unclear. Moreover, research on insomnia and the continuation of outpatient treatment is lacking. We hypothesize a high correlation between depression and insomnia among patients with diverse mental illnesses. Additionally, we posit that insomnia significantly influences the continuity of outpatient visits. To this end, we evaluated insomnia and depression symptoms in psychiatric patients both at their initial visit and one year later. We also examined factors related to insomnia at the outset and factors associated with the ongoing utilization of outpatient treatment. The participants of the study consisted of patients who made their first visit to the outpatient department of psychiatry and neurology at Showa University East Hospital between June 1, 2021, and March 31, 2023, and who continued attending the outpatient clinic for one year. Clinical characteristics were assessed using the Self-rating Depression Scale (SDS) and the Athens Insomnia Scale (AIS). The study's findings were collected from a cohort of 1106 patients and revealed that more than 70% experienced insomnia at the time of their initial visit. In total 137 patients continued to receive outpatient treatment for one year, and their AIS scores improved from 9 points to 5 points. A multivariate analysis revealed that the SDS items of depressed mood and insomnia were confounding factors influencing AIS improvement. Given that 70% of patients complained of insomnia at the time of their first visit and that sleep improved in many of the 12.4% of patients who continued to receive outpatient treatment for at least one year, the results suggest that sleep status is an important determinant of whether a patient continues to attend outpatient clinics.

The benefits of early psychiatric treatment in patients with oncological pathology

The benefits of early psychiatric treatment in patients with oncological pathology

Medical experience as an influencing parameter in emergency medical care for psychiatric emergencies: retrospective analysis of a multicenter survey

BackgroundPrehospital care of psychiatric patients often relies on the medical experience of prehospital emergency physicians (PHEPs). The psychiatrists (PSs) involved in the further treatment of psychiatric patients also often rely on their experience. Furthermore, the interaction between PHEPs and PSs is characterized by interaction problems and different approaches in the prehospital care of the psychiatric emergency.ObjectivesTo analyze the phenomenon of “medical experience” as a cause of possible interaction-related problems and assess its impact on the prehospital decision-making process between prehospital emergency physicians and psychiatrists.MethodsThe retrospective data analysis was conducted between November 2022 and March 2023. Medical experience was defined as follows, based on the demographic information collected in the questionnaires: For PHEPs, the period since obtaining the additional qualification in emergency medicine was defined as a surrogate marker of medical experience: (i) inexperienced: < 1 year, (ii) experienced: 1–5 years, (iii) very experienced: > 5 years. For PSs, age in years was used as a surrogate parameter of medical experience: (i) inexperienced: 25–35 years, (ii) experienced: 35–45 years, (iii) very experienced: > 45 years.ResultsInexperienced PSs most frequently expressed anxiety about the psychiatric emergency referred by a PHEP (27.9%). Experienced PHEPs most frequently reported a lack of qualifications in handling the care of psychiatric emergencies (p = 0.002). Very experienced PHEPs were significantly more likely to have a referral refused by the acute psychiatric hospital if an inexperienced PS was on duty (p = 0.01). Experienced PHEPs apply an intravenous hypnotic significantly more often (almost 15%) than PSs of all experience levels (p = 0.001). In addition, very experienced PHEPs sought prehospital phone contact with acute psychiatry significantly more often (p = 0.01).ConclusionPHEPs should be aware that the PS on duty may be inexperienced and that treating emergency patients may cause him/her anxiety. On the other hand, PHEPs should be receptive to feedback from PS who have identified a qualification deficiency in them. Jointly developed, individualized emergency plans could lead to better prehospital care for psychiatric emergency patients. Further training in the prehospital management of psychiatric disorders is needed to minimize the existing skills gap among PHEPs in the management of psychiatric disorders.

Purpose in Life: Addressing Transdiagnostic Psychopathologies Concerning Patients' Sense of Purpose.

Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.

