Journal articles on the topic 'Acute Mental Health Facility'
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Jenkin, Gabrielle L. S., Jacqueline McIntosh, and Susanna Every-Palmer. "Fit for What Purpose? Exploring Bicultural Frameworks for the Architectural Design of Acute Mental Health Facilities." International Journal of Environmental Research and Public Health 18, no. 5 (February 27, 2021): 2343. http://dx.doi.org/10.3390/ijerph18052343.
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Acute mental health care facilities have become the modern equivalent to the old asylum, designed to provide emergency and temporary care for the acutely mentally unwell. These facilities require a model of mental health care, whether very basic or highly advanced, and an appropriately designed building facility within which to operate. Drawing on interview data from our four-year research project to examine the architectural design and social milieu of adult acute mental health wards in Aotearoa New Zealand, official documents, philosophies and models of mental health care, this paper asks what is the purpose of the adult inpatient mental health ward in a bicultural country and how can we determine the degree to which they are fit for purpose. Although we found an important lack of clarity and agreement around the purpose of the acute mental health facility, the general underpinning philosophy of mental health care in Aotearoa New Zealand was that of recovery, and the CHIME principles of recovery, with some modifications, could be translated into design principles for an architectural brief. However, further work is required to align staff, service users and official health understandings of the purpose of the acute mental health facility and the means for achieving recovery goals in a bicultural context.
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Faddy, Steven C., Kevin J. McLaughlin, Peta T. Cox, and Senthil S. Muthuswamy. "The Mental Health Acute Assessment Team: a collaborative approach to treating mental health patients in the community." Australasian Psychiatry 25, no. 3 (January 31, 2017): 262–65. http://dx.doi.org/10.1177/1039856216689655.
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Objective: Many models of community-based mental health crisis teams have been reported. We present our experience of an outreach team made up of a paramedic and mental health nurse. Methods: A proof-of-concept was conducted in Western Sydney. The primary outcome was the proportion of patients where the team were able to facilitate the most appropriate care. Results: Nearly 70% of patients were able to be treated outside the Emergency Department, with about two-thirds being transported directly to a mental health facility. Conclusion: We have demonstrated that our model of care is successful in enabling appropriate physical and mental health care for patients suffering an acute mental health crisis.
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Potter, Mertie L., Roberta Vitale-Nolen, and Ann M. Dawson. "Implementation of Safety Agreements in an Acute Psychiatric Facility." Journal of the American Psychiatric Nurses Association 11, no. 3 (June 2005): 144–55. http://dx.doi.org/10.1177/1078390305277443.
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Berg, John E. "Psychometric testing of immigrants and natives in an acute psychiatry facility." Mental Illness 9, no. 2 (October 19, 2017): 48–51. http://dx.doi.org/10.1108/mi.2017.6987.
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The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a broad range of languages may be such an augmentation of our diagnostic armamentarium. Whether such tests are in use, and how they are distributed among different patient categories was the aim of the study. All referrals in one calendar year (N=1168), as they are depicted in the hospital computerized medical records, were investigated. Fifty-six (6.1%) out of 926 ethnic Norwegians and six (3.0%) out of 198 non-Western immigrants were tested, whereas none of the 44 Western immigrants. The difference between ethnic Norwegians and the immigrants was significant (Z=-3.05 and P=0.002). Psychometric tests were thus almost not in use, and even lesser so in immigrants. Mean number of resident days was higher among those tested, 11.7 (SD=11.2) versus those not tested, 7.4 (SD=10.4) days, t=2.97 and P=0.004. Length of stay for ethnic Norwegians did not differ from that for non-Western immigrants 11.4 versus 11.7, respectively. The patients tested were older than those not tested. Mean age was 43.0 (SD=14.4) versus 38.8 (SD=12.1), with a t=2.65 and P=0.03. The difference in resident days between all immigrants and ethnic Norwegians was significant with a Z=−2.232 and P=0.026. Level of testing was higher in ethnic Norwegians, and the tested patients stayed longer, maybe indicating more room for testing. Whether this low test-activity influences treatment quality is an unsettled question.
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Killaspy, Helen, Joy Dalton, Shirley McNicholas, and Sonia Johnson. "Drayton Park, an alternative to hospital admission for women in acute mental health crisis." Psychiatric Bulletin 24, no. 3 (March 2000): 101–4. http://dx.doi.org/10.1192/pb.24.3.101.
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Aims and MethodTo describe Drayton Park, the first women-only residential mental health crisis facility in the UK and to investigate whether it is succeeding in its remit of providing a viable alternative to hospital admission. We randomly selected case files from 100 women admitted to Drayton Park since its opening and examined variables including demographic details, the reasons for referral, diagnosis and the source of referral.ResultsOur findings show that the service is able to respond quickly to referrals and appears to be functioning safely. The women admitted have a relatively short length of stay, half suffer from depressive episodes and one-third have a relapse of schizophrenia or bipolar disorder.Clinical ImplicationsThis project appears to be succeeding in providing a safe alternative to hospital admission for women with severe and enduring mental health problems.
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Turner, Mark A., Mathew D. Kiernan, Andrew G. McKechanie, Peter J. C. Finch, Frank B. McManus, and Leigh A. Neal. "Acute military psychiatric casualties from the war in Iraq." British Journal of Psychiatry 186, no. 6 (June 2005): 476–79. http://dx.doi.org/10.1192/bjp.186.6.476.
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BackgroundThe view that most military personnel evacuated from war zones are suffering from combat stress reactions, or are otherwise traumatised by the horrors of war, has an impact on all aspects of military psychiatry.AimsTo delineate the reasons for psychiatric aeromedical evacuation from Iraq from the start of build-up of UK forces in January 2003 until the end of October that year, 6 months after the end of formal hostilities.MethodA retrospective study was conducted of field and in-patient psychiatric assessments of 116 military personnel evacuated to the UK military psychiatric in-patient facility in Catterick Garrison.ResultsEvacuees were mainly non-combatants (69%). A significant proportion were in reserve service (21%) and had a history of contact with mental health services (37%). Only 3% had a combat stress reaction. In over 85% of cases evacuation was for low mood attributed to separation from friends or family, or difficulties adjusting to the environment.ConclusionsThese findings have implications especially for screening for suitability for deployment, and for understanding any longer-term mental health problems arising in veterans from Iraq.
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Sung, Chih-Wei, Chi-Hsin Chen, Cheng-Yi Fan, Jia-How Chang, Chia Chun Hung, Chia-Ming Fu, Li Ping Wong, Edward Pei-Chuan Huang, and Tony Szu-Hsien Lee. "Mental health crisis in healthcare providers in the COVID-19 pandemic: a cross-sectional facility-based survey." BMJ Open 11, no. 7 (July 2021): e052184. http://dx.doi.org/10.1136/bmjopen-2021-052184.
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ObjectivesDuring a pandemic, healthcare providers experience increased mental and physical burden. Burnout can lead to treatment errors, patient mortality, increased suicidal ideation and substance abuse as well as medical malpractice suits among medical staff. This study aimed to investigate the occurrence of burnout, acute stress disorder, anxiety disorder and depressive disorder among healthcare providers at the third month of the COVID-19 pandemic.DesignA cross-sectional facility-based survey.SettingHospitals around the country with different levels of care.ParticipantsA total of 1795 respondents, including 360 men and 1435 women who participated in the survey.Primary outcome measuresBurnout was assessed using the Physician Work Life Study. A score of ≥3 implied burnout.ResultsOf the 1795 respondents, 723 (40.3%) reported burnout, and 669 (37.3%) cared for patients with COVID-19. Anxiety levels were mild in 185 (10.3%) respondents, moderate in 209 (11.6%) and severe in 1401 (78.1%). The mean Center for Epidemiologic Studies Depression Scale-10 score was 9.5±6.3, and 817 (45.5%) respondents were classified as having depression. Factors associated with burnout were working in acute and critical care (ACC) divisions (adjusted OR (aOR)=1.84, 95% CI 1.20 to 3.39, p=0.019), caring for patients with COVID-19 (aOR=3.90, 95% CI 1.14 to 13.37, p=0.031) and having depressive disorder (aOR=9.44, 95% CI 7.44 to 11.97, p<0.001).ConclusionsPhysicians and nurses are vulnerable to burnout during a pandemic, especially those working in ACC divisions. Anxiety disorder, depressive disorder and care of patients with COVID-19 may be factors that influence the occurrence of burnout among healthcare providers.
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Proctor, Steven L., and Albert M. Kopak. "Mental health correlates of substance use behaviors among a nationally representative sample of juvenile offenders." Journal of Criminological Research, Policy and Practice 8, no. 1 (December 15, 2021): 45–52. http://dx.doi.org/10.1108/jcrpp-09-2021-0053.
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Purpose This paper aims to extend previous findings by identifying the mental health correlates of both acute and chronic substance use behaviors among a large nationally representative sample of juvenile offenders. Design/methodology/approach Survey of Youth in Residential Placement interview data from 6,920 juvenile offenders (76% male) detained in 290 US facilities were analyzed to determine bivariate relationships between two indicators of substance use (acute and chronic) and seven mental health domains (depression/isolation, anxiety, anger, trauma, inattention, hallucinations and suicidality). Findings Prevalence rates of above average indications for all seven mental health domains were significantly higher among offenders under the influence of a substance at the time they committed their instant offense compared to those not under the influence. Offenders with above average indications in the seven studied mental health areas reported a higher level of chronic effects of substance use relative to those with average or below mental health indications. Practical implications The results have important implications for the assessment and treatment of co-occurring mental health issues among juvenile offenders with substance use issues. Juveniles with above average mental health indications may be more prone to experiencing a number of substance-related problems. Observed results may guide the implementation of routine assessment procedures at the juvenile detention level. Intake specialists should screen and administer comprehensive mental health assessments for juveniles who report substance intoxication at the time of their instant offense. Juvenile offenders who report clinical levels of mental health symptoms should receive a comprehensive assessment of substance use and related problems. Originality/value Although the co-occurrence of substance use and mental health issues among juvenile justice involved populations is well documented, previous research studies in this area have included a number of limitations. Relatively small offender sample populations, often from a single facility, warrant further work with a large, nationally representative sample of juvenile offenders. Inconsistency in measures of substance use and the failure to distinguish between acute and chronic measures of substance use in prior studies also require further investigation. This study contributes to the extant co-occurring substance use and mental health knowledge base by identifying the mental health correlates of both acute and chronic substance use behaviors among a large nationally representative sample of juvenile offenders.
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Adesanya, Adesina. "Impact of a Crisis Assessment and Treatment Service on Admissions into an Acute Psychiatric Unit." Australasian Psychiatry 13, no. 2 (June 2005): 135–39. http://dx.doi.org/10.1080/j.1440-1665.2005.02176.x.
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Objective: To assess the impact of a regional/rural crisis assessment and treatment service (CAT) on admissions into an acute adult inpatient psychiatric facility. Methods: Relevant data for admissions into an acute adult inpatient psychiatric facility in the 18 month periods before and after the establishment of a CAT were compared. Data extracted from available clinical records were transferred into an appropriately structured pro forma for statistical analysis. Results: There were 69 and 53 index inpatient unit admissions in the two time periods. The majority of these were for single, unemployed men aged in their 30s. Although statistically non-significant, the results appear to suggest that there were proportionately fewer readmissions and that admissions were likely to be influenced by illness severity and diagnostic considerations in the period following the establishment of the CAT. The establishment of CAT did not appear to have had much impact on the duration of psychiatric hospitalization. Conclusions: Crisis assessment and treatment services operating within a re-gional/rural integrated mental health setting appear to have only limited impact on hospitalization for psychiatric crisis presentations. There is a need for further studies looking at a broader range of outcome variables in the assessment of the impact of CAT on psychiatric hospitalization in such settings.
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Berg, John E., and Jorid Grimeland. "Leadership by fragmented destruction after a merger: an example from a facility of acute psychiatry." Mental Illness 5, no. 2 (September 1, 2013): 38–40. http://dx.doi.org/10.1108/mi.2013.e11.
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Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations. Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust. Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper.
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Baum, Emily, and Zhuyun Lin. "Maoism and mental illness: psychiatric institutionalization during the Chinese Cultural Revolution." History of Psychiatry 33, no. 3 (August 18, 2022): 293–307. http://dx.doi.org/10.1177/0957154x221090631.
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This article offers a preliminary analysis of psychiatric treatment during the Chinese Cultural Revolution on the basis of interviews and rare case records obtained from ‘F Hospital’ in southern China. In contrast to the prevailing view of psychiatry during this time, which highlights either rampant patient abuse or revolutionary ideology, we show that psychiatric treatment at this facility was not radically altered by the politics of the Maoist period. Instead, treatments were informed by a predominantly biomedical understanding of mental illness, one that derived from the prior training of the facility’s lead physicians. Although political education was nominally incorporated into patient rehabilitation and outpatient care, it was not a constitutive element of inpatient treatment during the acute phase of illness.
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Simpson, C. J., C. E. Hyde, and E. B. Faragher. "The Chronically Mentally Ill in Community Facilities." British Journal of Psychiatry 154, no. 1 (January 1989): 77–82. http://dx.doi.org/10.1192/bjp.154.1.77.
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The quality of life of chronically mentally ill patients in acute wards in a district general hospital, a hostel ward and group homes was compared. Within the spectrum of care of these patients, the severity of psychopathology corresponded to their placement. Analysis, including adjustments for the influence of psychopathology, showed differences between the three types of facility. Although differences existed between all types of care, residents in group homes and the hostel ward shared more similarities in quality of life than those in the district general hospital. Problems of caring for the chronically mentally ill on acute wards are highlighted.
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Edward-Chandran, Therese, De Malcolm, and RC Bowen. "Reduction of Length of Stay in an Acute Care Psychiatric Unit." Canadian Journal of Psychiatry 41, no. 1 (February 1996): 49–51. http://dx.doi.org/10.1177/070674379604100111.
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Objective: To study the association between reduced length of stay in an acute care psychiatric unit and readmission rates. Method: Data on average length of stay, total discharges and readmission rates from April 1988 to March 1994 for 2 hospitals with high average lengths of stay was obtained from the Canadian Institute for Health Information database. Results: The average length of stay decreased from 25 days to 16 days, reaching the national level at one hospital. An initial increase in the readmission rate subsequently declined to pre-study levels. There was no change in length of stay at the other hospital. Conclusion: Reducing the length of stay in an acute care facility by 9 days to an average of 16 days did not lead to a sustained increase in the readmission rate.
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Shi, Sandra, Brianne Olivieri-Mui, Ellen McCarthy, and Dae Hyun Kim. "Functional Trajectories and Quality of Life in Post-Acute Skilled Nursing Facility care after hospitalization." Innovation in Aging 5, Supplement_1 (December 1, 2021): 817. http://dx.doi.org/10.1093/geroni/igab046.3001.
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Abstract Frailty predicts readmissions and mortality after acute hospitalizations. Understanding whether frailty predicts functional recovery after acute hospitalizations may help guide post-acute care and rehabilitation. This feasibility study enrolled 24 adults aged ≥65 years from a skilled nursing facility (SNF) after acute hospitalization. We calculated a deficit-accumulation frailty index (FI range: 0-1; non-frail [≤0.25], mild frailty [0.26-0.35], moderate [0.36-0.45], and severe [>0.45]) via in-person assessment on SNF admission. We measured weekly functional improvement with modified Barthel Index, as well as quality of life. Modified Barthel Index and quality of life were measured weekly by Patient-Reported Outcome Measurement Information System (PROMIS) (standardized score with mean 50 and SD 10, higher is better). The mean age was 83.3 years [SD 8.0], and 17 (71.8%) were female. Length of stay for those with severe frailty (FI>0.45) was 26.8 days [10.7] compared to those who were not frail, mildly frail, or moderately frail (13.3 [7.3], 9.4 [4.4], and 15.2 [4.9] respectively). Those with severe frailty also had delayed functional improvement (mean Barthel Index 48.6, 53.4, and 56.6 on admission, week 1, and week 2 of SNF admission respectively), compared to those with moderate frailty (mean Barthel Index 47.5, 69, 73) or mild frailty (68.3, 86, 90.5). Self-reported mental and physical health-related quality of life was relatively unchanged across SNF episode for all frailty categories. These findings suggest that older adults with moderate or severe frailty may experience a typical course of delayed functional recovery and that further monitoring may be necessary for prognostication.
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Evans, Stacey, Jeffrey Smith, and Elena Caron. "A Case of Mercury Toxicity Complicated by Acute Inflammatory Demyelinating Polyneuropathy." Journal of Child Neurology 33, no. 13 (August 28, 2018): 817–19. http://dx.doi.org/10.1177/0883073818790408.
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A 13-year-old African American male presented with 2 months of subacute altered mental status, ptosis, areflexia, disordered gait, constipation, weight loss, abdominal and testicular pain, and hyperhidrosis. Initial workup at our facility was unrevealing until elevated serum mercury level was detected. Diagnosis of mercury toxicity was confirmed, and chelation therapy with succimer was started. After beginning succimer, the patient developed acute-onset weakness and was diagnosed with acute inflammatory demyelinating polyneuropathy. Supportive studies included elevated cerebrospinal fluid protein and acquired demyelinating polyneuropathy on nerve conduction study. He responded well to treatment with intravenous immunoglobulin and returned to his baseline state of health. Although there is a known association between mercury toxicity and axonal neuropathy, there is only 1 other case report of acute inflammatory demyelinating polyneuropathy in the setting of mercury toxicity. The nature of the correlation between these 2 entities in our case remains unclear.