Managing the risk of suicide in a psychiatry clinic: an ethnographic study on the work atmosphere of nurses during the pandemic period

IntroductionIt is known that the restrictions and clinical changes experienced during the pandemic period have negative effects on the care and treatment of psychiatric patients. However, insights on how the pandemic environment and the approaches of healthcare professionals serving during the pandemic affect the care and treatment of patients at risk of suicide are insufficient.ObjectivesThis ethnographic study aimed to identify the approaches of psychiatric nurses in managing suicide risk during the pandemic period in relation with their work environment.MethodsThis ethnographic research design used a sample of 13 psychiatric nurses in a psychiatric clinic in Ankara. Data were collected with in-depth interviews, participant observations and observant participations. Data were obtained from a total of 612 hours of observation and 13 planned nurse interviews. Data were analyzed using qualitative thematic analysis.ResultsThe emergent main theme from data analysis is explained under the title of “The risk of loss of inauthenticity in suicide risk management”. “Risk of loss of inauthenticity” means the fact that the individual suicidal risk factors and differences of the patients cannot be perceived/assessed by the nurses.ConclusionsSupposing all patients having the same suicide risk level by psychiatric nurses caused insensitivity to risky patients in the care process. Nurses’ inadequate approach to patient personality disorder and limited social interactions due to the pandemic atmosphere made it difficult for nurses to have knowledge and understanding of how patients cope with suicidal ideations. These findings show the importance of the use of valid and reliable scales with risk formulations and the significance of triage in crisis periods such as current pandemic. In addition, creating available online consultancy service alternatives may have an important role in the management of suicide risk for patients who are disturbed by long-term hospitalization. Also these findings may contribute to the creation of qualified care and treatment guidelines on suicide risk management for crisis periods.Disclosure of InterestNone Declared

A TRANSDISCIPLINARY APPROACH TO THE TREATMENT OF DRY EYE DISEASE IN PATIENTS WITH PSYCHIATRIC DISORDERS

IntroductionDry eye disease (DED) is a multifactorial disease of the tear film and ocular surface representing one of the most common problems in ophthalmological practice and significant public health problem. Characteristic symptoms of DED include gritty, sandy foreign body sensation as well as visual disturbances that have a negative impact on the patient’s daily activities and also affecting patient’s quality of life (QOL).ObjectivesThe objective of this research is to point out the importance of transdisciplinary approach to treatment of dry eye disease in patients with psychiatric disorders.MethodsWe reviewed all current available literature in Pubmed dealing with the topic of connection of dry eye disease and psychiatric disorders.ResultsIn recent years, the relationship between DED and psychiatric disorders has been gaining attention. A number of epidemiological studies have reported a possible association between dry eye and psychiatric disorders showing that the subjective symptoms of dry eye can be affected not only by changes of the tear film and ocular surface but also psychological factors such as anxiety, depression, schizophrenia, post-traumatic stress disorder (PTSP) and subjective happiness. Apart from psychiatric disorders, psychiatric medications are also considered as risk factors for DED due to their influence on the tear film status. The incidence of ocular side effects increases rapidly with the use of polypharmacy, a very common form of treatment used in psychiatry.Mental health disorders may be one of considerable contributing factors for dry eye symptoms and undiagnosed mental health conditions can be an influencing element for unexplained levels of DED symptoms. Depression, anxiety, stress, hypochondriasis, neuroticism, sleep and mood disorders may be associated with the exacerbation of symptoms to degrees that are not consistent with the objective signs related to tear dysfunction as well as changes in the anterior surface of the eye.There is often inconsistency between signs and symptoms of DED, where symptoms often are more related to non-ocular conditions including psychiatric disorders than to tear film parameters. Consequently, in many cases DED may be considered as a psychiatric as well as ophthalmological problem. Psychiatrists and ophthalmologists need to be aware of the potential influence of psychiatric disorders and medications on tear film stability.ConclusionsA detailed medical history, thorough ophthalmological examination and referral to a psychologist or psychiatrist may be essential in the treatment of those patients. In treatment of psychiatric patients, an integrative and transdisciplinary approach will result in better functioning and higher QOL.Disclosure of InterestNone Declared

Contribution of equine therapy in the management of post-traumatic stress disorder

For several years, animal-mediated therapies have been used in the treatment of psychiatric patients. Post-traumatic stress disorder has the particularity of being generated by an external event in a person a priori free of mental pathology. In this disorder, various so-called targeted psychotherapies have proven to be effective, including equine therapy.