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Wattis, John P., Alan Butler, Carol Martin, and Ted Sumner. "Outcome of admission to an acute psychiatric facility for older people: A pluralistic evaluation." International Journal of Geriatric Psychiatry 9, no. 10 (October 1994): 835–40. http://dx.doi.org/10.1002/gps.930091011.
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Fraser, Alan A., Anne Greer, and Pramod Jauhar. "Heroin Abusers in Psychiatric Beds." British Journal of Psychiatry 151, no. 2 (August 1987): 252–54. http://dx.doi.org/10.1192/bjp.151.2.252.
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A retrospective study was carried out of all heroin abusers admitted to an acute psychiatric unit to examine their use of the facility of in-patient care. The compliance with treatment was low. Most patients discharged themselves or were discharged prematurely for using drugs while in the ward; only 21% were discharged as planned. The value of hospital admission in the management of opiate abusers may have to be reconsidered in view of the increasing prevalence of heroin abuse and the limited number of psychiatric beds.
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Curson, D. A., T. R. E. Barnes, R. W. Bamber, S. D. Piatt, S. R. Hirsch, and J. C. Duffy. "I. Course of Illness, Stability of Diagnosis, and the Role of a Special Maintenance Clinic." British Journal of Psychiatry 146, no. 5 (May 1985): 464–69. http://dx.doi.org/10.1192/bjp.146.5.464.
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SummaryA follow-up study of all patients entering the MRC double-blind trial of fluphenazine decanoate in chronic schizophrenic out-patients achieved a trace rate of 94%. In general, these patients were severely disabled, continued under the care of the maintenance clinic, and their diagnoses remained remarkably consistent; more than one-fifth were found to be in acute schizophrenic relapse and in over a half of these cases, the relapse was not known to the treatment agency. The maintenance clinic attenders were little different from those who no longer used such a facility.
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Hugo, Malcolm. "Comparative Efficiency Ratings Between Public and Private Acute Inpatient Facilities." Australian & New Zealand Journal of Psychiatry 34, no. 4 (August 2000): 651–57. http://dx.doi.org/10.1080/j.1440-1614.2000.00742.x.
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Objectives: The aims of this study are to compare clinical outcomes and efficiency ratings in an acute psychiatric inpatient facility with findings from other studies, and to examine relationships between symptom severity, admission medico-legal status and length of stay. Method: The Health of the Nation Outcome Scales was administered at admission and discharge and analysed against admission medico-legal status and length of stay. Efficiency ratings were calculated and compared with those from other acute psychiatric inpatient settings. Results: Clinical outcomes and efficiency ratings were similar to those from other public acute inpatient facilities, with greater admission severities and higher efficiency ratings than those found in private facilities. Involuntary hospitalisation was found to be associated with higher admission severities and longer lengths of stay. Conclusions: Outcome or effect size is enhanced by higher admission severities, however, mean outcome per 10 days of stay is decreased by involuntary admission legal status. Factors unrelated to admission legal status effect differences in efficiency ratings found between public and private acute psychiatric inpatient facilities.
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Tao, Xiaohui, Thanveer Basha Shaik, Niall Higgins, Raj Gururajan, and Xujuan Zhou. "Remote Patient Monitoring Using Radio Frequency Identification (RFID) Technology and Machine Learning for Early Detection of Suicidal Behaviour in Mental Health Facilities." Sensors 21, no. 3 (January 24, 2021): 776. http://dx.doi.org/10.3390/s21030776.
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Remote Patient Monitoring (RPM) has gained great popularity with an aim to measure vital signs and gain patient related information in clinics. RPM can be achieved with noninvasive digital technology without hindering a patient’s daily activities and can enhance the efficiency of healthcare delivery in acute clinical settings. In this study, an RPM system was built using radio frequency identification (RFID) technology for early detection of suicidal behaviour in a hospital-based mental health facility. A range of machine learning models such as Linear Regression, Decision Tree, Random Forest, and XGBoost were investigated to help determine the optimum fixed positions of RFID reader–antennas in a simulated hospital ward. Empirical experiments showed that Decision Tree had the best performance compared to Random Forest and XGBoost models. An Ensemble Learning model was also developed, took advantage of these machine learning models based on their individual performance. The research set a path to analyse dynamic moving RFID tags and builds an RPM system to help retrieve patient vital signs such as heart rate, pulse rate, respiration rate and subtle motions to make this research state-of-the-art in terms of managing acute suicidal and self-harm behaviour in a mental health ward.
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Zeitz, Kathryn, and Paul Hester. "Use of a capacity audit tool in a mental health setting." Australian Health Review 40, no. 1 (2016): 82. http://dx.doi.org/10.1071/ah15065.
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Objective This paper reports on a pilot applying the capacity audit tool (CAT) in a mental health environment and what the tool reveals regarding mental health in-patient capacity issues. Methods The CAT was modified to create an electronic mental health-relevant tool to audit acute in-patient capacity. This tool was then piloted across nine bedded units, within a single Local Health Network, covering a total of 153 mental health beds. Results The application of the mental health CAT resulted in 100% compliance in completion. The findings revealed that 16% (25 beds) of the 153 beds surveyed were occupied by patients who did not need to occupy the bed or the bed was vacant. Of these 25 beds, 10 had patients awaiting transfer to another facility or service, nine were empty and six were occupied by patients ready for discharge but for whom there were delays. Conclusion The CAT was successfully applied to the mental health setting and identified a set of opportunities to improve processes and practices to reduce the identified delays or barriers in order to improve patient flow. What is known about the topic? Capacity management and, in particular, timely discharge are key components to optimise patient flow and improve access block for emergency departments. The CAT has been successfully applied in general health settings to identify key delays and barriers to discharge. What does this paper add? This article reports on the applicability of the CAT in a mental health setting and the ability of the tool to improve our understanding of bed capacity by identifying key reasons for the use of mental health in-patient beds across a stepped model of care and quantifying the most frequent causes of discharge delay. What are the implications for practitioners? This paper describes the modifications of the CAT to make it applicable to the mental health setting and the associated results obtained using the CAT in a mental health setting. The project demonstrated applicability of the tool to the mental health setting. It can be used in other jurisdictions to identify key discharge delays to underpin targeted improvement work within local mental health environments.
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Maloret, P., and T. Scott. "Don't ask me what's the matter, ask me what matters: Acute mental health facility experiences of people living with autism spectrum conditions." Journal of Psychiatric and Mental Health Nursing 25, no. 1 (November 13, 2017): 49–59. http://dx.doi.org/10.1111/jpm.12438.
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Yan, Hainian, Toshiaki Abe, Tung Gia Phan, Tuan Anh Nguyen, Tatuya Iso, Yasunori Ikezawa, Kiyo Ishii, Shoko Okitsu, and Hiroshi Ushijima. "Outbreak of acute gastroenteritis associated with group A rotavirus and genogroup I sapovirus among adults in a mental health care facility in Japan." Journal of Medical Virology 75, no. 3 (2005): 475–81. http://dx.doi.org/10.1002/jmv.20292.
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Mathur, Meeta, Abdul Halim, Mousumi Gupta, Bijayalaxmi Panda, and Arish Syed. "Community-based management of acute malnutrition (CMAM) in India: a position paper." International Journal of Research in Medical Sciences 6, no. 12 (November 26, 2018): 4128. http://dx.doi.org/10.18203/2320-6012.ijrms20184920.
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Considering the burden of Severely Acute Malnutrition (SAM) in India and the availability of SAM treatment at facility level, it is operationally not feasible to treat all SAM children. The community- based approach involves timely detection of severe acute malnutrition in the community and the provision of treatment for those without medical complications with ready-to-use therapeutic foods or other nutrient-dense foods at home. Community based Management of Acute Malnutrition (CMAM) is an integrated approach which on one hand focuses on treatment and on the other prevention. CMAM has a key component of community mobilization which is crucial for prevention. The present paper emphasizes the position of CMAM in India in terms of preventive vs curative, integrative approach, multi sectoral engagement, mental health perspective as per the facts available through secondary sources in India and also experiences of CMAM-I phase implemented in Rajasthan. A CMAM programme can be an ideal and well established programme considering the inclusion of different aspects such as alternative feasible solution, convergent action, multi-stakeholders roles and accountabilities.
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Constantino-Shor, Cheri, Golo Rani, Svaya Olin, Charity Holmes, and Keri Nasenbeny. "Containment of a COVID-19 Outbreak in an Inpatient Geriatric Psychiatry Unit." Journal of the American Psychiatric Nurses Association 27, no. 1 (November 6, 2020): 77–82. http://dx.doi.org/10.1177/1078390320970653.
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OBJECTIVES: The first known COVID-19 outbreak in a long-term care facility in the United States was identified on February 28, 2020, in King County, Washington. That facility became the initial U.S. epicenter of the COVID-19 pandemic when they discovered 129 cases associated with the outbreak (81 residents, 34 staff members, and 14 visitors) and 23 persons died. The vulnerability of the elderly population, shared living and social spaces, suboptimal infection control practices, and prolonged contact between residents were identified as contributing factors to the rapid spread of the disease. The first known case of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a U.S. inpatient geriatric psychiatry unit was also in King County, Washington, and occurred soon afterward on March 11th, 2020. Between March 11 and March 18, nine inpatients and seven staff members were confirmed to have SARS-CoV-2 infection. This article examines how the swift identification and isolation of confirmed patients, an enhanced infection prevention protocol, and engagement of frontline psychiatric care staff prevented a catastrophic outcome in a vulnerable population. METHODS: Here we describe infection control and nursing-led interventions that were quickly enacted in response to this SARS-CoV-2 outbreak in an inpatient geriatric psychiatry unit. RESULTS: The interventions effectively contained the outbreak, with no further patients and only one staff member testing positive for SARS-CoV-2 over the subsequent 2-month time period. CONCLUSIONS: We share our learnings and preventative infection control measures that can be adapted to a variety of settings to prevent or contain future outbreaks of COVID-19.
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Wang, Jinjiao, Meiling Ying, Xueya Cai, Thomas Caprio, Helena Temkin-Greener, and Yue Li. "Association Between Living Arrangement and Acute Care Use in Older Medicare Home Health Patients." Innovation in Aging 4, Supplement_1 (December 1, 2020): 518–19. http://dx.doi.org/10.1093/geroni/igaa057.1674.
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Abstract This secondary analysis used a 10% random sample from the national Outcome and Assessment Information Set (OASIS) of Medicare beneficiaries ≥ 65 years old who received home health (HH) care in 2017 (N=646,109). We examined the risk of hospital admission during a 60-day HH episode among Medicare home health patients in different living arrangements, including living alone at home (23.8%), living with other at home (64.8%), and residing in assisted facility (AL) facilities (11.4%). At the start of the HH episode, AL residents were older, more likely to have cognitive impairment, depressive symptoms, and limitations in activities of daily living (ADL) than those living at home at home (alone/with others). In the multivariable logistic regression model of hospital admission adjusting for demographic status (age, sex, race/ethnicity, Medicaid status), cognitive impairment, depressive symptoms, and ADL limitations, when compared to HH patients living with others at home (reference), AL residents were 15% less likely to have hospital admission (Odds Ratio [OR]=0.85, 95% Confidence Interval [CI]: 0.84, 0.88, p<0.001). HH patients living at home alone were not statistically significantly different from the reference (OR=0.99, 95% CI: 0.98, 1.01, p=0.47). HH patients in AL, despite having worse cognitive, mental, and physical function at baseline, had better outcomes than those living at home. This suggests 1) older adults living at home may have unmet health or personal care needs, and 2) synergies may exist between post-acute care through HH care and long-term care and support at AL that are critical to patient welfare.
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Browne, Angela, Alissa Cambier, and Suzanne Agha. "Prisons Within Prisons: The Use of Segregation in the United States." Federal Sentencing Reporter 24, no. 1 (October 1, 2011): 46–49. http://dx.doi.org/10.1525/fsr.2011.24.1.46.
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Since the 1980s, departments of corrections have sharply increased the use of segregation as a discipline and management tool. In effect, segregation is a secondary sentence imposed by the correctional facility—one that follows long after and usually is unrelated to the conviction for which the person is incarcerated. The consequences of holding an individual in these conditions over time may include new or exacerbated mental health disturbances, assaultive and other antisocial behaviors, and chronic and acute health disorders. In fact, studies show that prisoners who are released from segregation directly to the community reoffend at higher rates than general-population prisoners. Policy changes that will reduce the use and long-term impact of segregation will benefit not only the staff and prisoners in these units but also ultimately the well-being of facilities, systems, and the community.
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Karr, J., G. Iverson, H. Isokuortti, A. Kataja, A. Brander, J. Öhman, and T. Luoto. "A-04 Signs of Injury, Preexisting Health Conditions, and Emergency Department Discharge Location among Older Adults with Mild Traumatic Brain Injuries." Archives of Clinical Neuropsychology 35, no. 6 (August 28, 2020): 777. http://dx.doi.org/10.1093/arclin/acaa067.04.
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Abstract Objective Preexisting health conditions are associated with worse outcome following mild traumatic brain injury (MTBI), which is especially important in MTBI management among older adults. This study focused on older adults who presented to an emergency department (ED) following uncomplicated MTBI, examining the relationship between clinical signs of MTBI, preexisting conditions, and the location of ED discharge. Method Participants included older adults (n = 616, men = 44.8%, ≥55 years-old) who presented to the Tampere University Hospital ED with uncomplicated MTBI (GCS = 15; ground-level falls = 72.4%). Data were collected retrospectively from hospital records, including clinical signs of injury, preexisting health conditions [including preinjury abnormalities on head computed tomography (CT)], and location of follow-up (i.e., home versus other health/rehabilitation facility). A higher odds ratio (OR) indicated a greater likelihood of continued care discharge to another health facility. Results Among participants 55–69 years-old, preexisting neurological diseases (OR = 2.92), mental/behavioral health conditions (OR = 3.05), and CT abnormalities (OR = 3.02) were associated with greater odds of continued care. Among participants 70+ years-old, preexisting neurological diseases (OR = 2.60) and CT abnormalities (OR = 2.12) were associated with greater odds of continued care. Preexisting circulatory system diseases, loss of consciousness, and amnesia were not associated with greater odds of continued care for either age group. Conclusions Among older adults with uncomplicated MTBIs, preexisting health conditions were associated with greater odds of continued care than loss of consciousness or amnesia. These findings reveal the importance of preexisting health conditions in the acute clinical management of MTBI in older adults, in that preexisting conditions have greater associations with care planning than clinical signs of injury.
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Anato, Anchamo, Kaleab Baye, and Barbara Stoecker. "Determinants of depressive symptoms among postpartum mothers: a cross-sectional study in Ethiopia." BMJ Open 12, no. 9 (September 2022): e058633. http://dx.doi.org/10.1136/bmjopen-2021-058633.
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ObjectiveThis study aims to assess the determinants of depressive symptoms among postpartum mothers.DesignA community-based cross-sectional study was conducted.SettingTen randomly selected rural kebeles of Meket district of Ethiopia.ParticipantsA random sample of 232 mothers with infants 5–10 months was included in this study.Data analysisForward multivariable logistic regression analysis.ResultsThe factors significantly associated with increased odds of maternal postpartum depressive symptoms were: moderate (adjusted OR (AOR) 4.44, 95% CI 1.34 to 14.72) and severe (AOR 12.98, 95% CI 5.24 to 32.14) household food insecurity; infant underweight (AOR 2.99, 95% CI: 1.21 to 7.37) and infant acute respiratory infection (ARI) (AOR 7.0, 95% CI: 3.09 to 15.99). Maternal education, workload and age, household socioeconomic status, distance to the health facility, and child stunting, diarrhoea and fever were not significantly associated with postpartum depressive symptoms in adjusted logistic regression.ConclusionHousehold food insecurity, infant ARI and infant underweight had significant associations with postpartum depressive symptoms. Therefore, interventions that address infant nutrition and health and household food insecurity within the framework of the productive safety net programmes (PSNPs) as well as programmes focused on preventing, detecting and solving maternal mental health challenges may be helpful to improve maternal mental well-being and promote graduation from the PSNP.
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Sindvani, Rhea, and Lisa Barry. "Characterization of Skilled Nursing Facility Residents Admitted With Substance Use Disorders." Innovation in Aging 4, Supplement_1 (December 1, 2020): 44. http://dx.doi.org/10.1093/geroni/igaa057.143.
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Abstract For reasons including the opioid epidemic and more widespread substance use across all ages, the prevalence of individuals meeting preadmission criteria for skilled nursing facility (SNF)-level care and who have substance use disorders (SUDs) is growing. However, little is known about this population. We characterized a sample of residents with SUDs in two SNFs that target admission of difficult-to-place individuals in Hartford, Connecticut. Residents admitted between June 1, 2018 and May 31, 2019 and had an SUD per Pre-Admission Screening and Resident Review (PASRR) were included. Using retrospective chart review, we collected data including demographics, physical and mental health conditions, psychiatric medications, and participation in SNF-provided SUD counseling. Of 163 residents admitted with an SUD, all were admitted following an acute hospitalization. Residents’ average age was 49.9(SD=11.7) years (range 21-79). They were 61% male and racially diverse; 56% Caucasian, 27% Hispanic, 16% Black. SUDs on admission included opioid use disorder (48%), alcohol use disorder (33%), unspecified psychoactive SUD (26%), cocaine use disorder (25%), and Other (20%). Of these, 18% and 16% were taking methadone or suboxone, respectively and 25% were taking an antipsychotic medication. Comorbidities such as bipolar disorder (15%) and viral hepatitis (26%) were prevalent. A total of 40 (25%) residents participated in SUD counseling; none of the aforementioned factors was associated with participation. This is the first study to characterize a sample of residents from SNFs that target individuals with SUDs. Improved understanding of this unique and growing subset of the SNF population may help optimize their treatment.