The first generation and second generation antipsychotic drugs and their pharmacology in treatment of schizophrenia

In this review report, an attempt made to present an overview of schizophrenia &amp; those drugs which are used in treatment of psychiatric disorders as well as some treatments for psychosis. In 1908, the schizophrenia word was coined by Eugen Bleuler (Swiss psychiatrist). The use antipsychotics as medication began from 1933 in France. Laborit and Huguenard administrated the aliphatic Phenothiazine, Chlorpromazine during surgery due to its potential anesthetic effect, in 1951. Thereafter, Hamon and Delay extended the use of this treatment in psychiatric patients. Due to abnormal brain structure &amp; functioning occurs schizophrenia as well as psychotic disorders. Schizophrenia a condition in people unable to differentiate between real &amp; imaginary world. In this article we all know about Schizophrenia &amp; Antipsychotics drugs. In that include symptoms &amp; their types, cause, risk factor, antipsychotics classification &amp; their pharmacology etc. In that there are three types of symptoms namely positive, Negative, Cognitive. Exact causes of schizophrenia are unknown. In the treatment of Schizophrenia or psychotics disorders the physicians commonly used antipsychotic medicines or drugs to treat their symptoms. Antipsychotic drugs further divided into two major classes namely Typical &amp; Atypical antipsychotics. Chlorpromazine is the first medicine or drug which is used to treat symptoms of schizophrenia and schizoaffective disorders. Clozapine is most effective or potent antipsychotics drug. Which is belongs to the atypical antipsychotics which are reducing the risk of schizoaffective patients. Physicians recommend a combination of antipsychotics along with psychotherapy. In this article we have covered Brahmyadiyoga is an Ayurvedic remedies.

Time trends in co-occurring substance use and psychiatric illness (dual diagnosis) from 2000 to 2017 – a nationwide study of Danish register data

Objective This article aims to describe the time trend in number of dual diagnosis patients treated in the psychiatric system in Denmark from 2000 to 2017. Method We calculated the share of patients with dual diagnosis, number of dual diagnosis contacts, number of unique individuals with dual diagnosis as well as number of new patients with dual diagnosis among patients in psychiatric treatment, i.e. among inpatients, outpatients and patients in emergency departments. In order to calculate this, we merged data from the National Patient Register (NPR), the National Registry of Alcohol Treatment, the National treatment registry for substance use, the National Prescription Registry and the Danish National Health Service register in the period from 2000 to 2017. Results We found an overall increase in patients with dual diagnosis in psychiatric treatment in Denmark from 2000 to 2017. We further detected an increase in the age and sex-standardized number of patients with dual diagnosis in treatment over time, however most markedly for outpatients. Further, inclusion of data from other sources of data than the NPR dramatically increased the number of patients that could be identified as dual diagnosis patients. Using these data, almost half of all male inpatients could be identified as dual diagnosis while the share was more than 40% for patients with schizophrenia, schizotypal and delusional disorders (F2) and patients with personality disorders (F6). Conclusions The increase of individual diagnosis patients necessitates action at different levels. This includes improvement of preventive measures as well as improvement of treatment for this underserved group.

Lend Me Your Eyes

Abstract The introductory text situates the therapeutic practices of Gina Ferreira and Lula Wanderley in relation to the work of Brazilian modernist artist Lygia Clark. Ferreira is a social psychologist who uses the arts—for instance, photography and film—for the socialization and treatment of psychiatric patients. Wanderley is an artist who brings creativity into the realm of psychiatric care. Both have significantly expanded the sites and amplified the applications of Clark's Estruturação do self (Structuration of the self) therapy sessions by working in public psychiatric hospitals and clinics in Rio de Janeiro and with marginalized populations. In “Lend Me Your Eyes,” Gina Ferreira offers a poetic account of both Lygia Clark's practice and how communication became a “‘therapeutic’ possibility” for the artist. These thoughts frame Ferreira's narration of her clinical care of a client (patient) named Pedro. In “The Silence That Words Hold,” Lula Wanderley describes his artistic engagement with psychiatry and his use of Clark's therapy with clients such as Rosa. The two articles compelling attest to how Clark's Estruturação do self resonates beyond the institutionalized spaces of the art museum and the academy.