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Smith, Montray, and Vicki Hines-Martin. "Strategies to Decrease Nurses’ Stress in a Federal Medical Station (FMS) Medical Needs Shelter in the U.S. after a Hurricane Disaster." Prehospital and Disaster Medicine 34, s1 (May 2019): s168. http://dx.doi.org/10.1017/s1049023x19003832.
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Introduction:National Disaster Medical System (NDMS) Disaster Medical Assistance Teams (DMATs) are used to provide medical care when local and state resources are overwhelmed in response to natural and human-made disasters. The stress these professionals experience during these events requires intentional and therapeutic interventions to support emotional and mental resilience. Evidence-based interventions will be presented.Aim:DMATs were deployed after Hurricane Maria to work in a Federal Medical Station (FMS), at the Coliseum Bencito, Manati, Puerto Rico. The FMS was operated through a collaboration of federal agencies and non-government agencies. Community infrastructure was impacted, including two damaged area hospitals, overwhelming available resources with increased patient care demands. The facility provided acute care and short-term services around the clock for a 10-day period, serving several hundred clients, in and around the municipality of Manati.Methods:Several strategies were utilized to decrease stress levels while nurses worked at the FMS included having a safe and secure environment, sharing stories with peers, taking scheduled breaks, utilizing physical activities (Zumba), and having designated sleeping areas. Additional strategies used for clients were relief supply choices, allowing one person to stay with special needs client, and bereaved care.Results:Nurses were able to decrease stress levels to themselves and clients while working with community partners providing acute and chronic health care needs at the area where health care services were impacted. Verbal and written feedback was provided during formal and informal meetings as well as receiving client comments on the services given at the facility.Discussion:Contribution to practice-heightened emotional responses in a disaster setting are expected and should be a focus of intervention even with health care providers. Nurses were able to employ disaster nursing knowledge, including mental health strategies in this setting and be able to better address the needs of others.
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Shibata, Renae, Mary O. Dereski, and Virginia G. Uhley. "3.60 HALDOL AND ATIVAN INTRAMUSCULAR INJECTION ADMINISTRATION TRENDS FOR BEHAVIORAL EMERGENCY SITUATIONS IN AN ACUTE CARE REHABILITATION FACILITY FOR ADOLESCENTS." Journal of the American Academy of Child & Adolescent Psychiatry 55, no. 10 (October 2016): S161. http://dx.doi.org/10.1016/j.jaac.2016.09.192.
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Singh, Devendra Raj, Dev Ram Sunuwar, Shraddha Adhikari, Sunita Singh, and Kshitij Karki. "Determining factors for the prevalence of depressive symptoms among postpartum mothers in lowland region in southern Nepal." PLOS ONE 16, no. 1 (January 22, 2021): e0245199. http://dx.doi.org/10.1371/journal.pone.0245199.
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Background Postpartum depression is the most common mental health problem among women of childbearing age in resource-poor countries. Poor maternal mental health is linked with both acute and chronic negative effects on the growth and development of the child. This study aimed to assess the prevalence and factors associated with depressive symptoms among postpartum mothers in the lowland region in southern Nepal. Methods A hospital-based analytical cross-sectional study was conducted from 1st July to 25th August 2019 among 415 randomly selected postpartum mothers attending the child immunization clinic at Narayani hospital. The postpartum depressive symptoms were measured using the validated Nepalese version of the Edinburg Postnatal Depression Scale (EPDS). The data were entered into EpiData software 3.1v and transferred into Stata version 14.1 (StataCorp LP, College Station, Texas) for statistical analyses. To identify the correlates, backward stepwise binary logistic regression models were performed separately for the dichotomized outcomes: the presence of postpartum depressive symptoms. The statistical significance was considered at p-value <0.05 with 95% confidence intervals (CIs). Results Among the total 415 study participants, 33.7% (95% CI: 29.2–38.5%) of postpartum mothers had depressive symptoms. Study participant’s whose family monthly income <150 USD compared to ≥150 USD (aOR = 13.76, 95% CI: 6.54–28.95), the husband had migrated for employment compared to not migrated (aOR = 8.19, 95% CI:4.11–15.87), nearest health facility located at more than 60 minutes of walking distance (aOR = 4.52, 95% CI: 2.26–9.03), delivered their last child by cesarean section compared to normal (vaginal) delivery (aOR = 2.02, 95% CI: 1.12–3.59) and received less than four recommended antenatal care (ANC) visits (aOR = 2.28, 95% CI:1.25–4.15) had higher odds of depressive symptoms. Participants who had planned pregnancy (aOR = 0.44, 95% CI: 0.25–0.77) were associated with 56% lower odds of depressive symptoms. Conclusions One-third of the mothers suffered from postpartum depressive symptoms. The participant’s husband migrated for employment, family income, distance to reach a health facility, delivery by cesarean section, not receiving recommended ANC visits, and plan of pregnancy were independent predictors for postpartum depressive symptoms. The study results warranted the urgency for clinical diagnosis of PPD and implementation of preventive package in study settings. Mental health education to pregnant women during ANC visits and proper counseling during the antepartum and postpartum period can also play a positive role in preventing postpartum depression.
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Berg, John E. "Electroconvulsive treatment of a patient with Parkinson's disease and moderate depression." Mental Illness 3, no. 1 (February 22, 2011): 8–10. http://dx.doi.org/10.4081/mi.2011.e3.
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Depression is a usual comorbidity in patients with Parkinson's disease. It has been known for more than 50 years that electroconvulsive treatment (ECT) has a positive effect on the muscular symptoms of Parkinson's disease. Many countries do not allow giving ECT for this indication. We have recently treated a resident patient in an acute psychiatric facility referred to the hospital with moderate depressive symptoms and strong suicidal ideation. Before and after a series of ECT he filled out the Beck Depression Inventory and the Antonovsky Sense of Coherence test. The scores before ECT were 20 and 2.69, respectively, and after 12 treatments 14 and 3.38. Both test results indicate improvement regarding level of depression and coping in life. The physiotherapists treating him observed that his rigidity was reduced and his gait improved. Muscular tonus was reduced and increased his tendency of falling as he had less tonus in muscles close to joints. Self help efficiency in daily tasks improved. He got cognitive impairment during and in the weeks after ECT. Electroconvulsive treatment should be offered to more patients with Parkinson disease and depression in order to lessen the burden of both depression and Parkinson symptoms.
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Beiruti, Karine, Anan Abu Awad, Galina Keigler, Chen Hanna Ryder, and Radi Shahien. "Atypical development of neurosyphilis mimicking limbic encephalitis." International Journal of STD & AIDS 30, no. 2 (September 26, 2018): 194–97. http://dx.doi.org/10.1177/0956462418797873.
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A previously healthy 35-year-old man suffering from behavioral and mental deterioration for three months was referred to our facility. On admission, the patient was dysphasic and had tonic-clonic seizures. Neurological examination showed mental confusion, euphoric mood, mania, paranoia, and mild motor dysphasia. Magnetic resonance imaging (MRI) was performed twice but no abnormalities were revealed. His acute confusional state, elevated cerebrospinal fluid (CSF) protein, epileptic seizure and electroencephalogram showing intermittent frontal slowness were all suggestive of encephalitis. The patient was treated with acyclovir without significant improvement in his condition. Testing for herpes simplex virus and human immunodeficiency virus was negative. Limbic encephalitis was suspected and the patient was treated with intravenous immunoglobulin (IVIG) for five days. Venereal disease research laboratory and Treponema pallidum hemagglutination assay were both tested positive in serum and CSF. Neurosyphilis was diagnosed, and the patient received a 14-day course of penicillin G with gradual improvement. Anti-N-methyl-D-aspartate-receptor (anti-NMDAR) antibodies were positive in serum, confirming the presence of encephalitis. The atypical clinical presentation of neurosyphilis with symptomatology mimicking encephalitis and no MRI abnormalities made the diagnosis challenging. Coexistence of neurosyphilis with anti-NMDAR encephalitis has been reported only in one recent study. Our case demonstrates the importance of testing for syphilis in patients with unexplained neurologic deficits and suspected encephalitis.
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Schene, Aart H., Bob van Wijngaarden, and Berthold P. R. Gersons. "Partial or full-time hospitalization: patients̍ preference." Epidemiologia e psichiatria sociale. Monograph Supplement 6, S1 (April 1997): 145–54. http://dx.doi.org/10.1017/s1827433100000915.
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Partial hospitalization (PH) fulfills four different functions in the mental health care system. First it can be a continuation of full-time hospitalization (FH). Secondly it functions as a rehabilitation oriented day care facility for the chronically ill. Thirdly it can be an extension of an outpatient treatment for patients without any indication for FH. And lastly it can be an alternative to (sub)acute FH (Schene & Gersons, 1986). Of course a particular PH service can fulfill different functions at the same time. However, based on data from a nationwide survey in The Netherlands we found clear differences between PH services that were specialized in one of the four functions mentioned (Schene et al., 1988).PH might be regarded as a real and useful alternative to FH, provided it adheres to the original inpatient treatment objectives and their related functions, without any loss of quality. It should accommodate the same, or at least a comparable, patient population. Only under those conditions can PH really replace FH.
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Morlino, M., A. Calento, V. Schiavone, G. Santone, A. Picardi, and G. de Girolamo. "Use of psychiatric inpatient services by heavy users: Findings from a national survey in Italy." European Psychiatry 26, no. 4 (May 2011): 252–59. http://dx.doi.org/10.1016/j.eurpsy.2010.11.005.
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AbstractPurposeTo analyze factors associated with a patient's probability of being a Heavy User (HU) of inpatient psychiatric services and to compare the HU inpatient population with Non-Heavy Users (NHUs).Patients and methodsThe survey was conducted among inpatients enrolled in the PROGRES-Acute-project, an Italian nationwide survey of public and private inpatient facilities. Patients with three or more admissions over the last 12 months were considered HUs, and patients who had undergone one or two admissions during the same period made up the NHU group.ResultsFour hundred and thirty-five (40.5%) were HUs, and 640 (59.5%) NHUs. HUs were younger, more frequently unmarried, unemployed, receiving a disability-pension, and either homeless or living in a residential facility. HUs were more likely to have experienced conflicts with their partners or family members during the week prior to admission. A logistic regression analysis revealed that age, age at first admission, number of life-time admissions, and having been the victim of violence were the most important predictive factors for the HU phenomenon.ConclusionOur study suggests that specific attention should be given to patients’ family context, due to its crucial role in daily informal care and in the triggering of events leading to rehospitalization.
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Bisht, JS. "AN OBSERVATIONAL CROSS-SECTIONAL STUDY ON THE NEUROPSYCHIATRIC MANIFESTATIONS OF COVID-19 PANDEMIC IN SUSPECTED AND POSITIVE PATIENTS IN NORTHERN INDIA." Journal of Medical pharmaceutical and allied sciences 10, no. 4 (September 15, 2021): 3288–90. http://dx.doi.org/10.22270/jmpas.v10i4.1408.
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Psychotherapy and grief reduction have been the mainstays of mental health care. Mental health on the other hand, is distinct from the lack of ‘Mental Illness in that it encompasses psychological, social, and psychological wellbeing. The purpose of this study is to assess the Hamilton Depression Rating in COVID-19 patients in a tertiary care facility in Northern India. An observational study of Covid-19 positive individuals hospitalized to a tertiary healthcare centre in northern India was conducted. Over the course of six months, 1040 Covid-19 positive/ suspected individuals were enrolled in this study. The HDRS (Hamilton Rating Scale for Depression) was designed with hospital patients in mind, stressing the physical signs and symptoms of depression. The HAM-D scale is used to assess the severity of depression in patients with Covid-19. Despite the fact that there are 21 sections, the patient's score is based on the first 17 responses. During the six-month research period, a total of 1040 covid-19 suspected and positive patients were admitted. There were 240 covid-19 positive patients and 800 covid-19 suspicious patients out of a total of 1040. In positive patients, anxiety was present in 95.83 percent, mood change in 55 percent, and fear of death 23.33 percent; in suspected covid-19 patients, anxiety was present in 57 percent, mood alteration in 19 percent, and fear of death 13.5 percent. According to current research, severe COVID-19 may produce delirium in the acute stage of disease, followed by depression, anxiety, lethargy, insomnia, and post-traumatic stress disorder (PTSD) in the long term.
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Gigantesco, Antonella, Rossella Miglio, Giovanni Santone, Giovanni de Girolamo, Renata Bracco, Pierluigi Morosini, Bruno Norcio, and Angelo Picardi. "Process of Care in General Hospital Psychiatric Units: National Survey In Italy." Australian & New Zealand Journal of Psychiatry 41, no. 6 (June 2007): 509–18. http://dx.doi.org/10.1080/00048670701341921.
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Objective: To investigate the process of care in Italian public acute inpatient facilities. Method: Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. Results: Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5±7.1 days, 37.0±55.3 days and 12.0±3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during mealtimes (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurst provision. Conclusions: The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital–community mental health service interface.
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Seregin, A., E. Dmitrieva, G. Simutkin, and S. Ivanova. "The potential protein marker of bipolar disorder." European Psychiatry 65, S1 (June 2022): S155—S156. http://dx.doi.org/10.1192/j.eurpsy.2022.417.
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Introduction Difficulties in the diagnosis of bipolar disorder (BD) are associated with a lack of understanding of the mechanisms of its pathogenesis. Identification of proteins involved in the pathogenesis of BD will bring us closer to an understanding of its mechanisms and can help in diagnosis. Objectives The search of proteomic biomarkers of bipolar disorder. Methods We performed a proteomic analysis of the serum of 16 healthy people and 33 patients with BD. Patients were hospitalized in an acute state of the depressive phase, and they did not receive therapy for more than 6 months. Blood was collected before the start of therapy. Serum was purified from major proteins by affinity chromatographyandseparatedby1D-electrophoresis. After trypsinolysis, the proteins were identified by HPLC/mass spectrometry. The ELISA kit was used to determine the amount of zNMDAR1. Results We identified a protein that does not occur in healthy people: a subunit of the glutamate NMDA receptor zeta-1 (zNMDAR1). As a result, we found a statistically significant (p = 0.037) almost fivefold increase in the concentration of this protein in the serum of patients with bipolar disorder (0.64 [0.18; 0.78] ng/ml) compared with healthy individuals. Conclusions Thus, in bipolar disorder NMDAR is damaged, which can lead appearance of their subunits in the serum, and which indicated a violation of glutamatergic neurotransmission. Then this protein claims the role of markers of bipolar disorder. Mass spectrometric analysis was carried out of the “Human Proteome” Core Facility of the Institute of Biomedical Chemistry Moscow. RSW project, state registration number AAAA-A19-119020690013-2. Disclosure No significant relationships.
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Weber, Bo, Dominic Chan, and Sandy Hammer. "Eculizumab Use in a Temporarily Dialysis-Dependent Patient With Shiga Toxin–Producing Escherichia Coli Hemolytic Uremic Syndrome With Neurological Complications." Journal of Pediatric Pharmacology and Therapeutics 27, no. 1 (December 22, 2021): 90–95. http://dx.doi.org/10.5863/1551-6776-27.1.90.
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Shiga toxin–producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is the most common cause of acute renal failure in children, and it is associated with thrombocytopenia and hemolytic anemia. Although this disease primarily affects the kidney, it can also contribute to cellular damage in other organ systems, such as the CNS. Eculizumab is a monoclonal antibody that binds to complement proteins to prevent complement-mediated intravascular hemolysis in atypical HUS. In STEC-HUS, complement activation also occurs by Shiga toxin, and previous cases of eculizumab use in the setting of neurological involvement have been shown to be successful. We report the successful use of eculizumab in the setting of typical STEC-HUS–induced neurological symptoms including seizure, altered mental status, and left arm weakness. The patient also experienced concomitant renal failure requiring dose adjustment for hemodialysis. Following 2 doses of eculizumab, our patient was discharged to an inpatient rehabilitation facility with resolution of her renal injury, seizures, and altered mentation without adverse effects from eculizumab throughout the admission. Based on our case study, it appears that eculizumab may be given during or between hemodialysis without dose adjustment.
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Visser, Philip, Alison Dwyer, Juli Moran, Mary Britton, Melodie Heland, Filomena Ciavarella, Sandy Schutte, and Daryl Jones. "Medical emergency response in a sub-acute hospital: improving the model of care for deteriorating patients." Australian Health Review 38, no. 2 (2014): 169. http://dx.doi.org/10.1071/ah13245.