Introduction: Art's Histories Without Art History

Abstract The introductory text situates the therapeutic practices of Gina Ferreira and Lula Wanderley in relation to the work of Brazilian modernist artist Lygia Clark. Ferreira is a social psychologist who uses the arts—for instance, photography and film—for the socialization and treatment of psychiatric patients. Wanderley is an artist who brings creativity into the realm of psychiatric care. Both have significantly expanded the sites and amplified the applications of Clark's Estruturação do self (Structuration of the self) therapy sessions by working in public psychiatric hospitals and clinics in Rio de Janeiro and with marginalized populations. In “Lend Me Your Eyes,” Gina Ferreira offers a poetic account of both Lygia Clark's practice and how communication became a “‘therapeutic’ possibility” for the artist. These thoughts frame Ferreira's narration of her clinical care of a client (patient) named Pedro. In “The Silence That Words Hold,” Lula Wanderley describes his artistic engagement with psychiatry and his use of Clark's therapy with clients such as Rosa. The two articles compelling attest to how Clark's Estruturação do self resonates beyond the institutionalized spaces of the art museum and the academy.

The Silence That Words Hold

Abstract The introductory text situates the therapeutic practices of Gina Ferreira and Lula Wanderley in relation to the work of Brazilian modernist artist Lygia Clark. Ferreira is a social psychologist who uses the arts—for instance, photography and film—for the socialization and treatment of psychiatric patients. Wanderley is an artist who brings creativity into the realm of psychiatric care. Both have significantly expanded the sites and amplified the applications of Clark's Estruturação do self (Structuration of the self) therapy sessions by working in public psychiatric hospitals and clinics in Rio de Janeiro and with marginalized populations. In “Lend Me Your Eyes,” Gina Ferreira offers a poetic account of both Lygia Clark's practice and how communication became a “‘therapeutic’ possibility” for the artist. These thoughts frame Ferreira's narration of her clinical care of a client (patient) named Pedro. In “The Silence That Words Hold,” Lula Wanderley describes his artistic engagement with psychiatry and his use of Clark's therapy with clients such as Rosa. The two articles compelling attest to how Clark's Estruturação do self resonates beyond the institutionalized spaces of the art museum and the academy.

Case Study on Ludotherapy and Aromatherapy in Support of Treatment in Psychiatric Patients

The present research was carried out at the Samuel Ramírez Moreno psychiatric hospital, which aimed to describe the importance of recreational activities and aromatherapy for the treatment of psychiatric patients, the longitudinal qualitative study method a qualitative longitudinal cut study, involving 75% of patients with mental health. It is important to improve the quality of life of the patient, the activities aimed at stimulating their functionability, as well as to reduce the violence and stress that users constantly present during their hospital stay. The results showed that the recreational activities and aromatherapy produce cognitive stimulation, which is a set of pathways, forms, methods, and techniques that are effective in the functioning of capacities such as memory, language, and reasoning these functions are important to maintain intellectual skills in order to restore autonomy to the user. Its main benefits are physical and physiological: Expanding your body expression, stimulating concentration and mental agility, improving balance, increasing blood circulation This helps to release serotonin and endorphins. Recreational activities and aromatherapy are of utmost importance in the elderly, mainly in users with mental disorders so games are learning tools and cognitive activity as they stimulate the mind by forcing it to think and activate different skills in their daily life. Aromatherapy improves mood for relaxation, in situations of stress or anxiety has a soothing effect that facilitates relaxation and mental peace because essential oils can serve the balance between the right and left hemispheres.

Treatment of Psychiatric Patients under the Poor Relief Act and Hōmen-Iin (Welfare Commissioners) Who Worked in Kyoto City in the 1930s

Treatment of Psychiatric Patients under the Poor Relief Act and <i>Hōmen-Iin</i> (Welfare Commissioners) Who Worked in Kyoto City in the 1930s

Psychodynamics of Medication Adherence in the Treatment of Psychiatric Patients

Psychodynamics of Medication Adherence in the Treatment of Psychiatric Patients

Insecure attachment as a transdiagnostic risk factor for major psychiatric conditions: A meta-analysis in bipolar disorder, depression and schizophrenia spectrum disorder

Insecure attachment has been suggested as a major risk factor for mental health problems as well as a key element for the development and trajectory of psychiatric disorders. The aim of this meta-analysis was to assess whether insecure attachment constitutes a global transdiagnostic risk factor in bipolar disorder, depression, and schizophrenia spectrum disorders. We conducted a PRISMA-based systematic quantitative review to explore the prevalence of insecure attachment among patients of three representative psychiatric disorders - major depression, schizophrenia spectrum disorders and bipolar disorder - in comparison with healthy controls (HC) from a transdiagnostic point of view. Effect sizes on differences of anxious, avoidant and insecure prevalence were calculated based on 40 samples including a total of n = 2927 individuals. Overall, results indicated a large effect on prevalence of insecure attachment across all disorders compared to HC (k = 30, g = 0.88, I2 = 71.0%, p < 0.001). In a transdiagnostic comparison, the only difference was found in avoidant attachment, which was significantly lower (p = 0.04) compared to HC in the schizophrenia spectrum disorder subgroup (k = 10, g = 0.31, I2 = 76.60%, p < 0.0001) than the depression subgroup subgroup (k = 12, g = 0.83, I2 = 46.65%, p < 0.0001). The lack of further transdiagnostic differences between three distinct psychiatric disorders corroborates insecure attachment as a general vulnerability factor to psychopathology. Our findings warrant further investigations, which should explore the pathways from attachment insecurity towards psychopathology. Insecure attachment likely has implications on assessment, prediction and treatment of psychiatric patients.

Improving facilitation of ECT treatment for patients in an acute medical hospital

AimsA Quality Improvement Project aiming to streamline facilitation of electroconvulsive therapy (ECT) treatment for psychiatric patients at a general acute hospital and reduce cancellation rates via the use of a checklist.ECT treatment is an essential aspect of psychiatric care for patients with severe depression or treatment-resistant psychosis. Facilitation of ECT treatment is an uncommon task for liaison psychiatry and the medical and nursing teams responsible for patients’ medical care. Between August-October 2019, this liaison psychiatry team had 3 patients undergoing ECT treatment a total of 13 times, with treatment being cancelled on 4 occasions. After engagement with stakeholders from the acute medical teams, the liaison team and the ECT suite team, key areas requiring intervention were identified to help reduce the rates of cancellation. Areas identified included a lack of ownership on the logistic and operational aspects of ECT amongst staff, a lack of knowledge of what the process involved and a lack of confidence in managing said patients. Difficulties in communication between teams and accurate documentation may contribute to errors and cancellation of ECT sessions, which in turn would delay treatment and impact on patient safety and clinical outcomes.MethodThe first author, a Foundation Year 1 doctor, developed a 10-point checklist to be referred to when arranging ECT for patients, to ensure errors were not made which could lead to missed treatment and delayed recovery. The tasks and responsibilities of each key member of the team were clearly identified. This checklist was included in all ECT patients’ files and teaching was provided to staff involved. Feedback was obtained from staff involved regarding the clarity of information and their confidence in managing such cases.ResultIn the month following initial intervention the liaison psychiatry team organised 12 ECT sessions. The checklist was pasted into notes the day before each ECT session and 0 sessions were missed for avoidable reasons. Feedback from staff showed all teams felt more confident co-ordinating ECT treatment as a result of the checklist.ConclusionCreating a 10-point checklist for the facilitation of ECT treatment in patients at a medical hospital was beneficial in reducing avoidable errors from 16% to 0%. The liaison psychiatrists, medical doctors, and nurses involved reported greater confidence in managing patients undergoing ECT and described the checklist as enhancing the feeling of teamwork and communication within the multi-disciplinary team, and felt it had improved patient safety and clinical outcomes.