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Objective To assess the frequency, characteristics and outcomes of medical emergency response (MER) calls in a sub-acute hospital setting. Methods The present study was a retrospective observational study in a sub-acute hospital providing aged care, palliative care, rehabilitation, veteran’s mental health and elective surgical services. We assessed annual MER call numbers between 2005 and 2011 in the context of contemporaneous changes to hospital services. We also assessed MER calls over a 12-month period in detail using standardised case report forms and the scanned medical record. Results There were 2285 multiday admissions in the study period where 141 MER calls were triggered in 132 patients (61.7 calls per 1000 admissions). The median patient age was 83.0 years, and 55.3% of patients were men. Most calls occurred on weekdays and during the daytime, and were triggered by altered conscious state, low oxygen saturations and hypotension. Documentation of escalation of care before the MER call was not present in 99 of 141 (70.2%) calls. Following the call, in 70 of 141 (49.6%) cases, the patient was transferred to the acute campus, where 52 (74.2%) and 14 (20%) patients required ward and intensive care level treatment, respectively. Thirty-seven of 132 (28%) patients died. A palliative care physician adjudicated that most of these patients who died (24/37; 64.9%) were appropriate for a call, but that 19 (51.4%) should have received palliation at the time of the call. Compared with survivors, patients who died after the MER call were more likely originally admitted from supported accommodation. Conclusions MER calls in our sub-acute hospital occurred in elderly patients and are associated with an in-hospital mortality of 28%. A small proportion of patients required intensive care level treatment. There is a need to improve processes involving escalation of care before MER call activation and to revise advance care directives. What is known about this topic? Rapid response team (RRT) activation has been well described in the acute hospital setting. Although the impact on survival benefit to patients remains controversial, it has been widely adopted as a model of care to respond to deteriorating ward patients. This is particularly relevant in Australia at present with the implementation of the new National Safety and Quality Health Service Standards. What does this paper add? There have not been any previous papers published on rapid response systems in a sub-acute hospital. This paper describes some of the changes and challenges associated with increasing RRT activations in a sub-acute health care facility. What are the implications for practitioners? For clinicians in a sub-acute setting, the study reinforces the importance of pre-emptively documenting and communicating advance care directives. In addition, it is important to identify patients with reversible pathology likely to benefit from transfer and acute care, and to avoid the transfer of those who will not and, instead, provide appropriate palliation. For practitioners involved in models of care for deteriorating patients, the study provides information on where problems occurred in our system and the strategies used to address these issues.
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Alonso-Solís, Anna, Susana Ochoa, Eva Grasa, Katya Rubinstein, Asaf Caspi, Kinga Farkas, Zsolt Unoka, et al. "A Method to Compare the Delivery of Psychiatric Care for People with Treatment-Resistant Schizophrenia." International Journal of Environmental Research and Public Health 17, no. 20 (October 16, 2020): 7527. http://dx.doi.org/10.3390/ijerph17207527.
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Introduction: Community services are gaining ground when it comes to attention to patients with psychiatric diseases. Regarding patients with treatment-resistant schizophrenia (TRS), the use of information and communication technology (ICT) could help to shift the focus from hospital-centered attention to community services. This study compares the differences in mental health services provided for patients with TRS in Budapest (Hungary), Tel-Aviv (Israel) and Catalonia (Spain) by means of a method for the quick appraisal of gaps among the three places, for a potential implementation of the same ICT tool in these regions. Methods: An adapted version of the Description and Standardised Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) instrument was made by researchers in Semmelweis University (Budapest, Hungary), Gertner Institute (Tel-Aviv, Israel) and Hospital de la Santa Creu I Sant Pau and Parc Sanitari Sant Joan de Déu (Catalonia, Spain). Results: Two types of outpatient care services were available in the three regions. Only one type of day-care facility was common in the whole study area. Two residential care services, one for acute and the other for non-acute patients were available in every region. Finally, two self-care and volunteer-care facilities were available in the three places. Conclusion: Although the availability of services was different in each region, most of the services provided were sufficiently similar to allow the implementation of the same ICT solution in the three places.
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Fryer, Michelle A., Michael Beech, and Gerard J. A. Byrne. "Seclusion use with Children and Adolescents: An Australian Experience." Australian & New Zealand Journal of Psychiatry 38, no. 1-2 (January 2004): 26–33. http://dx.doi.org/10.1177/0004867404038001-211.
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Objective To summarize the current state of knowledge on the use of seclusion and restraint with children and adolescents and to report the findings of an exploratory study to identify factors that place a child or adolescent at increased risk of seclusion during their admission. Method Literature searches were undertaken on MEDLINE, CINAHL and PsyclNFO databases. Articles were identified that focused specifically on seclusion and restraint use with children and adolescents or contained material significant to this population. The study reports findings from a retrospective review of patient charts, seclusion registers and staffing from an Australian acute inpatient facility. Results The data available in regard to seclusion use in this population is limited and flawed. Further research is needed on the use and outcomes of seclusion and restraint and on alternative measures in the containment of dangerousness. Both the literature and this study find that patients with certain factors are at increased risk of being secluded during an inpatient stay. These factors include being male, diagnoses of disruptive behaviour disorder and a previous history of physical abuse. Staffing factors did not show a relationship to the use of seclusion. Conclusions There are patient factors that predict increased risk of seclusion; these factors and their interrelationships require further elucidation. Further research is also needed on the outcomes, both positive and negative, of seclusion use and of alternatives to seclusion.
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Rodulfo, Alejandro, Alberto Augsten, Erin Wainwright, and Gil Abramovici. "A Case of Severe Fioricet Withdrawal Presenting During Admission to an Inpatient Psychiatric Unit." Case Reports in Psychiatry 2021 (November 8, 2021): 1–4. http://dx.doi.org/10.1155/2021/6371953.
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Background. Butalbital-containing combination (BCC) analgesics have the potential for the development of tolerance and dependence. Misuse and withdrawal of these agents should be considered in patients presenting with new-onset psychosis. This case highlights how butalbital withdrawal may be missed in the emergency department setting and underscores how early identification may affect management and prognosis. Case Presentation. A 40-year-old female with a history of migraine, depression, and anxiety presented to the emergency department (ED) with new-onset psychosis following a recent seizure-like episode. At home, the patient was prescribed butalbital-acetaminophen-caffeine (Fioricet), duloxetine, alprazolam, and zolpidem for these conditions. On arrival to the ED, the patient was disoriented and appeared to be responding to internal stimuli. Following initial medical evaluation, the patient was cleared for further psychiatric assessment, during which she developed acute-onset autonomic instability while waiting for a bed on the inpatient psychiatric unit. She then became agitated, requiring multiple emergency medications, and eventually required emergent intubation and was admitted to the intensive care unit (ICU). Following extubation, a psychiatric consultation was performed. On assessment, the patient was alert and oriented and no longer exhibited psychotic symptoms. She admitted to using butalbital-acetaminophen-caffeine (Fioricet) daily for the past 10 years and had recently run out of her prescribed medication. She acknowledged that she was taking more than prescribed and requested substance use treatment resources, for which she was subsequently discharged to an inpatient drug rehabilitation facility. Conclusions. Given the time constraints inherent to the ED setting, a complete substance use history (both illicit and prescribed) may be challenging to obtain. However, it remains critical for providers to identify patients at risk for life-threatening withdrawal from sedative, hypnotics, and anxiolytic agents.
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Surati, Mansi, Manoj Kanchanbhai Patel, Sunita Bhanudas Nikumbh, Rajesh Ramkunwar Yadav, Abhishek Dnyaneshwar Kukde, Anoop Mohan Nigwekar, and Kumar M. Dhawale. "Executing and assessing programme for mental well-being in an old age home during the COVID-19 pandemic by a homoeopathic institution: Challenges and outcomes." Journal of Integrated Standardized Homoeopathy 5 (December 31, 2022): 86–92. http://dx.doi.org/10.25259/jish_35_2022.
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Objective: COVID-19 pandemic has affected the provision of psychiatric care across the world and the elderly have been the most disadvantaged. Psychological stress in them is not only due to excess mortality risk but also due to restrictions instituted to mitigate the chances of contracting COVID. The current pandemic is likely to lead to substantial changes in the health-care services as it has shown the need for improved multidisciplinary and community- centered care. The purpose of this paper is to address the challenges faced while implementing a multidisciplinary structured programme for the mental well-being in residents of old age home and assess the role played by the sustainable multidisciplinary structured interventions to alleviate the psychological suffering. The old age home in the study is situated in a remote area of Palghar district. Availing of required medical health-care facility during a pandemic was a challenge in itself, where delivering the multidisciplinary intervention for mental well-being was a much needed and never tested in such a setup. Material and Methods: Primary screening and knowledge of acute and chronic stressors revealed the current status of emotional wounds and hence the emotional sensitivity of the group. Scales (generalised anxiety disorder [GAD-7], patient health questionnaires [PHQ-2] and dementia assessment by rapid test [DART]) were employed to evaluate intensity of anxiety, depressive symptoms and dementia. Techniques to deal with distress demonstrated in each session were based on action learning principles. Structured group interventions were done through relevant videos, group discussions, relaxation techniques, meditation and physical exercise by the team of homoeopathic physicians, psychologist and physiotherapist. Results were subjected to statistical analysis. Results: There was a statistically significant reduction in anxiety following intervention, z = −3.886, P < 0.001, with a large effect size (r =.57). The median score on the anxiety decreased from 10 to 4 in a span of 10 months. No significant improvement was found in physical health and cognitive impairment.
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Rodriguez, Sara Russell, Jolianne Stone Tocco, Sue Mallonee, Lauri Smithee, Timothy Cathey, and Kristy Bradley. "Rapid Needs Assessment of Hurricane Katrina Evacuees—Oklahoma, September 2005." Prehospital and Disaster Medicine 21, no. 6 (December 2006): 390–95. http://dx.doi.org/10.1017/s1049023x0000409x.
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AbstractIntroduction:On 04 September 2005, 1,589 Hurricane Katrina evacuees from the New Orleans area arrived in Oklahoma. The Oklahoma State Department of Health conducted a rapid needs assessment of the evacuees housed at a National Guard training facility to determine the medical and social needs of the population in order to allocate resources appropriately.Methods:A standardized questionnaire that focused on individual and household evacuee characteristics was developed. Households from each shel-ter building were targeted for surveying, and a convenience sample was used.Results:Data were collected on 197 households and 373 persons. When com-pared with the population of Orleans Parish, Louisiana, the evacuees sampled were more likely to be male, black, and 45–64 years of age. They also were less likely to report receiving a high school education and being employed pre-hurricane. Of those households of <1 persons, 63% had at least one missing household member. Fifty-six percent of adults and 21% of children reported having at least one chronic disease. Adult women and non-black persons were more likely to report a pre-existing mental health condition. Fourteen percent of adult evacuees reported a mental illness that required medication pre-hur-ricane, and eight adults indicated that they either had been physically or sex-ually assaulted after the hurricane. Approximately half of adults reported that they had witnessed someone being severely injured or dead, and 10% of per-sons reported that someone close to them (family or friend) had died since the hurricane. Of the adults answering questions related to acute stress disor-der, 50% indicated that they suffered at least one symptom of the disorder.Conclusions:The results from this needs assessment highlight that the evac-uees surveyed predominantly were black, of lower socio-economic status, and had substantial, pre-existing medical and mental health concerns. The evac-uees experienced multiple emotional traumas, including witnessing grotesque scenes and the disruption of social systems, and had pre-existing psy-chopathologies that predisposed this population to post-traumatic stress dis-order (Post-traumatic Stress Disorder).x When disaster populations are displaced, mental health and social service providers should be available immediately upon the arrival of the evacuees, and should be integrally coordinated with the relief response. Because the displaced population is at high risk for disaster-related mental health problems, it should be monitored closely for persons with PTSD. This displaced population will likely require a substantial re-establishment of financial, medical, and educational resources in new communities or upon their return to Louisiana.
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Ward, Carol, Caili Wu, Lissah Heer, Sarah Farmer, Caleigh Treissman, and Melanie Carlyle. "511 - Examining the Impact of Individualized Music for Patients on A Geriatric Psychiatry Unit." International Psychogeriatrics 33, S1 (October 2021): 62. http://dx.doi.org/10.1017/s1041610221002064.
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Background:Clinicians are encouraged to use non-pharmacologic interventions first as part of the treatment of responsive behaviours due to mental health conditions. Music therapy is an example of such an intervention. In recent years, there has been an increased research focus on individualized music (IM) because it considers patient’s personal music preferences. However, the findings of whether IM listening is more beneficial than general music listening has been inconsistent.Objective:This study is to further compare the effects of IM and elevator (baseline) music listening on enjoyment behaviours of geriatric inpatients.Methods:Fifteen participants were recruited from a geriatric psychiatry unit in an acute tertiary mental health facility in British Columbia, Canada. Their mean age was 74 years and their mean MMSE was 18. Each participant attended two 30-minute music listening sessions. Each session included a 15-minute baseline music playlist and a 15-minute IM playlist. The sequence of the two playlists was counterbalanced for each participant across the two sessions. The IM playlists were created by interviewing each participant with a personalized music preference questionnaire. The baseline (elevator) playlist was simply consisted of instrumental, non-lyrical jazz and classical music and was the same for every participant. The enjoyment behaviors during the sessions for each participant were measured by the Enjoyment Behavioral Coding Scheme (EBCS), which was developed for this project based on previous literature and was shown to have a good inter rater reliability.Results:The average total scores of the EBCS across two sessions of IM and baseline music listening were calculated for each participant. Paired samples t-test was used to compare the scores. Though the mean total score of the EBCS for IM session was higher than that for the baseline session, the t-test showed the difference did not reach statistical significance.Conclusion:Participants appeared to enjoy both the IM and baseline music sessions equally.
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Hulse, Gary K. "Impediments to Screening for Hazardous Alcohol Use and Dependence in General Hospital Psychiatric Inpatients." Australian & New Zealand Journal of Psychiatry 35, no. 5 (October 2001): 606–12. http://dx.doi.org/10.1080/0004867010060508.
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Objective: The Alcohol Use Disorders Identification Test (AUDIT) has been developed to screen for hazardous and harmful alcohol consumption. It has been used among a variety of primary care, general population and general hospital populations. However, with the exception of one study undertaken by the author and colleagues, the use of the AUDIT in general hospital psychiatric patients has not been reported. This paper reports on a substudy of this larger study whose aim was to determine the frequency of hazardous alcohol use and dependence among patients admitted to the psychiatric units of general hospitals in Perth, Western Australia, and discusses major reasons for non-AUDIT screening among this group. Method: In a 12-month period 990 patients aged 18–64 years and residing in the Perth metropolitan area were admitted to the psychiatric unit of the two hospitals. Using the AUDIT alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders, was assessed. Results: Of the 834 admissions targeted for AUDIT screening 263 were not screened. This non-screening represented 27–42% of patients in each of the major diagnostic categories. There was no significant difference in the proportion of patients screened versus not screened for mood, adjustment or schizophrenia/psychosis. There were however, significantly fewer patients with anxiety disorder screened compared with mood disorder. Those non-screened patients in major psychiatric groups had significantly shorter hospital stays than their diagnostic counterparts who were screened. The major reason for non-screening in all groups was due to patients leaving the psychiatric facility before they could be accessed. This included discharge before screening, transfer to another psychiatric facility and short admission. To a lesser extent cognitive dysfunction accounted for non-screening among major diagnostic groups. Conclusions: Failure to screen patients was largely due to short hospital stays. Screening was impeded by the brief window period, commonly 1 or 2 days, between the absence of acute psychiatric sequelae and discharge. This situation contrasts dramatically to the medical or surgical admission where major sequelae are largely resolved in 2–3 days and AUDIT screening can take place over the remaining 3–4 days prior to discharge. To be effective in the general hospital psychiatric setting, alcohol screening needs to be incorporated into the routine ward assessment procedures. The brevity of the AUDIT makes this possible. This would maximize the time available to implement an intervention programme to those found to be consuming alcohol at a hazardous or harmful level.
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Ward, Louise, and Karleen Gwinner. "Have you got what it takes? Nursing in a Psychiatric Intensive Care Unit." Journal of Mental Health Training, Education and Practice 10, no. 2 (May 11, 2015): 101–16. http://dx.doi.org/10.1108/jmhtep-08-2014-0021.
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Purpose – A Psychiatric Intensive Care Unit (PICU) and or High Dependency Unit (HDU) is a locked, intensive treatment facility available to people experiencing acute psychiatric distress. For many people who access public mental health services in Australia, the PICU/HDU is the primary point of admission, and should represent and facilitate timely assessment and an optimum treatment plan under a recovery framework. Nurses are the largest health discipline working in this specialty area of care. The paper aims to discuss these issues. Design/methodology/approach – A qualitative study aimed to investigate the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. Identifying how nurses provide care in the PICU/HDU will inform a clinical practice guideline to further support this specialty area of care. Four focus groups were facilitated with 52 registered nurses attending. Findings – The nurse participants identified specific skills under four distinct themes; Storytelling, Treatment and recovery, Taking responsibility, and Safeguarding. The skills highlight the expertise and clinical standard required to support a recovery model of care in the PICU. Research limitations/implications – The research findings highlight urgency for a National PICU/HDU clinical practice guideline. Practical implications – A PICU/HDU practice guideline will promote the standard of nursing care required in the PICU/HDU. The PICU/HDU needs to be recognised as a patient centred, therapeutic opportunity as opposed to a restrictive and custodial clinical area. Social implications – Providing transparency of practice in the PICU/HDU and educating nurses to this specialty area of care will improve client outcome and recovery. Originality/value – Very few studies have explored the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. A dearth of research exists on what is required to work in this specialty area of care.